Hyperthermic intraperitoneal chemotherapy with raltitrexed for peritoneal recurrence presenting with massive ascites following radical surgery for advanced gastric cancer: a case report

Peritoneal recurrence is the most common form of recurrence after radical gastrectomy for gastric cancer (GC) and is the main cause of death. The median survival period is 3-6 months, and the 5-year survival rate is almost zero. So far, the treatment methods recommended by various clinical guidelines for peritoneal metastasis (PM) of GC are all palliative systemic chemotherapy (SC). However, the therapeutic effect is not ideal. One possible reason is the existence of the blood-peritoneal barrier, which makes it difficult for drugs to reach the peritoneal metastatic foci fully. Based on this, surgeons have gradually attempted the intraperitoneal administration mode in clinical practice. Hyperthermic intraperitoneal chemotherapy (HIPEC) improves the anti-tumor efficacy through the synergistic effect of heat and chemotherapy drugs and has achieved good therapeutic effects in the treatment of PM of GC. Raltitrexed is mainly used for intravenous administration and intraperitoneal chemotherapy for advanced colorectal cancer. HIPEC with raltitrexed for the treatment of PM after radical gastrectomy for GC is extremely rare. This article introduces a case of advanced GC with peritoneal recurrence and a large amount of ascites 11 months after radical gastrectomy. After 5 cycles of HIPEC with raltitrexed, a favorable therapeutic effect was achieved. The patient experienced significant clinical improvement, characterized by the resolution of ascites, alleviation of symptoms, and prolonged survival, thereby creating an opportunity for subsequent comprehensive treatment. It is hoped that this case can provide a treatment option for patients with peritoneal recurrence after radical gastrectomy for GC.