Current opportunities for combined treatment of gastric cancer patients with peritoneal carcinomatosis

Patients with locally advanced gastric cancer are at high risk of peritoneal dissemination. Poor prognosis after surgical treatment is mostly associated with presence of free tumor cells in peritoneal cavity that were not identified during pre-surgery examination. Staging laparoscopy and peritoneal washing with cytological examination are now routinely used to detect peritoneal carcinomatosis and for an accurate cancer staging. Yet there is no standard treatment for patients with morphologically confirmed peritoneal dissemination of gastric origin. International oncological associations such as NCCN, ESMO and AJCC identify presence of free tumor cells in peritoneal cavity as distant metastasis where palliative chemotherapy is recommended as the only treatment option. Literature review shows that even if complete regression of micrometastases is achieved after chemotherapy alone, survival rate of this group of patients remains poor. Today some authors prove combined treatment strategies for patients with peritoneal micrometastases of gastric origin to be effective. Because of the limited number of patients included in these studies there is no specific combined treatment scheme that can be recommended as a standard protocol of treatment patients with advanced gastric cancer.