Table 1. Types and indications of various modalities of IP chemotherapy for gastric cancer.
| Types of IP chemotherapy | Indication | Summary | |
|---|---|---|---|
| HIPEC | |||
| HIPEC+CRS | Curative treatment for patients with PM | Radical and invasive procedure with significant morbidity rate. May benefit patients who have limited PM (PCI ≤6) [9,14,15]. | |
| Laparoscopic HIPEC | Palliative treatment for patients with PM | Small number of studies report laparoscopic HIPEC to be relatively safe and having some efficacy in treating PM. Further studies are needed to verify the safety and efficacy of this modality [17,18,19]. | |
| Gastrectomy+HIPEC | Adjuvant treatment for patients at high risk of PM | Evidence suggests that the addition of HIPEC to gastrectomy reduces the risk of peritoneal recurrence, but has significant morbidity rate. Ongoing RCT (GASTRICHIP Trial, NCT01882933) aims to address these concerns [9,22,23,24]. | |
| Cather-based chemotherapy | |||
| SIPC | Palliative treatment for patients with PM | Safe procedure which allows for repeated dosing. A number of phase II studies have reported a median overall survival of 21–34 months following conversion gastrectomy in patients with complete resolution of PM. Unfortunately, these findings were not replicated in the only phase III trial to date comparing SIPC with systemic chemotherapy, possibly arising from issues with study methodology [36,37,38,40]. | |
| EPIC | Adjuvant treatment for patients at high risk of PM | Individual studies demonstrating improvement in overall survival, but with an increased risk of bleeding and intra-abdominal sepsis [41,42,43,44]. | |
| Emerging modalities | |||
| PIPAC | Palliative treatment for patients with PM | Safe procedure which allows for repeated dosing while preserving quality of life. Growing evidence suggests efficacy for PM, with multiple ongoing trials to verify these findings [52,53,54,55]. | |
IP = intraperitoneal; HIPEC = hyperthermic intraperitoneal chemotherapy; CRS = cytoreductive surgery; EPIC = early postoperative intraperitoneal chemotherapy; SIPC = systemic and intraperitoneal chemotherapy; PIPAC = pressurized intraperitoneal aerosol chemotherapy; PM = peritoneal metastasis; PCI = peritoneal carcinomatosis index.