Diapositive 1 - Chirurgie

Carcinoses gastriques
Traitement curatif et préventif
Glehen olivier
Chirurgie Oncologique
Hospices Civils de Lyon
Centre Hospitalier Lyon Sud
Université Claude Bernard Lyon 1

Gastric peritoneal carcinomatosis
Major problem of the
disease evolution
More than 50% of potentially curable
gastric cancer died of peritoneal
recurrence
60% of all causes of gastric cancer deaths
is from peritoneal carcinomatosis

Gastric carcinomatosis Natural History
Palliative treatment
-Sadeghi EVOCAPE 1 (Cancer 2000) : n=127. (prospective)
Palliative systemic chemotherapy.
Median survival : 3 months
1/3 of synchronous carcinomatosis
-No real improvement of prognosis with new systemic agents
-Targeted therapy (Trastuzumab): < 20% of patients
-Metastatic gastric cancer in 2013
Median survival < 1 year (6 months ??)

Management of peritoneal carcinomatosis:
EVOLUTION
Before 1980
PALLIATIVE TREATMENT
1980-95: HIPEC,
EPIC
1995-2000: Cytoreductive surgery,
phase II studies
2000-2010: Registration, randomized study,
Development of expert centers
CURATIVE TREATMENT OF PC

Traitement d’une
maladie locorégionale
Traitement de la maladie macroscopique
Chirurgie de cytoréduction
Péritonectomies
Traitement de la maladie microscopique
Chimiothérapie intrapéritonéale
Principes du
traitement curatif des Carcinoses
Péritonéales
Traitement de la maladie métastatique
Chimiothérapie systémique