Heated intraperitoneal chemotherapy and gastrectomy for gastric cancer in the U.S.: the time is now

Peritoneal metastasis is a common final pathway in patients with gastric adenocarcinoma. Microscopic evidence of early peritoneal dissemination of gastric cancer is present in a substantial proportion of patients presumed to have localized disease. Prognosis is poor even for patients with microscopic and low-volume peritoneal carcinomatosis highlighting the need for a more effective treatment strategy. Treatment of peritoneal carcinomatosis with intraperitoneal chemotherapy has been evaluated in gastric cancer and is associated with improved survival in selected patients. We hypothesize that removal of the primary tumor combined with treatment of low-volume peritoneal metastasis may improve survival in patients with gastric cancer. Our group is investigating the role of heated intraperitoneal chemotherapy administered at time of gastrectomy in patients with gastric adenocarcinoma and metastasis limited to the peritoneum. To date, trials dedicated to the study of regional therapy for peritoneal metastasis due to gastric cancer have originated primarily in Asian centers. Although the incidence of gastric cancer is relatively low in the United States, mortality rates are high and the need is real for prospective study of intraperitoneal chemotherapy in patients with this deadly disease.