Good Doctor·Hyperthermic Perfusion | Literature Review and Analysis | (6) “Clinical Study on the Treatment of Advanced Gastric Cancer with Ascites Using Hyperthermic Intraperitoneal Chemotherapy”

Good Doctor·Hyperthermic Perfusion | Literature Review and Analysis | (6) “Clinical Study on the Treatment of Advanced Gastric Cancer with Ascites Using Hyperthermic Intraperitoneal Chemotherapy”

[Abstract]

Case selection: The hyperthermic perfusion chemotherapy group comprised 52 patients, including 38 males and 14 females; age range, 38–71 years, with a median age of 56 years. The chemotherapy‑only group included 50 patients, comprising 33 males and 17 females; age range, 40–75 years, with a median age of 55 years.

Methods: A total of 102 patients with gastric cancer complicated by malignant ascites, who were admitted to the Oncology Department of PLA General Hospital No. 309 from September 2008 to August 2011, were randomly assigned to either a hyperthermic intraperitoneal chemotherapy (HIPEC) group or a conventional chemotherapy group. All patients received docetaxel 75 mg/m² by intravenous infusion on day 1, repeated every 3 weeks. In the HIPEC group, cisplatin injection 40 mg/m² was administered intraperitoneally as part of HIPEC, once weekly for three consecutive weeks. In the conventional chemotherapy group, cisplatin injection 40 mg/m² was given intraperitoneally as part of HIPEC, once weekly for three consecutive weeks; efficacy and adverse events were then assessed.

Results: The response rates in the combination group and the monotherapy group were 69.23% and 46.00%, respectively (P<0.05). After treatment, the proportions of patients with improved KPS scores were 63.46% and 40.00% in the two groups, respectively (P<0.05). The incidence of major adverse events was similar between the two groups, primarily consisting of nausea, vomiting, and leukopenia.

Conclusion: Hyperthermic intraperitoneal chemotherapy demonstrates definitive efficacy in treating malignant ascites secondary to gastric cancer, while also improving patients’ quality of life and exhibiting a low incidence of adverse events, making it worthy of clinical adoption and broader application.

丨Article丨Source丨Core丨Background丨

“Clinical Study on Hyperthermic Intraperitoneal Chemotherapy for Advanced Gastric Cancer with Ascites” – Chinese Journal of Clinical Oncology, Volume 39, Issue 8 (Liao Guoqing, Qu Yimei, Wang Hongmei, Liu Penghui, Li Liangliang)

Objective: To evaluate the efficacy and safety of intraperitoneal hyperthermic perfusion combined with chemotherapy in the treatment of advanced gastric cancer complicated by peritoneal effusion.

[Keywords] Hyperthermic Intraperitoneal Chemotherapy, Chemotherapy, Gastric Cancer, Ascites, Quality of Life, Adverse Drug Reactions

Academic Commentary and Analysis

This study addresses the clinically challenging issue of advanced gastric cancer complicated by malignant ascites, comparing two treatment regimens: intraperitoneal hyperthermic perfusion chemotherapy combined with systemic chemotherapy versus conventional intraperitoneal chemotherapy. The primary outcomes of interest include the efficacy of ascites control, improvements in quality of life, and adverse events in both groups. By focusing on the clinical challenges faced by patients with advanced gastric cancer—namely, the difficulty of controlling malignant ascites, its frequent recurrence, and short survival—this research aligns closely with real-world clinical needs. 
 

Characteristics/Advantages of This Study

Outstanding value exploration

This clinical study was officially published in 2012, with patient data collected from September 2008 to August 2011. At that time, the application of hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative management of advanced gastric cancer in China was still in an exploratory phase. In particular, performing percutaneous catheter placement under local anesthesia at the bedside of medical‑ward patients to establish effective circulation and deliver constant‑temperature thermal perfusion represented a highly innovative approach in oncologic clinical practice. The research team pioneered a non‑surgical clinical trial of circulating hyperthermic chemotherapy in patients with advanced gastric cancer complicated by ascites, marking one of the earliest such investigations in China. This work provided robust empirical evidence to guide the optimization of treatment parameters and facilitate broader clinical implementation. 
 

The experimental design is reasonable.

The study enrolled a total of 102 patients with advanced gastric cancer and malignant ascites, who were randomly assigned to either the hyperthermic intraperitoneal chemotherapy (HIPEC) group (n=52) or the conventional chemotherapy group (n=50). Baseline characteristics were comparable between the two groups. Both groups received the same systemic chemotherapy regimen—docetaxel 75 mg/m² administered by intravenous infusion every three weeks. For local treatment, the intraperitoneal dose of cisplatin was identical in both groups (40 mg/m²); however, the administration technique differed markedly: the conventional chemotherapy group received standard intraperitoneal injection via percutaneous puncture, whereas the HIPEC group underwent continuous‑temperature hyperthermic perfusion using a TRL2000 extracorporeal circulation hyperthermic chemotherapy device manufactured by Harbin Yuhang Technology Co., Ltd. The perfusion was maintained at an inlet temperature of 43.5–44°C and an outlet temperature of 41.5–42°C, with a sustained circulating duration of 60 minutes. Study variables were tightly controlled, and the design closely mirrored real‑world clinical practice. 
 

Comprehensive evaluation dimensions

The study evaluated the efficacy of ascites management according to the WHO’s recent criteria for assessing therapeutic response, while also quantifying patients’ quality of life using KPS scores measured before treatment and at 6 weeks post‑treatment. Results showed that in the hyperthermic intraperitoneal chemotherapy (HIPEC) group, the effective rate of ascites control was 69.23% (36/52), significantly higher than the 46.00% (23/50) observed in the chemotherapy‑only group, with a statistically significant difference (P<0.05). The improvement rate in KPS scores was 63.46% (33/52), also significantly greater than the 40.00% (20/50) in the control group, again reaching statistical significance (P<0.05). Regarding safety, the major adverse events in both groups were nausea, vomiting, and leukopenia, with no significant difference in incidence; moreover, no cases of intra‑abdominal infection occurred in the HIPEC group. This study not only confirmed the therapeutic advantages of HIPEC but also demonstrated the safety of circulatory hyperthermic perfusion performed under local anesthesia via percutaneous catheterization. Furthermore, the paper elucidates the underlying mechanisms of intracavitary hyperthermic perfusion by integrating principles such as the synergistic sensitization effect of hyperthermia and chemotherapeutic agents, as well as physical flushing, providing robust evidence. 
 

Highly practical in clinical settings

This clinical study leverages percutaneous puncture and catheterization techniques performed under local anesthesia, enabling effective hyperthermic intraperitoneal chemotherapy to be administered directly in the medical oncology ward without requiring operating‑room facilities. The procedure is relatively simple and minimally invasive. The TRL2000 extracorporeal circulation hyperthermic perfusion chemotherapy system used in the study can maintain a constant temperature of the perfusate through continuous dynamic monitoring and feedback control, providing a viable technical reference for grassroots medical institutions seeking to implement similar therapies. 
 

Overall Evaluation

This study was conducted during the exploratory and developmental phase of HIPEC technology in China from 2008 to 2011. A total of 102 patients with advanced gastric cancer complicated by malignant ascites were prospectively enrolled and randomly assigned to either a group receiving hyperthermic intraperitoneal chemotherapy (HIPEC) combined with systemic chemotherapy or a group receiving conventional intraperitoneal chemotherapy. Systematic comparative observations were performed with respect to ascites control, quality-of-life improvement, and adverse events. The results demonstrated that HIPEC combined with systemic chemotherapy significantly increased the rate of effective ascites control, exhibited robust therapeutic efficacy, improved patients’ quality of life, and was associated with a low incidence of adverse reactions, indicating a favorable safety profile. These clinical findings not only provide early evidence supporting the use of HIPEC in the management of ascites in advanced gastric cancer but also offer practical guidance for optimizing treatment parameters, establishing standardized clinical protocols, and enabling grassroots medical institutions to implement this therapy.

Expert Profile

Dr. Liu, M.D., Ph.D. 
Professional Society Member: 
American Society for Cell Biology (2006–present) 
American Heart Association (2006–present) 
American Thoracic Society (1997–present) 
2023–2025.5 Associate Professor, Department of Cardiology, University of Miami, USA 
1999–2023 Assistant/Associate Professor, Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, USA 
1996–1999 Postdoctoral Fellow, Department of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, USA 
1992–1995: Master of Medicine, Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University (under Professor Sun Bin) 
1986–1992: Clinical Physician, Department of Respiratory Medicine, General Hospital of the Shenyang Military Region 
1981–1986 Bachelor of Medicine, Department of Clinical Medicine, Fourth Military Medical University