There is no standard treatment for
peritoneal carcinomatosis (PC) from
gastric cancer. New bidirectional
chemotherapy (neoadjuvant intraperitoneal-systemic
chemotherapy protocol (
NIPS)) was developed. The aim of the present study was to assess the safety and efficacy of
NIPS and to show the selection for
cytoreductive surgery on PC from
gastric cancer. Seventy-nine patients with PC from
gastric cancer were treated with
NIPS. A peritoneal port system was introduced into the abdominal cavity. The peritoneal wash cytological examination through a port was done before and after
NIPS. The patients were treated with oral
TS-1 twice a daily for 21 days, followed by a 1-week rest. On day 1, 8, and 15 from the start of oral
TS-1 administration, 30 mg/m(2) of
Docetaxel and 30 mg/m(2) of cisplatinum with 500 ml of saline were introduced into the peritoneal cavity through the port. A median course of oral
TS-1 was 2.1 course and a median time of IP chemoterapy was 5.8. Peritoneal free
cancer cells (PFCCs) had been detected in 65 (82.2%) patients before
NIPS, and the positive cytology changed to be negative in 41 (63.0%) patients after
NIPS. After
NIPS, 41 patients underwent
laparotomy, and complete cytoreduction was done in 32 (78%) patients. Complete cytoreduction was done in 27 (51.9%) of 52 patients with negative cytology but in only 4 (14.8%) of 27 patients with positive cytology (P < 0.001). Patients with negative cytology after
NIPS survived significantly longer than those with positive cytology. The adverse effects after
NIPS were mild and there was no treatment-related deaths. The grade 3/4 hematological adverse effects were found in 2 (2.6%) patients. Grade 3 renal toxicity and port site
infection was found in three patients, respectively.
NIPS using a port system is a safe and effective treatment for PC. Peritoneal wash cytology through a port system is a good
indicator to select the patients to perform
cytoreductive surgery.