• 제목/요약/키워드: Peritoneal metastasis

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Treatment Modality Based Survival in Gastric Carcinoma Patients with Stand-Alone Peritoneal Metastasis: a Case-Control Study

  • Jeong, Oh;Jung, Mi Ran;Kang, Ji Hoon
    • Journal of Gastric Cancer
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    • 제21권2호
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    • pp.122-131
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    • 2021
  • Purpose: To date, there are no promising treatments for gastric carcinoma with peritoneal metastasis. Some researchers have suggested a survival benefit of gastrectomy in select patients. This study investigated the survival of gastric carcinoma patients with stand-alone peritoneal metastasis according to the type of treatment modality. Materials and Methods: We reviewed the data of 132 patients with gastric carcinoma and stand-alone peritoneal metastasis. We performed gastrectomy when the primary tumor was deemed resectable and systemic chemotherapy was administered. We analyzed patient survival according to the type of treatment, and the prognostic value of gastrectomy was evaluated in univariate and multivariate models. Results: Among all patients, 70 underwent gastrectomy plus chemotherapy, 20 underwent gastrectomy alone, 36 underwent chemotherapy alone, and 6 received supportive care. The median patient survival was 13 months. Patients who underwent gastrectomy had significantly longer survival than those who did not undergo gastrectomy (14 vs. 8 months, P<0.001). Patients who received chemotherapy showed significantly longer survival than those who did not (13 vs. 7 months, P=0.032). Patients who underwent gastrectomy plus chemotherapy showed better survival than those who underwent other treatments. In multivariate analysis, gastrectomy was found to be an independent prognostic factor (hazard ratio, 0.52; 95% confidence interval, 0.33-0.82) in addition to chemotherapy. Conclusions: Our study showed that patients who underwent gastrectomy plus chemotherapy had the best survival. Although the survival benefit of gastrectomy remains uncertain, it is a favorable prognostic indicator in patients with stand-alone peritoneal metastasis.

Effective Response of the Peritoneum Microenvironment to Peritoneal and Systemic Metastasis from Colorectal Carcinoma

  • Yu, Min;Niu, Zhi-Min;Wei, Yu-Quan
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권12호
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    • pp.7289-7294
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    • 2013
  • We here document discovery of a new and simple model of tumor seeding involving the mouse peritoneum. Irradiated tumor cells administered by i.p. injection provided effective vaccination against peritoneal carcinomatosis and distal metastasis with colorectal carcinomas. In flow cytometric analysis, CD4+ and CD8+ T lymphocytes, macrophages and myeloid-derived suppressor cells (MDSCs), which are easy to obtain in the peritoneal cavity, were revealed to have significant differences between immunized and non-immunized mice and these contributed to antitumor responses. We also observed that both serum and peritoneal lavage fluid harvested from immunized mice showed the presence of CT26-specific autoantibodies. In addition, increase in level of TGF-${\beta}1$ and IL-10 in serum but a decrease of TGF-${\beta}1$ in peritoneum was found. Taken together, these findings may provide a new vaccine strategy for the prevention of peritoneal and even systemic metastasis of carcinomas through induction of an autoimmune response in the peritoneum.

Recent Update on the Treatment of Colorectal Peritoneal Metastasis: A Surgical Perspective

  • Hye Jung Cho;Woo Ram Kim
    • Journal of Digestive Cancer Research
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    • 제10권2호
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    • pp.74-81
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    • 2022
  • Colorectal peritoneal metastasis has been an incurable disease for centuries. However, since the new millennium, recent advancements in therapies are achieved with modern chemotherapeutic agents, target agents, and immune checkpoint blockade introduction. Modern chemotherapies, from a nearly nonexistent median survival if untreated, have raised the duration to 16 months with target agents. Experts have once again surpassed its limit by introducing intraperitoneal chemotherapy and cytoreductive surgery (CRS). Numerous clinical trials regarding CRS and hyperthermic intraperitoneal chemotherapy have now opened new doors in peritoneal carcinomatosis treatment, even securing complete remission. In addition, up-to-date modalities, such as pressurized intraperitoneal aerosol chemotherapy and immunotherapies, showed promising results at an early stage.

동시 간전이 직장 구불결장암 환자의 재발성 복수에 대한 SB 복강 주입의 복수 감소 효과 증례 (Ascites-decreasing Effect of SB Intraperitoneal Injection to a Refractory Ascites Patient with Synchronous Colorectal Liver Metastasis and Metachronous Peritoneal Carcinomatosis : A Case Report)

  • 전형준;김종민;조종관;이연월;한균인;유화승
    • 대한한방내과학회지
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    • 제34권4호
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    • pp.466-477
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    • 2013
  • Objectives : To report and demonstrate the effect of decreasing ascites volume by SB intraperitoneal injection to a refractory ascites patient with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis. Methods : Two cycles of intraperitoneal and intravenous SB injection were conducted. Each injection cycle was made up of 4 days. Nine vials of SB were injected to the patient every day. To compare the volume of ascites between pret- and post-treatment, follow-up computed tomography was done on June 3, 2013. To observe other therapeutic effects of SB injection, laboratory tests were conducted periodically. Results : On the follow-up computed tomography images, the amount of ascites and pleural effusion had decreased compared to the April 30, 2013 computed tomography images. The levels of aspartate transaminase, alanine aminotransferase and lactate dehydrogenase decreased significantly from May 9, to May 30, 2013. The amount of oral intake increased constantly during hospitalization. The patient's symptoms such as abdominal distension, abdominal pain and dyspnea were improving until discharge. Conclusions : Even if thiese results cannot be applied to every synchronous colorectal cancer liver metastasis patient, we demonstrated that SB intraperitoneal injection has ascites-decreasing effect to refractory ascites patients with synchronous colorectal liver metastasis and metachronous peritoneal carcinomatosis.

Recent Advances in Intra-peritoneal Chemotherapy for Gastric Cancer

  • Chia, Daryl K.A.;So, Jimmy Bok Yan
    • Journal of Gastric Cancer
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    • 제20권2호
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    • pp.115-126
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    • 2020
  • Peritoneal metastasis (PM) frequently occurs in patients with gastric cancer (GC) and confers a dismal prognosis despite advances in systemic chemotherapy. While systemic chemotherapy has poor peritoneal penetration, intraperitoneal (IP) chemotherapy remains sequestered, resulting in high peritoneal drug concentrations with less systemic side-effects. The first application of IP treatment was hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) for gastric cancer peritoneal metastasis (GCPM); but was associated with an increased morbidity and mortality rate without significantly improving overall survival (OS). While CRS confers limited benefit, the potential role of prophylactic HIPEC and laparoscopic neoadjuvant HIPEC are currently being evaluated. Combination systemic and IP chemotherapy (SIPC) gained popularity in the 1990s, since it provided the benefits of IP treatment while reducing surgical morbidity, demonstrating promising early results in multiple Phase II trials. Unfortunately, these findings were not confirmed in the recent PHOENIX-GC randomized controlled trial; therefore, the appropriate treatment for GCPM remains controversial. Small observational studies from Japan and Singapore have reported successful downstaging of PM in GC patients receiving SIPC who subsequently underwent conversion gastrectomy with a median OS of 21.6-34.6 months. Recently, the most significant development in IP-directed therapy is pressurized IP aerosol chemotherapy (PIPAC). Given that aerosol chemotherapy achieves a wider distribution and deeper penetration, the outcomes of multiple ongoing trials assessing its efficacy are eagerly awaited. Indeed, IP-directed therapy has evolved rapidly in the last 3 decades, with an encouraging trend toward improved outcomes in GCPM, and may offer some hope for an otherwise fatal disease.

Peritoneal Washing Cytology Positivity in Gastric Cancer: Role of Lymph Node Metastasis as a Risk Factor

  • Sojung Kim;Han Hong Lee;Kyo Young Song;Ho Seok Seo
    • Journal of Gastric Cancer
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    • 제24권2호
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    • pp.185-198
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    • 2024
  • Purpose: Peritoneal washing cytology (PWC) is a widely used diagnostic tool for detecting peritoneal metastasis of advanced gastric cancer. However, the prognosis of patients with positive PWC remains poor even after gastrectomy, and treatments vary among institutions and eras. In this study, we identified the clinical factors that can help predict cytology-positive (CY(+)) gastric cancer. Materials and Methods: We retrospectively reviewed the national data of patients with gastric cancer from 2019, as provided by the Information Committee of the Korean Gastric Cancer Association. Of the 13,447 patients with gastric cancer, 3,672 underwent PWC. Based on cytology results, we analyzed the clinicopathological characteristics and assessed the possibility of CY(+) outcomes in relation to T and N stages. Results: Of the 3,270 patients who underwent PWC without preoperative chemotherapy, 325 were CY(+), whereas 2,945 were negative. CY(+) was more commonly observed in patients with Borrmann type IV gastric cancer, an undifferentiated histological type, and advanced pathological stages. Multivariate analysis revealed Borrmann type IV (odds ratio [OR], 1.821), tumor invasion to T3-4 (OR, 2.041), and lymph node metastasis (OR, 3.155) as independent predictors of CY(+). Furthermore, for circular tumor location, the N stage emerged as a significant risk factor for CY(+), particularly when the tumor was located on the posterior wall (PW) side. Conclusions: Lymph node metastasis significantly affects CY(+) outcomes, particularly when the tumor is located on the PW side. Therefore, PWC should be considered not only in suspected serosal exposure cases but also in cases of lymph node metastasis.

항암화학요법과 한방치료를 병행하여 전환수술이 가능하게 호전된 진행성 위암 환자 1례 (A Case Report of an Advanced Gastric Cancer Patient Who Was Able to Undergo Conversion Surgery Treated with Chemotherapy and Korean Medicine)

  • 장권준;고은비;황우석;김관일;이범준;정희재;신광순
    • 대한한방내과학회지
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    • 제41권5호
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    • pp.911-925
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    • 2020
  • Objectives: The purpose of this study was to report a case of a patient with advanced gastric cancer with peritoneal metastasis treated with chemotherapy and Korean medicine Methods: A patient with advanced gastric cancer with peritoneal metastasis was treated with Xeloda/cisplatin since April 2019. The cycle was repeated every three weeks for a total of 11 times. At the same time, the patient was treated with Korean medicine. The tumor size was measured by computed tomography (CT) and esophagogastroduodenoscopy (EGD). Adverse events were evaluated by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0. Results: After treatment with Xeloda/cisplatin and Korean medicine for nine months, the extent of the proximal portion of the primary tumor and the size and number of multiple nodules around the stomach decreased and the cancer cells with peritoneal metastasis disappeared. The symptoms of discomfort and physical activity were gradually improved. As a result, the patient underwent conversion surgery. Conclusions: This case study suggests that the combination of chemotherapy and Korean medicine may contribute to the reduction in tumor size as well as the improvement in the quality of life.

위암 평가에 있어 F-18 FDG PET 또는 PET/CT의 역할 (Role of F-18 FDG PET or PET/CT in the Evaluation of Gastric Cancer)

  • 윤미진
    • Nuclear Medicine and Molecular Imaging
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    • 제40권3호
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    • pp.141-147
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    • 2006
  • PET detects only less than 50% of early gastric cancer and 62-98% of advanced gastric cancer. Therefore, mass screening programs are recommended for all adults over the age of 40 for early detection and early treatment of gastric cancer through endoscopy or various radiological tests. The most important step after being diagnosed with gastric cancer is accurate staging, which mainly evaluates tumor resectability to avoid unnecessary surgery. Important factors that affect tumor resectability are whether the tumor can be separated from adjacent organs or important blood vessels, the extent of lymph node metastasis, presence of peritoneal metastasis, or distant organ metastasis. To evaluate the extent of local tumor invasion, anatomical imaging that has superior spatial resolution is essential. There are a few studies on prognostic significance of FDG uptake with inconsistent results between them. In spite of lower sensitivities for lymph node staging, the specificities of CT and PET are very high, and the specificity for PET tends to be higher than that for CT. Limited data published so far show that PET seems less useful in the detection of lung and bone metastasis. In the evaluation of pleural or peritoneal metastasis, PET seems very specific but insensitive as well. When FDG uptake of the primary tumor is low, the distant metastasis is also known to show low FDG uptake reducing its detection. There are only a few data available in the evaluation of recurrence detection and treatment response using FDG PET.

위암 환자에서 수술 전 복막전이 예측을 위한 혈청 종양 표지자의 유용성: CA 19-9와 CEA (The Usefulness of Serum Tumor Markers as a Predictor of Peritoneal Metastasis in Patients with Gastric Carcinoma: CA 19-9 and CEA)

  • 정오;주재균;박영규;유성엽;정미란;김호군;김동의;김영진
    • Journal of Gastric Cancer
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    • 제8권3호
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    • pp.129-135
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    • 2008
  • 목적: 다른 소화기계 악성종양에 비하여 위암에서 종양표지자의 역할은 매우 제한적이다. 여러 연구들에서 종양표지자는 예후 및 재발과 밀접한 연관이 있음이 보고되었으나, 종양표지자를 이용한 수술 전 원격전이 예측의 유용성에 관한 보고는 매우 드물다. 대상 및 방법: 2004년부터 2006년까지 본원에서 위암으로 수술을 시행 받은 환자 중 종양 표지자의 비특이적 증가를 초래하는 요인을 가진 환자를 제외한 788명의 환자를 대상으로 수술 전 CEA, CA 19-9와 임상병리학적 특성간에 상관관계를 분석하였다. 결과: CEA 양성여부는 연령, 성별과 같은 종양과 무관한 비특이적 인자에 의해서도 영향을 받으며, 림프절 전이여부와 독립적인 상관관계가 있었으나 종양의 침윤도와는 상관관계가 없었다. 원격전이의 예측에서 CEA는 복막전이나 혈행성 전이와 유의한 상관관계가 없었다. 이에 비해 CA 19-9는 종양의 침윤도 림프절 전이와 각각 독립적인 상관관계를 보였으며, 원격전이 중 복막 전이여부와 유의한 상관관계를 보였다. 특히, 증가 정도에 따라 CA 19-9가 5배 이상 증가 시에 복막전이에 대한 위험도가 유의하게 증가함을 보였다. 결론: CA 19-9는 측정이 간편하고 용이할 뿐만 아니라, 수술 전 비치유인자인 복막전이를 예측하는데 도움을 줌으로써, 이에 따른 환자의 추가적인 검사를 통하여 적절한 치료 방침을 세우는데 임상적으로 유용한 도구라고 판단된다.

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Malignant Ascites after Subduroperitoneal Shunt in a Patient with Leptomeningeal Metastasis

  • Lee, Min-Ho;Lee, Jung-Il
    • Journal of Korean Neurosurgical Society
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    • 제50권4호
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    • pp.385-387
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    • 2011
  • Leptomeningeal metastasis is a devastating complication of advanced stage cancer. It is frequently accompanied by hydrocephalus and intracranial hypertension that must be treated by ventriculoperitoneal shunts. However, there are actual risks of peritoneal seeding or accumulation of malignant ascites after the cerebrospinal fluid diversion procedure, though it has not been reported. Here, we present the case of a patient with non-small cell lung cancer with leptomeningeal metastasis in whom malignant ascites developed after a subduroperitoneal shunt.