Cancers represent a significant global health burden, affecting millions of individuals each year

Background: Gastric cancer is a serious health issue both globally and in Kazakhstan. Worldwide, gastric cancer ranks fifth in incidence, with the highest rates reported in East Asia, the Andes of South America, and Eastern Europe, while the lowest rates are reported in North America, Northern Europe, Africa, and Southeast Asia. Over 70% of the cases occur in resource-limited countries. In Kazakhstan, gastric cancer ranks third in morbidity and second in mortality, representing a serious clinical and social problem. Annually, 1600 deaths from malignant gastric neoplasms are registered. Peritoneal metastasis is considered one of the most severe complications of gastric cancer and has long been regarded as its terminal stage. The average life expectancy of patients with peritoneal metastasis is only 3-6 months, reflecting a high mortality rate and the limited efficacy of current treatments. Objective: We hypothesize that the prophylactic use of pressurized intraperitoneal aerosol chemotherapy (PIPAC) may reduce the incidence of peritoneal metastasis. The aim of this study is to evaluate the incidence of peritoneal metastasis following prophylactic PIPAC in patients with gastric cancer. The primary goal of this research is to evaluate whether adding prophylactic PIPAC to standard treatment before neoadjuvant chemotherapy can reduce the incidence of peritoneal metastasis in patients with locally advanced gastric cancer. Methods: This study is a single-center nonrandomized controlled trial with a planned enrollment of 160 patients. All participants will be included in one of the 2 groups: intervention group (PIPAC + perioperative chemotherapy + gastrectomy with D2 lymphadenectomy) or control group (perioperative chemotherapy + gastrectomy with D2 lymphadenectomy). The primary end point is the incidence of peritoneal metastasis, and the secondary end points are overall survival, recurrence-free survival, treatment-related adverse events, and personal satisfaction. Results: As of September 2025, this study is funded and recruiting; 102 participants have already been enrolled. Recruitment is planned to be performed between January 2025 and December 2026. No interim analyses have been performed; primary results are planned for Q1 2027. The manuscript is expected to be published by Q4 2027. Conclusions: Compared to standard chemotherapy, PIPAC has been reported to significantly improve survival rates in patients with peritoneal metastasis of gastric origin. We suggest that the neoadjuvant use of PIPAC may reduce the incidence of peritoneal metastasis and improve long-term survival outcomes. The results of our study will provide key information on the practicality and viability of PIPAC as a prophylactic technique for preventing the progression of gastric cancer. Trial Registration: ClinicalTrials.gov NCT06784765; https://clinicaltrials.gov/study/NCT06784765 International Registered Report Identifier (IRRID): PRR1-10.2196/78053

BACKGROUND Gastric cancer is a serious health issue both globally and in Kazakhstan. Worldwide, gastric cancer ranks fifth in incidence, with the highest rates reported in East Asia, the Andes of South America, and Eastern Europe, while the lowest rates are reported in North America, Northern Europe, Africa, and Southeast Asia. Over 70% of the cases occur in resource-limited countries. In Kazakhstan, gastric cancer ranks third in morbidity and second in mortality, representing a serious clinical and social problem. Annually, 1600 deaths from malignant gastric neoplasms are registered. Peritoneal metastasis is considered one of the most severe complications of gastric cancer and has long been regarded as its terminal stage. The average life expectancy of patients with peritoneal metastasis is only 3-6 months, reflecting a high mortality rate and the limited efficacy of current treatments. OBJECTIVE We hypothesize that the prophylactic use of pressurized intraperitoneal aerosol chemotherapy (PIPAC) may reduce the incidence of peritoneal metastasis. The aim of this study is to evaluate the incidence of peritoneal metastasis following prophylactic PIPAC in patients with gastric cancer. The primary goal of this research is to evaluate whether adding prophylactic PIPAC to standard treatment before neoadjuvant chemotherapy can reduce the incidence of peritoneal metastasis in patients with locally advanced gastric cancer. METHODS This study is a single-center nonrandomized controlled trial with a planned enrollment of 160 patients. All participants will be included in one of the 2 groups: intervention group (PIPAC + perioperative chemotherapy + gastrectomy with D2 lymphadenectomy) or control group (perioperative chemotherapy + gastrectomy with D2 lymphadenectomy). The primary end point is the incidence of peritoneal metastasis, and the secondary end points are overall survival, recurrence-free survival, treatment-related adverse events, and personal satisfaction. RESULTS As of September 2025, this study is funded and recruiting; 102 participants have already been enrolled. Recruitment is planned to be performed between January 2025 and December 2026. No interim analyses have been performed; primary results are planned for Q1 2027. The manuscript is expected to be published by Q4 2027. CONCLUSIONS Compared to standard chemotherapy, PIPAC has been reported to significantly improve survival rates in patients with peritoneal metastasis of gastric origin. We suggest that the neoadjuvant use of PIPAC may reduce the incidence of peritoneal metastasis and improve long-term survival outcomes. The results of our study will provide key information on the practicality and viability of PIPAC as a prophylactic technique for preventing the progression of gastric cancer. CLINICALTRIAL ClinicalTrials.gov NCT06784765; https://clinicaltrials.gov/study/NCT06784765 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/78053

Peritoneal metastases are a common manifestation of malignant tumor progression in various locations. Despite the availability of systemic therapy and surgical approaches, many patients continue to face unmet clinical needs, reduced quality of life, and unfavorable outcomes. In response to these limitations, pressurized intraperitoneal aerosol chemotherapy was developed in the early 2000s. While this technique has generated increasing clinical interest, concerns remain regarding potential occupational and environmental risks, particularly due to aerosolized exposure to cytotoxic agents. This scoping review aimed to explore and summarize current evidence on occupational risks and safety measures implemented during pressurized intraperitoneal aerosol chemotherapy sessions for the treatment of peritoneal metastases. Based on available data, we also sought to identify clinical recommendations to ensure the protection of healthcare personnel and the operating room environment. Materials and methods. Relevant publications were identified through a systematic search of PubMed, Scopus, and eLibrary databases. Eligible studies described the pressurized intraperitoneal aerosol chemotherapy method, personal and collective protective measures, or organizational recommendations for safe handling of cytostatic aerosols in the surgical setting. Results. The search identified 185 publications, of which 37 met the inclusion criteria. The included studies mainly consisted of observational reports, experimental simulations, and institutional guidelines. Key safety measures included the use of closed aerosol delivery systems, high-efficiency ventilation, personal protective equipment, and standardized decontamination protocols. Evidence of long-term occupational risk was limited, but most studies emphasized the necessity of strict adherence to safety procedures. Conclusions. This review contributes to the evidence base supporting the occupational and environmental safety of pressurized intraperitoneal aerosol chemotherapy sessions. The synthesized findings can inform the adaptation and standardization of multilayered protection strategies and training protocols for healthcare workers, thereby minimizing risks to staff and the operating environment.

Introduction. Gastric cancer remains one of the leading causes of malignant mortality worldwide and occupies a significant place in the oncological morbidity structure in Kazakhstan. Accurate preoperative assessment of the extent of the disease is essential for choosing the optimal treatment strategy. Computed tomography (CT) is widely used for gastric cancer staging, but its accuracy can vary depending on the stage of the disease, the biological characteristics of the tumor, and the technical parameters of the examination. Aim. To evaluate the concordance between the results of CT staging and the final pathological conclusion in patients with gastric cancer in the clinical practice of Kazakhstan. Materials and methods. A retrospective analysis of CT scans was conducted in patients with histologically confirmed gastric cancer referred from various regions of the country and operated on at the National Research Oncology Center. All CT scans were performed before surgery. Staging results were compared with postoperative pathological data. Sensitivity, specificity, accuracy, and the Kappa coefficient of agreement were calculated. Results. The study included 42 patients. The accuracy of CT based on the T-score ranged from 73.2% (T3) to 95.1% (T4a), with the highest concordance for T4a (κ=0.72). For N-stage, the accuracy was 78.6% (κ=0.46). When assessing M-stage, the overall accuracy reached 87.8%, but the kappa coefficient was negative (κ=–0.06), which is associated with the rarity of M1 detection. The rate of understaging exceeded the rate of overstaging, especially at early stages T1–T2. Conclusion. CT demonstrates high diagnostic efficacy in assessing late T-stage disease and distant metastases, but its capabilities in early stages and in detecting lymph node metastases are limited. Optimization of protocols and integration of CT with endoscopic ultrasound and staging laparoscopy can improve staging accuracy and clinical outcomes in patients with gastric cancer. Введение.Рак желудка остаётся одной из ведущих причин смертности от злокачественных новообразований во всём мире и занимает значимое место в структуре онкологической заболеваемости Казахстана. Точная предоперационная оценка распространённости процесса необходима для выбора оптимальной тактики лечения. Компьютерная томография (КТ) широко используется для стадирования рака желудка, однако её точность может варьировать в зависимости от стадии заболевания, биологических особенностей опухоли и технических параметров исследования. Цель. Оценить соответствие между результатами КТ-стадирования и окончательным патоморфологическим заключением у пациентов с раком желудка в условиях клинической практики Казахстана. Материалы и методы. Проведён ретроспективный анализ КТ-исследований у пациентов с гистологически подтверждённым раком желудка, направленных из различных регионов страны и прооперированных в Национальном научном онкологическом центре. Все КТ выполнялись до хирургического вмешательства. Результаты стадирования сопоставлялись с послеоперационными патоморфологическими данными. Рассчитывались чувствительность, специфичность, точность и коэффициент согласия Каппа. Результаты. В исследование включены 42 пациента. Точность КТ по T-критерию варьировала от 73,2% (T3) до 95,1% (T4a), с наибольшим уровнем согласия при T4a (κ=0,72). Для N-стадии точность составила 78,6% (κ=0,46). При оценке M-стадии общая точность достигала 87,8%, однако коэффициент Каппа был отрицательным (κ=–0,06), что связано с редкостью выявления M1. Частота недооценки (understaging) превышала частоту переоценки (overstaging), особенно на ранних стадиях T1–T2. Заключение.КТ демонстрирует высокую диагностическую эффективность при оценке поздних T-стадий и отдалённых метастазов, однако её возможности при ранних формах и определении лимфогенного метастазирования ограничены. Оптимизация протоколов и интеграция КТ с эндоскопическим ультразвуком и стейджинговой лапароскопией могут повысить точность стадирования и улучшить клинические результаты у пациентов с раком желудка. Кіріспе. Асқазан обыры әлем бойынша қатерлі ісіктерден өлім-жітімнің негізгі себептерінің бірі болып қала береді және...

Pathological lymph-node status after neoadjuvant treatment and surgery (ypN) is prognostic in gastric cancer but unavailable before resection. We developed a pilot prediction model to estimate ypN risk from seven variables recorded before radical surgery in patients treated within a single-center PIPAC program; the timing of blood counts relative to neoadjuvant treatment could not be established. Of 62 patients, 47 with recorded ypN were analyzed (18 ypN-positive). Predictors were clinical T and N stage, tumor grade, age, body-mass index, white-cell count, and platelet count. Ridge logistic regression (primary), random forest, and Firth logistic regression were evaluated by cross-validation. Out-of-fold AUCs were 0.701 (95% confidence interval 0.539-0.851), 0.667 (0.488-0.831), and 0.703 (0.532-0.851), respectively; Brier scores were 0.227, 0.227, and 0.222 (prevalence-only reference 0.236). Performance was modest and imprecise; because the predictor panel was selected using the same cross-validation, estimates may be optimistic. These findings are an exploratory signal requiring independent validation.