Intraperitoneal chemotherapy for gastric cancer

Area of Science:

• Oncology
• Gastroenterology
• Clinical Trials
• Chemotherapy

Background:

• Gastric cancer with peritoneal metastasis has a poor prognosis and is often considered incurable.
• Intraperitoneal chemotherapy (IPC) is explored for preventing and treating peritoneal metastasis, but clinical evidence is conflicting.
• There is a need for a comprehensive evaluation of IPC's effects in gastric cancer.

Purpose of the Study:

• To evaluate the benefits and harms of IPC in gastric cancer.
• Specifically, to compare prophylactic IPC plus radical surgery versus radical surgery alone for high-risk patients.
• Also, to compare therapeutic IPC plus cytoreductive surgery (CRS) versus CRS alone for patients with confirmed peritoneal metastasis.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, Chinese databases) and trial registries was conducted.
• Included were parallel randomized controlled trials (RCTs) comparing IPC with no IPC for prophylactic or therapeutic use.
• Meta-analysis was used to synthesize results for overall survival, disease-free survival (DFS), progression-free survival (PFS), and adverse events, with evidence certainty assessed by GRADE.

Main Results:

• Nine RCTs involving 829 participants were included; most had high risk of bias or some concerns.
• Very low-certainty evidence suggests prophylactic and therapeutic IPC may improve overall survival but may have little effect on DFS or anastomotic leakage.
• Therapeutic IPC may delay tumor progression (PFS) but shows little to no difference in quality of life (QOL) or serious adverse events (SAEs).

Conclusions:

• Current evidence for IPC in gastric cancer is limited and highly uncertain, precluding definitive conclusions.
• IPC may offer survival benefits, but more high-quality, long-term RCTs, especially in non-Asian populations, are needed.
• Ongoing studies may alter current findings; comprehensive safety and QOL data are also required.