Peritoneal carcinomatosis from gastric cancer treatment perspectives. A narrative review
Pepenin M.O.1, Kondratskyi Y.M.1, Dobrzhanskyi O.Y.1, Kolesnyk A.V.1, Horodetskiy A.V.1, Kopchak K.V.1, Zemskov S.V.2
- 1Nonprofit Organization «National Cancer Institute», Kyiv, Ukraine
- 2Bogomolets National Medical University, Kyiv, Ukraine
Summary. Aim of the review: to summarize the current evidence on therapeutic approaches for peritoneal carcinomatosis (PC) in gastric cancer (GC), focusing on the prospects of implementing intraperitoneal chemotherapy, particularly pressurized intraperitoneal aerosol chemotherapу (PIPAC), in clinical practice in Ukraine. Object of the review. Patients with GC PC, represent a challenging cohort due to the limited efficacy of systemic therapies and a traditionally poor prognosis. Methods. A narrative literature review was performed using international guidelines (National Comprehensive Cancer Network — NCCN, Peritoneal Surface Oncology Group International — PSOGI, European Society For Medical Oncology — ESMO), clinical trials, meta-analyses, and Ukrainian national standards. Special attention was given to index of peritoneal carcinomatosis (PCI) and CC indices, the role of staging laparoscopy, response assessment using the Peritoneal Regression Grading Score (PRGS), and local-regional therapies such as HIPEC and PIPAC. Main results. Systemic chemotherapy remains the cornerstone for PC in GC, yet its efficacy is hampered by the peritoneal-plasma barrier. Local intraperitoneal approaches like HIPEC and PIPAC offer promising benefits. The DRAGON-01 RCT confirmed that bidirectional chemotherapy (systemic plus intraperitoneal) improves overall survival and enables conversion surgery. PIPAC is a minimally invasive, repeatable, and low-toxicity method that demonstrates good histological response and can be applied even in extensive disease cases. The PRGS has proven to be a reliable tool for evaluating treatment efficacy. Given its safety and reproducibility, PIPAC is a viable option for integrating multimodal strategies. Conclusions. PC in GC should not be viewed as an ultimately terminal condition. Selected patients may benefit from combined systemic, regional, and surgical treatments. PIPAC is an emerging tool with favorable safety and clinical feasibility that deserves further research and implementation within the Ukrainian oncological landscape.
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