Researchers at the Mayo Clinic have made significant advancements in the treatment of stomach cancer, particularly in cases where the cancer has spread to the lining of the abdominal cavity, known as peritoneal metastasis.
Their innovative approach, detailed in a recent publication in the Annals of Surgical Oncology, has more than doubled the survival rate for these patients, offering new hope where there previously was little.
Stomach cancer, or gastric cancer, begins with the uncontrolled growth of cells in the stomach and is often diagnosed in the advanced stages when it has spread, making it harder to treat.
Dr. Travis Grotz, a surgical oncologist at the Mayo Clinic, highlights a troubling increase in the incidence of stomach cancer, particularly among younger people, where the cancer tends to be more advanced at diagnosis.
Traditionally, the prognosis for patients whose stomach cancer has spread to the peritoneum is bleak, with average survival typically about one year with systemic therapy alone.
The Mayo Clinic study introduced a treatment protocol that combines cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). Cytoreductive surgery involves removing all visible cancer tumors from the stomach and abdominal cavity.
This is followed by HIPEC, where the abdominal cavity is bathed in heated chemotherapy drugs—cisplatin and paclitaxel in this instance—for 90 minutes.
Heating the chemotherapy helps increase the dosage and enhance penetration, effectively killing remaining microscopic cancer cells more efficiently than traditional methods.
This approach has led to a significant improvement in survival rates. Dr. Grotz reports that with this new treatment strategy, the median survival for stage 4 gastric cancer patients, typically around 13 months, has seen remarkable improvement. In their study, 55% of patients were still alive three years post-treatment.
The study involved patients aged 46-62, all with stage 4 gastric cancer and peritoneal metastasis. These patients had undergone an average of seven cycles of chemotherapy before the combined surgery and HIPEC treatment.
Post-procedure, the average hospital stay was about six days, with the majority of patients experiencing no complications. Those who did face complications encountered mostly lower-grade issues that did not extend their hospital stay.
The research team conducted rigorous follow-ups, including clinical assessments with imaging and tumor markers every three to four months for the first two years, and every six months thereafter.
The one, two, and three-year overall survival rates for the patients were 96%, 78%, and 55% respectively.
Looking ahead, the Mayo Clinic team is exploring ways to further enhance these outcomes.
They are investigating the potential of performing similar procedures using robotic surgery, which would involve smaller incisions, potentially reducing recovery times, decreasing complication rates, and shortening hospital stays.
Dr. Grotz is optimistic about the future, aiming to initiate treatment sooner after diagnosis to prevent the spread of cancer to the peritoneum and improve survival rates even further.
This breakthrough is particularly significant in the field of gastric cancer treatment, offering not only extended life but also improved quality of life for patients.
Dr. Grotz, motivated by a desire to make a meaningful impact in cancer treatment since his days as a medical student, believes that while there is still much to be done, these advancements are crucial steps forward in providing hope and healing for those affected by this challenging disease.
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The research findings can be found in Annals of Surgical Oncology.
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