Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1498-1507
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1498
Elemene-containing hyperthermic intraperitoneal chemotherapy combined with chemotherapy for elderly patients with peritoneal metastatic advanced gastric cancer
Zhi-Xiong Chen, Jin Li, Wen-Bin Liu, Shou-Ru Zhang, Hao Sun
Zhi-Xiong Chen, Hao Sun, Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
Jin Li, Department of Ultrasound, The Fifth People's Hospital of Chongqing, Chongqing 400062, China
Wen-Bin Liu, Department of Hepatobiliary and Pancreatic Oncology, Chongqing University Cancer Hospital, Chongqing 400030, China
Shou-Ru Zhang, Department of Teaching and Research Section, Chongqing University Cancer Hospital, Chongqing 400030, China
Author contributions: Sun H and Chen ZX concepted and designed; Chen ZX and Li J; Chen ZX, Liu WB, and Zhang SR analysed the data and interpretation; all authors wrote the manuscript and approval of the final manuscript.
Institutional review board statement: All procedures performed in studies that involved human participants were in accordance with the ethical standards of the institutional and/or national research committee, and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The present study was approved by the Ethics Committee of CUCH.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and analyzed in the present study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao Sun, MM, Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Sha pingba District, Chongqing 400030, China. sunhao68@sina.com
Received: September 18, 2021
Peer-review started: September 18, 2021
First decision: October 27, 2021
Revised: November 19, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: February 16, 2022
Processing time: 145 Days and 23.2 Hours
Abstract
BACKGROUND

Almost all elderly patients with peritoneal metastatic gastric cancer (PGC) are unlikely to tolerate cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and adjuvant chemotherapy. However, determining how to optimize the treatment strategy for such patients has always been a clinical problem. Both HIPEC and palliative adjuvant chemotherapy can benefit patients with PGC. Therefore, optimizing HIPEC and chemotherapy regimens has potential clinical value in reducing side effects, and improving treatment tolerance and clinical effectiveness.

AIM

To explore the effect of HIPEC containing elemene, which is an anti-cancer component extracted in traditional Chinese herbal medicine, combined with reduced capecitabine and oxaliplatin (CapeOx) chemotherapy regimens, in elderly patients with PGC.

METHODS

In the present study, 39 of 52 elderly PGC patients were included and assigned to different HIPEC treatment groups [lobaplatin group (group L) and mixed group (group M)] for analysis. Lobaplatin was used for all three HIPECs in group L. In group M, lobaplatin was used in the middle of the three HIPECs, and elemene was used for the first and third HIPEC. After HIPEC, patients received CapeOx chemotherapy. The incidence of complications (abdominal infection, lung infection, and urinary tract infection), myelosuppression, immune function (CD4/CD8 ratio), average length of hospital stay, and prognosis were compared between these two groups.

RESULTS

There was no significant difference in the incidence of complications between the two groups during hospitalization (P > 0.05). Compared to patients in group M, patients in group L exhibited severe myelosuppression (P = 0.027) and increased length of hospital stay (P = 0.045). However, no overall survival benefit was observed in group M. Furthermore, the immune function of patients in group M was less affected (P < 0.001), when compared to that of patients in group L. The multivariate analysis suggested that the cycles of chemotherapy after perfusion significantly affected the prognosis of patients in both groups.

CONCLUSION

Compared to the lobaplatin-based HIPEC regimen, the administration of elemene reduced the myelosuppression incidence in elderly PGC patients. The present study sheds light on the implementation of this therapeutic strategy for this set of patients.

Keywords: Gastric cancer; Hyperthermic intraperitoneal chemotherapy; Peritoneal metastasis; Oxaliplatin; Capecitabine

Core Tip: Elderly patients with advanced gastric cancer (GC) cannot tolerate high-intensity treatment. In addition, intraperitoneal hyperthermic perfusion chemotherapy (HIPEC) and capecitabine and oxaliplatin (CapeOx) regimens have limited therapeutic effects on advanced GC. On the other hand, the extracted Chinese herbal medicine, elemene, has anti-cancer effects and negligible side effects. In the present study, the use of elemene-containing HIPEC combined with a CapeOx chemotherapy regimen was proven to be more tolerant for elderly patients with peritoneal metastatic gastric cancer, making this a clinical choice for such patients.