Current status and future prospects of clinical trials on CRS plus HIPEC for gastric cancer peritoneal metastases

Purpose: There is no standard treatment for peritoneal metastases (PM) from gastric cancer (GC). The aim of this review is to evaluate the clinical trials on cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for GC PM.Materials and methods: The published clinical trials on CRS+HIPEC for GC PM are critically evaluated, and survival and safety are the primary endpoints. In addition, the registered ongoing clinical trials are summarised.Results: The natural course of GC PM is <5 months. CRS+HIPEC could improve the overall survival (OS). In prospective studies, the median OS was 11.0 months in the CRS+HIPEC group vs. 5.4 months in the CRS alone group. In case-control studies, the median OS was 13.3 months in the CRS+HIPEC group vs. 7.9 months in the CRS alone group. In cohort studies, the median OS after CRS+HIPEC was 13.3. The median 1-, 2- and 5-year survival rates after CRS+HIPEC were 50.0%, 35.8% and 13.0%, respectively. There is no statistically significant increase in serious adverse events that are directly attributed to CRS+HIPEC.Conclusions: The combination of CRS and HIPEC is a promising integrated treatment strategy for GC PM that has encouraging initial results, calling for urgent further evaluation of this strategy in randomised control trials (RCTs).