Strategy to Reduce Peritoneal Metastases in Gastric Cancer

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Adding hyperthermic intraperitoneal chemotherapy to systemic chemotherapy after radical gastrectomy reduces the occurrence of peritoneal metastases and improves disease-free survival (DFS) for patients with locally advanced gastric cancer.

Why This Matters

  • Surgery and postoperative chemotherapy are standard of care for advanced gastric cancer, but up to half of patients develop peritoneal metastases with poor prognosis.

  • There is no consensus on how to prevent peritoneal metastases.

  • With hyperthermic intraperitoneal chemotherapy, the abdominal cavity is bathed in chemotherapy that has been heated, directly killing free cancer cells and micrometastases.

  • The findings suggest that adding hyperthermic intraperitoneal chemotherapy to standard treatment greatly reduces the risk of peritoneal metastases.

Study Design

  • The investigators randomly assigned 134 patients with advanced gastric cancer evenly to receive either systemic chemotherapy alone or systemic chemotherapy plus hyperthermic intraperitoneal chemotherapy after radical gastrectomy.

  • The hyperthermic intraperitoneal chemotherapy group had 3 L of heated saline containing 40 mg/m2 of cisplatin circulated in their peritoneal cavities for an hour. The procedure was performed twice within 72 hours of surgery.

  • Systemic chemotherapy consisted of 6–8 cycles of S-1 combined with oxaliplatin (SOX regimen) starting 4–6 weeks after surgery.

  • Most patients (90%) had stage III disease, and the rest stage II.

  • Median follow-up was 44 months.

Key Results

  • Overall, the 3-year DFS rate was 73.8% with hyperthermic intraperitoneal chemotherapy, vs 61.2% without it (P = .031).

  • In addition, 21% of patients in the hyperthermic intraperitoneal chemotherapy group developed peritoneal metastases, vs 40.3% with standard care (P = .015)

  • Three-year overall survival was 73.9% in the hyperthermic intraperitoneal chemotherapy group, vs 77.6% in the standard care arm, but the difference was not significant (P = .737).

  • There were no serious adverse events related to hyperthermic intraperitoneal chemotherapy, and postoperative complications were similar between the groups.

  • Grade 3 or 4 adverse events occurred in 14.2% of patients; there were no statistically significant between-group differences.

  • Metastases to other sites, such as the liver and distant lymph nodes, were also similar between the two arms.


  • Follow-up might have been too short to detect a difference in overall survival.

  • The trial was conducted at a single-center and was relatively small.


  • The study received no external funding, and the investigators did not report any financial relationships.

This is a summary of a preprint research study, “Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Plus Systemic Chemotherapy Versus Systemic Chemotherapy Alone in Locally Advanced Gastric Cancer After D2 Radical Resection: A Randomized Controlled Study,” led by Pengfei Yu of the Zhejiang Cancer Hospital, China, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected].

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