Prophylactic Preoperative HIPEC in Advanced Gastric Cancer at High Risk of Peritoneal Recurrence

  • End date
    Dec 3, 2026
  • participants needed
  • sponsor
    Jagiellonian University
Updated on 3 September 2021
cancer chemotherapy


The study was designed to evaluate the efficacy of perioperative FLOT4 chemotherapy in combination with perioperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced gastric cancer at high risk of peritoneal metastases. The impact of treatment on peritoneal recurrence and survival over 6 months, 1, 3 and 5 years will be assessed.


This is a randomized, multicenter, clinical trial in which 598 patients with advanced gastric cancer at high risk of peritoneal metastases are randomly allocated to receive either preoperative hyperthermic intraperitoneal chemotherapy (HIPEC) plus gastrectomy (experimental group) or gastrectomy alone (control group). All patients, regardless of allocation, will additionally receive 4 cycles of FLOT4 chemotherapy (docetaxel 60 mg/m2, oxaliplatin 85 mg/m2, leucovorin 200 mg/m2 and 5-fluorouracil 2600 mg/m2) before surgery HIPEC and 4 cycles of FLOT4 chemotherapy after gastrectomy. The main outcome is frequency of peritoneal recurrence by 6-months post-operative. Patients will be followed for 5 years and undergo additional evaluations at 6 months, 1 year, 3 and 5 years.

The study will take place at 7 hospitals across Poland. All participating centers have the equipment and skills to perform all necessary procedures in this study. The below centers specialize in the treatment of stomach cancer with many documented years of experience. They are trained in the maintenance of a register, possess the skills to conduct appropriate research analyses and are equipped with a system for assessing the quality of both surgical and oncological treatment.

Condition Gastropathy, Gastric Cancer, Gastric Carcinoma, Stomach Cancer, gastric cancers, Stomach Discomfort
Treatment FLOT4 + HIPEC + Surgery, FLOT4 + Surgery
Clinical Study IdentifierNCT04597294
SponsorJagiellonian University
Last Modified on3 September 2021


Yes No Not Sure

Inclusion Criteria

Gastric cancer confirmed histopathologically in tumor specimens
Age 18-75 years
Advanced gastric cancer cT3 / cT4a / N0-3b
No distant metastases on computed tomography (CT) scan of the chest, abdomen and pelvis (cM0)
Written consent to participate in the study

Exclusion Criteria

No clear histopathological confirmation of gastric cancer
Age > 75 years
Poor general condition (Performance Status 3 or more on the Eastern Cooperative Oncology Group (ECOG)/World Health Organization scale)
Previous abdominal surgery (including oncological surgery), other than laparoscopic cholecystectomy or appendectomy (open or laparoscopic)
Pregnancy and lactation
Refusal to participate or an inability to provide written consent
Coexisting cancer in another location
Systemic treatment or radiotherapy for another cancer
Dysphagia requiring surgical treatment (gastric resection or nutritional jejunostomy) before starting neoadjuvant treatment and indication for accelerated surgery for other reasons
Disqualification for perioperative FLOT4 chemotherapy as decided by a multi-specialist consultation
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