501
|
Liu JS, He SC, Zhang ZL, Chen R, Fan L, Qiu GL, Chang S, Li L, Che XM. Anticancer effects of β-elemene in gastric cancer cells and its potential underlying proteins: a proteomic study. Oncol Rep 2014; 32:2635-47. [PMID: 25333415 DOI: 10.3892/or.2014.3490] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/26/2014] [Indexed: 01/19/2023] Open
Abstract
Gastric cancer is a common malignancy with a poor prognosis. β-elemene is a broad-spectrum anticancer drug extracted from the traditional Chinese medicinal herb Curcuma wenyujin. In the present study, we investigated the anticancer effects of β-elemene in gastric cancer cells and the potential proteins involved. Human SGC7901 and MKN45 gastric cancer cells were treated with different concentrations of β-elemene. Cell viability, clonogenic survival and apoptotic cell death were assessed. β-elemene inhibited viability and decreased clonogenic survival of gastric cancer cells in a dose-dependent manner. Apoptosis induction contributed to the anticancer effects. We then employed a proteomic method, isobaric tags for relative and absolute quantitation (iTRAQ), to detect the proteins altered by β-elemene. In total, 147 upregulated proteins and 86 downregulated proteins were identified in response to β-elemene treatment in SGC7901 gastric cancer cells. Among them, expression of p21-activated protein kinase‑interacting protein 1 (PAK1IP1), Bcl-2-associated transcription factor 1 (BTF) and topoisomerase 2-α (TOPIIα) were validated by western blot analyses and the trends were consistent with iTRAQ results. Top pathways involved in β-elemene treatment in SGC7901 gastric cancer cells included ribosome signaling, peroxisome proliferator-activated receptors (PPARs) signaling pathway, regulation of actin cytoskeleton, phagosome, biosynthesis and metabolism of some amino acids. Collectively, our results suggest a promising therapeutic role of β-elemene in gastric cancer. The differentially expressed proteins provide further insight into the potential mechanisms involved in gastric cancer treatment using β-elemene.
Collapse
Affiliation(s)
- Jun-Song Liu
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shi-Cai He
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Zheng-Liang Zhang
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Rui Chen
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Lin Fan
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Guang-Lin Qiu
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Shuai Chang
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Liang Li
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xiang-Ming Che
- Department of General Surgery, The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
502
|
Canyilmaz E, Soydemir G, Serdar L, Uslu GH, Sahbaz A, Colak F, Kandaz M, Bahat Z, Yoney A. Evaluation of prognostic factors and survival results in gastric carcinoma: single center experience from Northeast Turkey. Int J Clin Exp Med 2014; 7:2656-2666. [PMID: 25356123 PMCID: PMC4211773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/26/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the prognostic factors affecting overall survival (OS), disease-free survival (DFS), and survival among patients undergoing chemoradiotherapy (CRT) for locally advanced gastric carcinoma. METHODS Between January 2001 and May 2014, 257 patients who presented to our clinic with a diagnosis of stage I-IIIC gastric cancer were evaluated. The male/female ratio of the cases was 2.02:1 and the median age was 55.16±11.8 (20-80) years. Four of the cases (1.6%) were stage IA, 13 (5.1%) were stage 1B, 41 (16%) were stage IIA, 40 (15.6%) were stage IIB, 50 (19.5%) were stage IIIA, 51 (19.8%) were stage IIIB, and 58 (22.6%) were stage IIIC. RESULTS The mean follow-up time was 22.5 months (3.3-155.0); loco-regional recurrence was noted in 34 (13.2%) patients who underwent postoperative chemoradiotherapy, and metastases were observed in 108 (42%) patients. The median OS duration was 26.7 months (95% confidence interval, 20-33.5) and the 2-, 5-, and 10-year OS was 52.8% (standard error [S.E.] 0.032), 36.1% (S.E. 0.032), and 26.9% (S.E. 0.034) respectively. The median DFS was 53.7 months and the 2-, 5-, and 10-year DFS were 58.9% (S.E. 0.034), 47.4% (S.E. 0.037), and 40.7% (S.E. 0.042), respectively. In multivariate analysis of prognostic factors, advanced T stage (p<0.0001), advanced nodal stage (p=0.001), and surgical margin status (p<0.0001) were related to decreased OS and DFS. CONCLUSION R1 resection, advanced T stage, and advanced nodal stage were adverse prognostic factors in gastric cancer patients who had undergone CRT after the operation.
Collapse
Affiliation(s)
- Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Gulsen Soydemir
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Lasif Serdar
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Gonca Hanedan Uslu
- Department of Radiation Oncology, Kanuni Research and Education HospitalTrabzon, Turkey
| | - Asli Sahbaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Fatma Colak
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Mustafa Kandaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Zumrut Bahat
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical UniversityTrabzon, Turkey
| |
Collapse
|
503
|
Lohr F, Georg D, Cozzi L, Eich HT, Weber DC, Koeck J, Knäusl B, Dieckmann K, Abo-Madyan Y, Fiandra C, Mueller RP, Engert A, Ricardi U. Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma: when should they be considered and which questions remain open? Strahlenther Onkol 2014; 190:864-6, 868-71. [PMID: 25209551 DOI: 10.1007/s00066-014-0719-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/01/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE Hodgkin lymphoma (HL) is a highly curable disease. Reducing late complications and second malignancies has become increasingly important. Radiotherapy target paradigms are currently changing and radiotherapy techniques are evolving rapidly. DESIGN This overview reports to what extent target volume reduction in involved-node (IN) and advanced radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy-compared with involved-field (IF) and 3D radiotherapy (3D-RT)- can reduce high doses to organs at risk (OAR) and examines the issues that still remain open. RESULTS Although no comparison of all available techniques on identical patient datasets exists, clear patterns emerge. Advanced dose-calculation algorithms (e.g., convolution-superposition/Monte Carlo) should be used in mediastinal HL. INRT consistently reduces treated volumes when compared with IFRT with the exact amount depending on the INRT definition. The number of patients that might significantly benefit from highly conformal techniques such as IMRT over 3D-RT regarding high-dose exposure to organs at risk (OAR) is smaller with INRT. The impact of larger volumes treated with low doses in advanced techniques is unclear. The type of IMRT used (static/rotational) is of minor importance. All advanced photon techniques result in similar potential benefits and disadvantages, therefore only the degree-of-modulation should be chosen based on individual treatment goals. Treatment in deep inspiration breath hold is being evaluated. Protons theoretically provide both excellent high-dose conformality and reduced integral dose. CONCLUSION Further reduction of treated volumes most effectively reduces OAR dose, most likely without disadvantages if the excellent control rates achieved currently are maintained. For both IFRT and INRT, the benefits of advanced radiotherapy techniques depend on the individual patient/target geometry. Their use should therefore be decided case by case with comparative treatment planning.
Collapse
Affiliation(s)
- Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
504
|
Miao RL, Wu AW. Towards personalized perioperative treatment for advanced gastric cancer. World J Gastroenterol 2014; 20:11586-11594. [PMID: 25206266 PMCID: PMC4155352 DOI: 10.3748/wjg.v20.i33.11586] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is one of the most frequently diagnosed cancers worldwide. Although the rate of gastric cancer has declined dramatically over the past decades in most developed Western countries, it has not declined in East Asia. Currently, a radical gastrectomy is still the only curative treatment for gastric cancer. Over the last twenty years, however, surgery alone has been replaced by a multimodal perioperative approach. To achieve the maximum benefit from the perioperative treatment, a thorough evaluation of the tumor must first be performed. A complete assessment of gastric cancer is divided into two parts: staging and histology. According to the stage and histology of the cancer, perioperative chemotherapy or radiochemotherapy can be implemented, and perioperative targeted therapies such as trastuzumab may also play a role in this field. However, perioperative treatment approaches have not been widely accepted until a series of clinical trials were performed to evaluate the value of perioperative treatment. Although multimodal perioperative treatment has been widely applied in clinical practice, personalization of perioperative treatment represents the next stage in the treatment of gastric cancer. Genomic-guided treatment and efficacy prediction using molecular biomarkers in perioperative treatment are of great importance in the evolution of treatment and may become an ideal treatment method.
Collapse
|
505
|
Nakajima T, Fujii M. What make differences in the outcome of adjuvant treatments for resected gastric cancer? World J Gastroenterol 2014; 20:11567-11573. [PMID: 25206264 PMCID: PMC4155350 DOI: 10.3748/wjg.v20.i33.11567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/09/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
After a long history of Dark Age of adjuvant chemotherapy for gastric cancer, definite evidences of survival benefit from adjuvant treatment have been reported since 2000s. These survival benefits are likely attributed to something new approach different from pervious studies. In 2001, South West Oncology Group INT0116 trial yielded survival benefit in curatively resected gastric cancer patients with postoperative chemoradiotherapy [5-fluorouracil (5-FU) + Leucovorin + radiotherapy], followed by positive result by MAGIC Trial, employing peri-operative(pre- and postoperative chemotherapy with Epirubicin, cisplatin (CDDP), 5-fluorouracil (ECF) regimen in patients with curative resection. A novel drug [S1: ACTS-GC (Adjuvant chemotherapy trial of TS-1 for gastric cancer) in 2007], or new drug combination chemotherapys [CDDP + 5-FU: FNCLCC/FFCD (Federation Nationale des Centres de Lutte contre le cancer/Federation Francophone de Cancerologie Digestive) in 2011, Capecitabine + Oxaliplatin: CLASSIC in 2012] also produced positive results in terms of improved prognosis. Neoadjuvant or perioperative chemotherapy, novel anti-cancer drugs, and chemoradiotherapy might be the key words to develop further improvement in the adjuvant treatment of resectable gastric cancer. Moreover, it is not new but still true to stress the importance of D2 surgery as the baseline treatment in order to minimize the amount of residual tumor after surgery.
Collapse
|
506
|
Stiekema J, Trip AK, Jansen EPM, Aarts MJ, Boot H, Cats A, Ponz OB, Gradowska PL, Verheij M, van Sandick JW. Does adjuvant chemoradiotherapy improve the prognosis of gastric cancer after an r1 resection? Results from a dutch cohort study. Ann Surg Oncol 2014; 22:581-8. [PMID: 25164039 DOI: 10.1245/s10434-014-4032-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of adjuvant chemoradiotherapy (CRT) on survival of non-metastatic gastric cancer patients who had undergone an R1 resection. METHODS We compared the survival of patients after an R1 gastric cancer resection from the population-based Netherlands Cancer Registry who did not receive adjuvant CRT (no-CRT group) with the survival of resected patients who had been treated with adjuvant CRT (CRT group) at our institute. Patients who had a resection between 2002 and 2011 were included. CRT consisted of radiotherapy (45 Gy) combined with concurrent cisplatin- or 5-fluorouracil-based chemotherapy. The impact of CRT treatment on overall survival was assessed using multivariable Cox regression and stratified propensity score analysis. RESULTS A series of 409 gastric cancer patients who had undergone an R1 resection were studied (no-CRT, N = 369; CRT, N = 40). In the no-CRT group, median age was higher (70 vs. 57 years; p < 0.001) and the percentage of patients with diffuse-type tumors was lower (43 vs. 80 %; p < 0.001). There were no significant differences in pathological T- and N-classification. There was a significant difference in median overall survival between the no-CRT and CRT group (13 vs. 24 months; p = 0.003). In a multivariable analysis, adjuvant CRT was an independent prognostic factor for improved overall survival (hazard ratio 0.54; 95 % confidence interval 0.35-0.84). This effect of CRT was further supported by propensity score analysis. CONCLUSIONS Adjuvant CRT was associated with an improved survival in patients who had undergone an R1 resection for gastric cancer.
Collapse
Affiliation(s)
- Jurriën Stiekema
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|
507
|
Zhai YJ, Su YP, Wang SJ, Ning FL, Wang ZB, Yu WZ, Chen SS. A phase II trial of post-operative chemoradiotherapy for completely resected gastric cancer with D2 lymphadenectomy. Oncol Lett 2014; 8:1844-1848. [PMID: 25202423 PMCID: PMC4156225 DOI: 10.3892/ol.2014.2382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/19/2014] [Indexed: 12/13/2022] Open
Abstract
The optimal post-operative adjuvant treatment for completely resected gastric cancer with D2 lymphadenectomy remains controversial. The present study was a phase II trial on post-operative chemoradiotherapy in 30 patients with gastric cancer. Patients with stage II to IV (M0) gastric cancer received two cycles of chemotherapy prior to and following chemoradiotherapy. The chemotherapy consisted of a 2-h infusion of oxaliplatin (100 mg/m2) and folinic acid (100 mg/m2), which was followed by a 46-h continuous infusion of 5-fluorouracil (5-FU; 2,400 mg/m2) through a portable pump, repeated every 3 weeks. The chemoradiotherapy consisted of 45 Gy of radiotherapy for 5 weeks and 5-FU continuous infusion (350 mg/m2/day). In total, 30 patients were enrolled in this study. All patients underwent the chemoradiotherapy treatment as planned. A total of 10 (33.3%) patients relapsed; two (6.7%) locoregional relapses and mediastinum metastases, four (13.3%) peritoneal relapses, and four (13.3%) distant metastases. The three-year overall survival and disease-free survival rates were 72.7 and 65%, respectively. The toxicities of chemotherapy and radiotherapy, consisting of neutropenia, nausea and hand-foot syndrome, were observed. In conclusion, post-operative chemoradiotherapy following complete resection of gastric cancer with D2 lymphadenectomy is feasible in a significant subset of patients.
Collapse
Affiliation(s)
- Yu-Jie Zhai
- Binzhou Medical University, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China ; Department of Oncology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Yi-Peng Su
- Binzhou Medical University, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Sheng-Jie Wang
- Binzhou Medical University, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China ; Department of Oncology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Fang-Ling Ning
- Department of Oncology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Zhen-Bo Wang
- Department of Oncology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Wen-Zheng Yu
- Department of Hematology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| | - Shao-Shui Chen
- Department of Oncology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, P.R. China
| |
Collapse
|
508
|
Choi YY, An JY, Hyung WJ, Noh SH. Comments to young surgeons concerning laparoscopic spleen-preserving D2 lymph node dissection for advanced gastric cancer on the upper body. Chin J Cancer Res 2014; 26:231-3. [PMID: 25035646 DOI: 10.3978/j.issn.1000-9604.2014.06.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/14/2022] Open
Abstract
Qualified radical gastrectomy with lymph node dissection is very important to the prognosis of patients with gastric cancer. Now D2 lymph node dissection is standard procedure for gastric cancer surgery, and spleen hilar lymph node dissection is mandatory for gastric cancer in upper body. Because the anatomy of vessels in this area is very complicated, D2 lymph node dissection is technical challenging not only for open gastrectomy but also for laparoscopic one. Adapting a new technique is important to all surgeons, but we surgeons should always consider a patient's safety as the most important factor during surgery and that efforts should be based on scientific rationale with oncologic principles. I hope that the recent report by Huang et al. about laparoscopic spleen preserving hilar lymph node dissection would be helpful to young surgeons who will perform laparoscpic total gastrectomy for gastric cancer.
Collapse
Affiliation(s)
- Yoon Young Choi
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
509
|
Stessin AM, Sison C, Schwartz A, Ng J, Chao CK, Li B. Does adjuvant radiotherapy benefit patients with diffuse-type gastric cancer? Results from the Surveillance, Epidemiology, and End Results database. Cancer 2014; 120:3562-8. [DOI: 10.1002/cncr.28913] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Alexander M. Stessin
- Department of Radiation Oncology; Weill Cornell Medical College; New York New York
| | - Cristina Sison
- Department of Biostatistics; The Feinstein Institute for Medical Research; Manhasset New York
| | - Allie Schwartz
- Department of Economics; Harvard University; Cambridge Massachusetts
| | - John Ng
- Department of Radiation Oncology; Weill Cornell Medical College; New York New York
| | - Clifford K.S. Chao
- Department of Radiation Oncology; Weill Cornell Medical College; New York New York
| | - Baoqing Li
- Department of Radiation Oncology; Weill Cornell Medical College; New York New York
| |
Collapse
|
510
|
Costa Junior WLD, Coimbra FJF, Batista TP, Ribeiro HSDC, Diniz AL. Evaluation of N-ratio in selecting patients for adjuvant chemoradiotherapy after d2-gastrectomy. ARQUIVOS DE GASTROENTEROLOGIA 2014; 50:257-63. [PMID: 24474226 DOI: 10.1590/s0004-28032013000400004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023]
Abstract
CONTEXT Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controversial. OBJECTIVE To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. METHODS A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol) at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. RESULTS Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable) presented "area under ROC curve" (AUC) of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power - AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread - 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150-1.202; P = 0.092). CONCLUSIONS This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%-25%).
Collapse
Affiliation(s)
- Wilson Luiz da Costa Junior
- Departamento de Cirurgia Abdominal, Hospital Antônio Cândido de Camargo (A. C. Camargo), São PauloSP, Brasil
| | | | - Thales Paulo Batista
- Departamento de Cirurgia/Oncologia, Faculdade Pernambucana de Saúde, Instituto de Medicina Integral, RecifePE, Brasil
| | | | - Alessandro Landskron Diniz
- Departamento de Cirurgia Abdominal, Hospital Antônio Cândido de Camargo (A. C. Camargo), São PauloSP, Brasil
| |
Collapse
|
511
|
Soon YY, Leong CN, Tey JCS, Tham IWK, Lu JJ. Postoperative chemo-radiotherapy versus chemotherapy for resected gastric cancer: a systematic review and meta-analysis. J Med Imaging Radiat Oncol 2014; 58:483-96. [PMID: 24995607 DOI: 10.1111/1754-9485.12190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/17/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study conducted a systematic review and meta-analysis (direct and indirect) of published randomised controlled trials (RCTs) to compare the effects of postoperative chemo-radiotherapy (ChRT) with chemotherapy (Ch) on overall and disease-free survival (DFS) for patients with resectable gastric cancer. METHODS We searched MEDLINE and CENTRAL from the date of inception and annual meeting proceedings of American Society of Clinical Oncology and American Society for Radiation Oncology from 1999 to November 2012 for RCTs comparing postoperative ChRT with Ch, postoperative ChRT with surgery alone and postoperative Ch with surgery alone. The primary outcome was overall survival (OS); secondary outcomes included DFS and toxicity. Hazard ratios (HRs), confidence intervals (CIs) and P values (P) were estimated with fixed effects models using Revman 5.1. RESULTS We found six trials comparing postoperative ChRT with Ch (n = 1171). Meta-analysis of direct comparison trials showed that postoperative ChRT significantly improved both OS (HR 0.80, 95% CI 0.65-0.98, P = 0.03) and DFS (HR 0.76, 95% CI 0.63-0.91, P = 0.003) when compared with Ch. There were no significant differences in toxicity between the two groups. CONCLUSIONS This study suggests a survival benefit of postoperative ChRT over Ch in patients with resected gastric cancer.
Collapse
Affiliation(s)
- Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, National University Health System, National University of Singapore, Singapore
| | | | | | | | | |
Collapse
|
512
|
Sudo K, Elimova E, Skinner HD, Hofstetter WL, Ajani JA. Critical appraisal of locoregional failure and systemic disease progression after preoperative chemoradiation of esophageal adenocarcinoma. Reply to R. Gertler et al. J Clin Oncol 2014; 32:2112-3. [PMID: 24868018 DOI: 10.1200/jco.2014.55.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kazuki Sudo
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elena Elimova
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heath D Skinner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jaffer A Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
513
|
Bajetta E, Floriani I, Di Bartolomeo M, Labianca R, Falcone A, Di Costanzo F, Comella G, Amadori D, Pinto C, Carlomagno C, Nitti D, Daniele B, Mini E, Poli D, Santoro A, Mosconi S, Casaretti R, Boni C, Pinotti G, Bidoli P, Landi L, Rosati G, Ravaioli A, Cantore M, Di Fabio F, Aitini E, Marchet A. Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer. Ann Oncol 2014; 25:1373-1378. [PMID: 24728035 DOI: 10.1093/annonc/mdu146] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Some trial have demonstrated a benefit of adjuvant fluoropirimidine with or without platinum compounds compared with surgery alone. ITACA-S study was designed to evaluate whether a sequential treatment of FOLFIRI [irinotecan plus 5-fluorouracil/folinic acid (5-FU/LV)] followed by docetaxel plus cisplatin improves disease-free survival in comparison with 5-FU/LV in patients with radically resected gastric cancer. PATIENTS AND METHODS Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to either FOLFIRI (irinotecan 180 mg/m(2) day 1, LV 100 mg/m(2) as 2 h infusion and 5-FU 400 mg/m(2) as bolus, days 1 and 2 followed by 600 mg/m(2)/day as 22 h continuous infusion, q14 for four cycles) followed by docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, q21 for three cycles (sequential arm) or De Gramont regimen (5-FU/LV arm). RESULTS From February 2005 to August 2009, 1106 patients were enrolled, and 1100 included in the analysis: 562 in the sequential arm and 538 in the 5-FU/LV arm. With a median follow-up of 57.4 months, 581 patients recurred or died (297 sequential arm and 284 5-FU/LV arm), and 483 died (243 and 240, respectively). No statistically significant difference was detected for both disease-free [hazard ratio (HR) 1.00; 95% confidence interval (CI): 0.85-1.17; P = 0.974] and overall survival (OS) (HR 0.98; 95% CI: 0.82-1.18; P = 0.865). Five-year disease-free and OS rates were 44.6% and 44.6%, 51.0% and 50.6% in the sequential and 5-FU/LV arm, respectively. CONCLUSIONS A more intensive regimen failed to show any benefit in disease-free and OS versus monotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01640782.
Collapse
Affiliation(s)
- E Bajetta
- Istituto di Oncologia, Policlinico di Monza, Monza
| | - I Floriani
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano.
| | - M Di Bartolomeo
- Struttura Complessa di Medicina Oncologica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - R Labianca
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - A Falcone
- Dipartimento di Ricerca Traslazionale, Università di Pisa, Istituto Toscano Tumori, Pisa
| | - F Di Costanzo
- S.C. Oncologia Medica, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - G Comella
- Oncologia Medica A, Fondazione Pascale, Istituto Nazionale dei Tumori, Napoli
| | - D Amadori
- I.R.C.C.S. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola
| | - C Pinto
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - C Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli
| | - D Nitti
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
| | - B Daniele
- Dipartimento di Oncologia, A.O.G. Rummo, Benevento
| | - E Mini
- Dipartimento di Scienze Della Salute, Sezione di Farmacologia Clinica e Oncologia, Università degli Studi di Firenze, Firenze
| | - D Poli
- Laboratory of Clinical Research, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milano
| | - A Santoro
- U.O. Oncologia e Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-I.R.C.C.S., Rozzano
| | - S Mosconi
- Unità di Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo
| | - R Casaretti
- S.C. di Oncologia Medica Addominale, dell'Istituto Tumori di Napoli, Napoli
| | - C Boni
- Oncologia, Arcispedale Santa Maria Nuova-I.R.C.C.S., Reggio Emilia, Reggio Emilia
| | - G Pinotti
- Divisione di Oncologia Medica, A.O. Ospedale di Circolo, Varese
| | - P Bidoli
- S.C. Oncologia Medica, A.O.S. Gerardo, Monza
| | - L Landi
- U.O. Oncologia Medica, Azienda USL6 di Livorno, Istituto Toscano Tumori, Livorno
| | - G Rosati
- Unità Oncologia Medica, Ospedale S. Carlo, Potenza
| | - A Ravaioli
- U.O. di Oncologia, Ospedale Infermi Rimini, Ospedale Cervesi, Azienda USL di Rimini, Rimini, Cattolica
| | - M Cantore
- Oncologia Medica, USL 1, Massa Carrara
| | - F Di Fabio
- U.O. di Oncologia Medica, Policlinico S.Orsola Malpighi, Bologna
| | - E Aitini
- Ospedale Carlo Poma, Mantova, Italy
| | - A Marchet
- Clinica Chiurgica 1, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Padova
| |
Collapse
|
514
|
Foo M, Crosby T, Rackley T, Leong T. Role of (chemo)-radiotherapy in resectable gastric cancer. Clin Oncol (R Coll Radiol) 2014; 26:541-50. [PMID: 24996375 DOI: 10.1016/j.clon.2014.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/17/2014] [Accepted: 06/10/2014] [Indexed: 12/17/2022]
Abstract
The prognosis of patients with locally advanced gastric cancer remains poor, despite radical surgical resection. Adjuvant therapy has been shown to improve survival and, in Western countries, is delivered either postoperatively (chemoradiotherapy) or perioperatively (chemotherapy). Debate continues as to which of these represents the optimal strategy. High-dose gastric irradiation comes at the expense of significant toxicity, and increasing efforts have focused on attempts to reduce toxicity and normal tissue doses. The development of advancing radiotherapy technologies now allows improved target delineation and coverage. However, gastric irradiation remains technically challenging and requires an understanding of postoperative surgical anatomy, patterns of failure and lymph node drainage, as well as an appreciation of the uncertainties around organ motion and filling. Ongoing trials are examining the optimal strategy in which to incorporate (chemo)-radiotherapy, as well as the addition of targeted therapies, in gastric cancer. This overview discusses the current role and evidence for (chemo)-radiotherapy, as well as the technical challenges encountered in the radiotherapeutic management of resectable gastric cancer.
Collapse
Affiliation(s)
- M Foo
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK
| | | | - T Leong
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Australia
| |
Collapse
|
515
|
Qian Z, Zhu G, Tang L, Wang M, Zhang L, Fu J, Huang C, Fan S, Sun Y, Lv J, Dong H, Gao B, Su X, Yu D, Zang J, Zhang X, Ji J, Ji Q. Whole genome gene copy number profiling of gastric cancer identifies PAK1 and KRAS gene amplification as therapy targets. Genes Chromosomes Cancer 2014; 53:883-94. [PMID: 24935174 DOI: 10.1002/gcc.22196] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/17/2014] [Accepted: 05/29/2014] [Indexed: 01/25/2023] Open
Abstract
Gastric cancer is the second leading cause of death from cancer worldwide, with an approximately 20% 5-year survival rate. To identify molecular subtypes associated with the clinical prognosis, in addition to genetic aberrations for potential targeted therapeutics, we conducted a comprehensive whole-genome analysis of 131 Chinese gastric cancer tissue specimens using whole-genome array comparative genomic hybridization. The analyses revealed gene focal amplifications, including CTSB, PRKCI, PAK1, STARD13, KRAS, and ABCC4, in addition to ERBB2, FGFR2, and MET. The growth of PAK1-amplified gastric cancer cells in vitro and in vivo was inhibited when the corresponding mRNA was knocked down. Furthermore, both KRAS amplification and KRAS mutation were identified in the gastric cancer specimens. KRAS amplification was associated with worse clinical outcomes, and the KRAS gene mutation predicted sensitivity to the MEK1/2 inhibitor AZD6244 in gastric cancer cell lines. In summary, amplified PAK1, as well as KRAS amplification/mutation, may represent unique opportunities for developing targeted therapeutics for the treatment of gastric cancer.
Collapse
Affiliation(s)
- Ziliang Qian
- Innovation Centre China, Asia & Emerging Market iMed, AstraZeneca Innovation Medicines and Early Development, 199 Liangjing Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, People's Republic Of China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
516
|
Smyth EC, Cunningham D. Operable gastro-oesophageal junctional adenocarcinoma: Where to next? World J Gastrointest Oncol 2014; 6:145-155. [PMID: 24936225 PMCID: PMC4058722 DOI: 10.4251/wjgo.v6.i6.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/13/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
Oesophageal junctional adenocarcinoma is a challenging and increasingly common disease. Optimisation of pre-operative staging and consolidation of surgery in large volume centres have improved outcomes, however the preferred adjunctive treatment approach remains a matter of debate. This review examines the benefits of neoadjuvant, peri-operative, and post-operative chemotherapy and chemoradiotherapy in this setting in an attempt to reach an evidence based conclusion. Recent findings relating to the molecular characterisation of oesophagogastric cancer and their impact on therapeutics are explored, in addition to the potential benefits of fluoro-deoxyglucose positron emission tomography (FDG-PET) directed therapy. Finally, efforts to decrease the incidence of junctional adenocarcinoma using early intervention in Barrett’s oesophagus are discussed, including the roles of screening, endoscopic mucosal resection, ablative therapies and chemoprevention.
Collapse
|
517
|
Trip AK, Poppema BJ, van Berge Henegouwen MI, Siemerink E, Beukema JC, Verheij M, Plukker JTM, Richel DJ, Hulshof MCCM, van Sandick JW, Cats A, Jansen EPM, Hospers GAP. Preoperative chemoradiotherapy in locally advanced gastric cancer, a phase I/II feasibility and efficacy study. Radiother Oncol 2014; 112:284-8. [PMID: 24856116 DOI: 10.1016/j.radonc.2014.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was initiated to investigate the feasibility and efficacy of preoperative radiotherapy with weekly paclitaxel and carboplatin in locally advanced gastric cancer. METHODS In a prospective study, patients with locally advanced gastric cancer stage IB-IV(M0) were treated with chemoradiotherapy followed by surgery 4-6 weeks after the last irradiation. Chemoradiotherapy consisted of radiation to a total dose of 45 Gy given in 25 fractions of 1.8 Gy, combined with concurrent weekly carboplatin and paclitaxel. RESULTS Between December 2007 and January 2012, 25 patients with cT3 (64%) or cT4 (36%) gastric cancer were included. One patient discontinued concurrent chemotherapy in the 4th week due to toxicity, but completed radiotherapy. Another patient discontinued chemoradiotherapy after the 3rd week due to progressive disease. Grade III adverse events of chemoradiotherapy were: gastrointestinal 12%, haematological 12% and other 8%. All patients, except one who developed progressive disease, were operated. Surgical complications were: general/infectious 48%, anastomotic leakage 12%, and bowel perforation 8%. Postoperative mortality was 4%. Microscopically radical resection rate was 72%. Pathological complete response rate was 16% and near complete response rate 24%. CONCLUSIONS In this study, preoperative chemoradiotherapy for patients with locally advanced gastric cancer was associated with manageable toxicity and encouraging pathological response rates.
Collapse
Affiliation(s)
- Anouk K Trip
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Boelo J Poppema
- Department of Medical Oncology, University Medical Centre Groningen, The Netherlands
| | | | - Ester Siemerink
- Department of Internal Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Jannet C Beukema
- Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University Medical Centre Groningen, The Netherlands
| | - Dick J Richel
- Department of Medical Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annemieke Cats
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Edwin P M Jansen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, The Netherlands.
| |
Collapse
|
518
|
Yang W, Raufi A, Klempner SJ. Targeted therapy for gastric cancer: molecular pathways and ongoing investigations. Biochim Biophys Acta Rev Cancer 2014; 1846:232-7. [PMID: 24858418 DOI: 10.1016/j.bbcan.2014.05.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 02/07/2023]
Abstract
Gastric cancer is currently the second leading cause of worldwide cancer mortality. Ongoing collaborative sequencing efforts have highlighted recurrent somatic genomic aberrations in gastric cancer, however, despite advances in characterizing the genomic landscape, there have been few advances in patient outcomes. Prognosis remains poor with a median overall survival of 12 months for advanced disease. The improved survival with trastuzumab, and more recently ramucirumab, underscore the promise of targeted and biologic therapies and the importance of molecular tumor characterization in gastric cancer. Here we review the most frequent actionable alterations in gastric cancer and highlight ongoing clinical investigations attempting to translate biologic understanding into improved clinical outcomes.
Collapse
Affiliation(s)
- Wei Yang
- University of California Irvine, Department of Medicine, Orange, CA, USA
| | - Alexander Raufi
- University of California Irvine, Department of Medicine, Orange, CA, USA
| | - Samuel J Klempner
- University of California Irvine, Division of Hematology-Oncology, Orange, CA, USA.
| |
Collapse
|
519
|
Ejaz A, Spolverato G, Kim Y, Squires MH, Poultsides G, Fields R, Bloomston M, Weber SM, Votanopoulos K, Worhunsky DJ, Swords D, Jin LX, Schmidt C, Acher AW, Saunders N, Cho CS, Herman JM, Maithel SK, Pawlik TM. Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer: a multi-institutional analysis. Ann Surg Oncol 2014; 21:3412-21. [PMID: 24845728 DOI: 10.1245/s10434-014-3776-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Use of perioperative chemotherapy (CTx) alone versus chemoradiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the utilization and effect of CTx alone versus cXRT on patients having undergone curative-intent resection for gastric cancer. METHODS Using the multi-institutional US Gastric Cancer Collaborative database, we identified 505 gastric cancer patients between 2000 and 2012 who received perioperative therapy in addition to curative-intent resection. The impact of perioperative therapy on survival was analyzed by the use of propensity-score matching of clinicopathologic factors among patients who received CTx alone versus cXRT. RESULTS Median patient age was 62 years, and most patients were male (58.2 %). Most patients had a T3 (38.7 %) or T4 (36.8 %) lesion and lymph node metastasis (73.4 %). A total of 211 (42.8 %) patients received perioperative CTx alone, whereas the remaining 294 (58.2 %) patients received cXRT. Factors associated with receipt of cXRT were younger age (odds ratio, 1.93) and lymph node metastasis (odds ratio, 4.02; both P < 0.05). At a median follow-up of 28 months, the median overall survival (OS) was 33.4 months, and the 5-year OS was 36.7 %. Factors associated with worse overall survival included large tumor size [hazard ratio (HR), 1.83], T3 (HR 2.96) or T4 (HR 4.02) tumors, and lymph node metastasis (HR 1.57; all P < 0.05). In contrast, receipt of cXRT was associated with improved long-term OS (CTx alone, 20.9 months; cXRT, 46.7 months; HR 0.51; P < 0.001). CONCLUSIONS cXRT was utilized in 58 % of patients undergoing curative-intent resection for gastric cancer. With propensity score-matched analysis, cXRT was an independent factor associated with improved recurrence-free survival and OS.
Collapse
Affiliation(s)
- Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, John L. Cameron Professor of Alimentary Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
520
|
Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 24 Suppl 6:vi57-63. [PMID: 24078663 DOI: 10.1093/annonc/mdt344] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- T Waddell
- GI Clinical Trials Unit, Royal Marsden Hospital, Sutton, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
521
|
Gastric carcinoma at Tanta Cancer Center: a comparative retrospective clinico-pathological study of the elderly versus the non-elderly. J Egypt Natl Canc Inst 2014; 26:127-37. [PMID: 25150128 DOI: 10.1016/j.jnci.2014.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/21/2014] [Accepted: 04/24/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND AIMS To study the clinico-pathological features, treatments and outcomes of gastric carcinoma (GC) in the elderly (⩾65 years) and the non-elderly Egyptian patients. METHODS This retrospective cohort study included 168 patients with histologically confirmed GC treated at Tanta Cancer Center between 2003 and 2007. RESULTS Compared to the non-elderly, elderly patients had significantly higher proportion of tumors involving the cardia (p=0.034) and of adenocarcinoma NOS histology (p=0.032). Treatments were largely comparable in the two groups. Response to palliative chemotherapy was achieved in 44.4% of the elderly and 25.5% of the non-elderly patients (p=0.417). The median overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were 6, 17 and 3 months, respectively. The median OS was 4 months in the elderly compared to 9 months in the non-elderly (p=0.005). The median DFS was 4 months in the elderly compared to 20 months in the non-elderly (p=0.004). The median PFS was 2 months in the elderly compared to 3 months in the non-elderly (p=0.685). In multivariate analysis, poor performance status was an independent predictor of poor OS, DFS and PFS. Non-curative or no surgery and lack of chemotherapy use were independent predictors of poor OS. Age was an independent predictor of poor DFS. CONCLUSIONS Compared to the non-elderly, GC in the elderly has similar clinico-pathological characteristics and exhibits comparable outcomes with the same treatment options. Treatments should be tailored to each patient.
Collapse
|
522
|
Gastric cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 2014; 40:584-591. [PMID: 24685156 DOI: 10.1016/j.ejso.2013.09.020] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 02/08/2023] Open
|
523
|
Ferro A, Peleteiro B, Malvezzi M, Bosetti C, Bertuccio P, Levi F, Negri E, La Vecchia C, Lunet N. Worldwide trends in gastric cancer mortality (1980–2011), with predictions to 2015, and incidence by subtype. Eur J Cancer 2014; 50:1330-44. [PMID: 24650579 DOI: 10.1016/j.ejca.2014.01.029] [Citation(s) in RCA: 482] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 12/11/2022]
|
524
|
Miceli R, Tomasello G, Bregni G, Bartolomeo MD, Pietrantonio F. Adjuvant chemotherapy for gastric cancer: Current evidence and future challenges. World J Gastroenterol 2014; 20:4516-4525. [PMID: 24782604 PMCID: PMC4000488 DOI: 10.3748/wjg.v20.i16.4516] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer still represents one of the major causes of cancer mortality worldwide. Patients survival is mainly related to stage, with a high proportion of patients with metastatic disease at presentation. Thus, the cure rate largely depend upon surgical resection. Despite the additional, albeit small, benefit of adjuvant chemotherapy has been clearly demonstrated, no general consensus has been reached on the best treatment option. Moreover, the narrow therapeutic index of adjuvant chemotherapy (i.e., limited survival benefit with considerable toxicity) requires a careful assessment of expected risks and benefits for individual patients. Treatment choices vary widely based on the different geographic areas, with chemotherapy alone more often preferred in Europe or Asia and chemoradiotherapy in the United States. In the present review we discuss the current evidence and future challenges regarding adjuvant chemotherapy in curatively resected gastric cancer with particular emphasis on the recently completed landmark studies and meta-analyses. The most recent patient-level meta-analysis demonstrated the benefit of adjuvant chemotherapy over curative surgery; the same Authors also showed that disease-free survival may be used as a surrogate end-point for overall survival. We finally discuss future research issues such as the need of economic evaluations, development of prognostic or predictive biomarkers, and the unmet clinical need of trials comparing perioperative chemotherapy with adjuvant treatment.
Collapse
|
525
|
Proserpio I, Rausei S, Barzaghi S, Frattini F, Galli F, Iovino D, Rovera F, Boni L, Dionigi G, Pinotti G. Multimodal treatment of gastric cancer. World J Gastrointest Surg 2014; 6:55-58. [PMID: 24829622 PMCID: PMC4013710 DOI: 10.4240/wjgs.v6.i4.55] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the second leading cause of death from malignant disease worldwide. Although complete surgical resection remains the only curative modality for early stage gastric cancer, surgery alone only provides long-term survival in 20% of patients with advanced-stage disease. To improve current results, it is necessary to consider multimodality treatment, including chemotherapy, radiotherapy and surgery. Recent clinical trials have shown survival benefit of combining different neoadjuvant or adjuvant protocols compared with surgery with curative intent. Furthermore, the implementation of chemotherapy with novel targeted agents could play an important role in the multimodal management of advanced gastric cancer. In this paper, we focus on a multidisciplinary approach in the treatment of gastric cancer and discuss future strategies to improve the outcome for these patients.
Collapse
|
526
|
Capecitabine in adjuvant radiochemotherapy for gastric adenocarcinoma. Radiol Oncol 2014; 48:189-96. [PMID: 24991209 PMCID: PMC4078038 DOI: 10.2478/raon-2013-0065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/13/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with non-metastatic gastric cancer surgery still remains the treatment of choice. Postoperative radiochemotherapy with 5-fluorouracil and leucovorin significantly improves the treatment outcome. The oral fluoropyrimidines, such as capecitabine, mimic continuous 5-fluorouracil infusion, are at least as effective as 5-fluorouracil, and such treatment is more comfortable for the patients. PATIENTS AND METHODS In the period from October 2006 to December 2009, 101 patients with gastric cancer in stages Ib-IIIc were treated with postoperative chemoradiation with capecitabine. Distal subtotal resection of the stomach was performed in 46.3%, total resection in 50.5% and multivisceral resection in 3.2% of patients. The main endpoints of this study were loco-regional control (LRC), disease-free survival (DFS), disease-specific survival (DSS) and overall survival (OS). The rates of acute side-effects were also estimated. RESULTS Seventy-seven percent of patients completed the treatment according to the protocol. The median follow-up time of all patients was 3.9 years (range: 0.4-6.3 years) and in survivors it was 4.7 years (range: 3.2-6.3 years). No death occurred due to the therapy. Acute toxicity, such as nausea and vomiting, stomatitis, diarrhoea, hand-foot syndrome and infections of grade 3 or 4, occurred in 5%, 1%, 2%, 8.9% and 18.8% of patients, respectively. On the close-out date 63.4% patients were still alive and with no signs of the disease. The 4-years follow-up survey showed that LRC, DFS, DSS and OS were 95.5%, 69.2%, 70.7%, and 66.2%, respectively. Higher pN-stage and splenectomy were found to be independent prognostic factors for all four types of survival and perineural invasion and lower treatment intensity for DFS, DSS and OS. CONCLUSIONS Postoperative radiochemotherapy with capecitabine is feasible, with low toxicity and the results of such treatment are good.
Collapse
|
527
|
Is postoperative adjuvant chemoradiotherapy efficacious and safe for gastric cancer patients with D2 lymphadenectomy? A meta-analysis of the literature. Eur J Surg Oncol 2014; 40:1614-21. [PMID: 24813809 DOI: 10.1016/j.ejso.2014.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/26/2014] [Accepted: 04/13/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adjuvant chemoradiotherapy (CRT) for patients with gastric cancer after D2 lymphadenectomy remains controversial. The objective of the present meta-analysis was to analyze efficacy and safety of postoperative CRT and establish a consensus on whether it is suitable for the patients. METHODS We searched PubMed, Ovid, Cochrane, and Web of Science. Statistical analysis was carried out by STATA version 12.0 software. The quality of evidence was assessed by Jadad and the Newcastle-Ottawa quality assessment scale. RESULTS Six studies involving 2135 patients were included for the meta-analysis. The results showed that, compared with non-CRT, postoperative adjuvant CRT was associated with a significant improvement in 5-year overall survival (OS) (HR = 0.79, 95% CI 0.68-0.92, P = 0.002) and 5-year relapse-free survival (RFS) (HR = 0.81, 95% CI 0.70-0.93, P = 0.004). However, there were no differences in distant metastasis (RR = 0.93, 95% CI 0.82-1.06, P = 0.304) and treatment-related toxicity between the two groups. CONCLUSIONS From the results of our study, postoperative adjuvant CRT may be associated with longer 5-year OS and 5-year RFS in patients with D2 lymphadenectomy, but might not improve 5-year disease-free survival compared to non-CRT. Methodologically high-quality comparative studies are needed for further evaluation.
Collapse
|
528
|
Mayer RJ, Venook AP, Schilsky RL. Progress against GI cancer during the American Society of Clinical Oncology's first 50 years. J Clin Oncol 2014; 32:1521-30. [PMID: 24752046 DOI: 10.1200/jco.2014.55.4121] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Robert J Mayer
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Alan P Venook
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
529
|
Giuliani A, Miccini M, Basso L. Extent of lymphadenectomy and perioperative therapies: Two open issues in gastric cancer. World J Gastroenterol 2014; 20:3889-3904. [PMID: 24744579 PMCID: PMC3983445 DOI: 10.3748/wjg.v20.i14.3889] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 11/23/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is one of the leading causes of death for cancer worldwide, although geographical variations in incidence exist. Over the last decades, its incidence and mortality have gradually decreased in Western countries, while these have increased, or remained stable, in the other world regions. Gastric cancer is often diagnosed at an advanced stage, with the only notable exception of Japan, where nationwide screening programs are enforced, due to local high incidence. Curative- intent surgery (i.e., gastrectomy, total or partial, and lymphadenectomy) remains the cornerstone of treatment of gastric cancer. Much has been debated about the extent of lymph node dissection and, although it is a valuable contribution to staging and cure, operative treatment only represents one aspect of overall effective management, as the risk of both locoregional and distant recurrences are high, and bear a poor prognosis. As a matter of fact, surgery, as a single modality treatment, has probably achieved its maximum efficacy for local control and survival, while other accompanying nonsurgical treatment modalities have to be taken into account, although their role is still the subject of considerable debate. The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative, intraoperative, and postoperative strategies.
Collapse
|
530
|
Abstract
OPINION STATEMENT To improve outcome of resectable gastric cancer, several treatment strategies have been evaluated. These include adjuvant chemotherapy, adjuvant chemoradiotherapy, and perioperative chemotherapy. The US Intergroup 0116 trial reported the benefit of postoperative chemoradiotherapy using 5-FU/leucovorin in a U.S. population. In this study, only 10 % of patients received D2 resection. For Korean patients after D2 resection, the ARTIST trial failed to show any benefit from adding radiotherapy to adjuvant chemotherapy in terms of 3-year disease-free survival. The MAGIC trial compared perioperative chemotherapy with surgery alone and reported a prolonged 5-year overall survival in the perioperative chemotherapy arm. In resectable gastric cancer, the benefit of adjuvant chemotherapy compared with surgery alone has been clearly demonstrated. After D2 dissection, S-1 adjuvant chemotherapy improved the overall survival (ACTS-GC trial) and capecitabine/oxaliplatin combination chemotherapy improved 3-year disease-free survival (CLASSIC trial). To date, for resectable gastric cancer, the use of chemotherapy in addition to surgery is beneficial for the reduction of recurrence and to improve overall survival. The optimal sequence of chemotherapy and surgery, as well as optimal chemotherapeutic agents, should be further studied. In D2-resected gastric cancer, the addition of radiotherapy to chemotherapy does not appear to provide any additional benefit.].
Collapse
Affiliation(s)
- Do-Youn Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea
| | | |
Collapse
|
531
|
Soyfer V, Geva R, Michelson M, Inbar M, Shacham-Shmueli E, Corn BW. The impact of overall radiotherapy treatment time and delay in initiation of radiotherapy on local control and distant metastases in gastric cancer. Radiat Oncol 2014; 9:81. [PMID: 24655942 PMCID: PMC3994343 DOI: 10.1186/1748-717x-9-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/09/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To study the impact of time factors on local and distant metastases in stomach cancer. METHODS 67 patients with gastric cancer who received adjuvant treatment were reviewed for the time to initiation of radiotherapy, overall duration of RT and the events of first local recurrence or distant metastasis. RESULTS The risk probability of local recurrence is increased by 10% (HR=1.1, p=0.0009) in association with each additional day of radiotherapy and by 3.8% (HR=1.038, p=0.13) per increased day of waiting time before the initiation of RT. The risk probability of distant recurrence was associated with an increase of 7.4% (HR=1.074 p=0.0031) with each additional day of RT time and by 2.3% (HR=1.023, p=0.0598) following the increase of a day of waiting time. Each day of prolongation of RT beyond 36 days was associated with an increased risk of local recurrence by 10% (OR=1.1, p=0.015). Prolongation of waiting time prior to initiation of irradiation retained significance in multivariate analysis. CONCLUSION There is an association between total treatment time and, to some extent, the time between the surgery and the initiation of radiation on local control and distant metastases.
Collapse
|
532
|
Zilberstein B, Malheiros C, Lourenço LG, Kassab P, Jacob CE, Weston AC, Bresciani CJC, Castro O, Gama-Rodrigues J, Borin AA, Buchpiegel C, Montagnini A, Leite CV, Deutsch CR, Kruel CDP, Mucerino D, Wohnrath D, Ilias E, Mrué F, Maluf-Filho F, Rocha F, de Souza F, Tomasich FS, Ishak G, Laporte G, de Souza HP, Cecconello I, Eisig J, Ohana J, Sabagga J, del Grande JC, de Jesus JP, Soares J, Dias LAN, Moreira LF, Correa M, Carvalho M, Andreollo NA, Áquila ND, Czeczko NG, Kruel N, Forones NM, da Motta OM, Malafaia O, Assumpção P, Leonardi P, Sakai P, Rocha PRS, Colleoni R, Gurgel R, Coral RP, Chalub S, Ribeiro- Junior U, Alves VAF, Vasquez VDL, Nadalin V. Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:2-6. [PMID: 23702862 DOI: 10.1590/s0102-67202013000100002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/16/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and staging of the tumor and number of lymph nodes resected and involved. AIM The Brazilian Consensus on Gastric Cancer promoted by ABCG was designed with the intention to issue guidelines that can guide medical professionals to care for patients with this disease. METHODS Were summarized and answered 43 questions reflecting consensus or not on diagnosis and treatment that may be used as guidance for its multidisciplinary approach. The method involved three steps. Initially, 56 digestive surgeons and related medical specialties met to formulate the questions that were sent to participants for answers on scientific evidence and personal experience. Summaries were presented, discussed and voted in plenary in two other meetings. They covered 53 questions involving: diagnosis and staging (six questions); surgical treatment (35 questions); chemotherapy and radiotherapy (seven questions) and anatomopathology, immunohistochemistry and perspective (five questions). It was considered consensus agreement on more than 70% of the votes in each item. RESULTS All the answers were presented and voted upon, and in 42 there was consensus. CONCLUSION It could be developed consensus on most issues that come with the care of patients with gastric cancer and they can be transformed in guidelines.
Collapse
|
533
|
Benefit of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis. Tumour Biol 2014; 35:4957-66. [DOI: 10.1007/s13277-014-1653-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/13/2014] [Indexed: 01/09/2023] Open
|
534
|
Kasper S, Schuler M. Targeted therapies in gastroesophageal cancer. Eur J Cancer 2014; 50:1247-58. [PMID: 24495747 DOI: 10.1016/j.ejca.2014.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 02/07/2023]
Abstract
Gastroesophageal cancers comprising gastric cancer (GC), and cancers of the distal oesophagus and gastroesophageal junction (GEJ) are a global health threat. In Western populations the incidence of GC is declining which has been attributed to effective strategies of eradicating Helicobacter pylori infection. To the contrary, GEJ cancers are on the rise, with obesity and reflux disease being viewed as major risk factors. During the past decade perioperative chemotherapy, pre- or postoperative radio-chemotherapy, and, in Asian populations, adjuvant chemotherapy have been shown to improve the outcome of patients with advanced GC and GEJ cancers suited for surgery. Less progress has been made in the treatment of metastatic disease. The introduction of trastuzumab in combination with platinum/fluoropyrimidine-based chemotherapy for patients with HER2-positive disease has marked a turning point. Recently, several novel agents targeting growth factor receptors, angiogenic pathways, adhesion molecules and mediators of intracellular signal transduction have been clinically explored. Here we summarise the current status and future developments of molecularly targeted therapies in GC and GEJ cancer.
Collapse
Affiliation(s)
- Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| |
Collapse
|
535
|
Wang X, Jin J, Li YX, Ren H, Fang H, Wang SL, Liu YP, Wang WH, Yu ZH, Song YW, Liu XF. Phase I study of postoperative radiotherapy combined with capecitabine for gastric cancer. World J Gastroenterol 2014; 20:1067-1073. [PMID: 24574780 PMCID: PMC3921531 DOI: 10.3748/wjg.v20.i4.1067] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/14/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) of capecitabine combined with postoperative radiotherapy for gastric cancer.
METHODS: We enrolled patients with any T stage and node-positive gastroesophageal or gastric adenocarcinoma after complete resection with negative margins (R0) or microscopic (R1) or macroscopic (R2) resection. Intensity modulated radiotherapy (IMRT) using a five-to-seven-field, coplanar, sliding window technique was delivered to the tumor bed (T4b), anastomosis site, duodenal stump and regional lymph nodes (LNs) to a total dose of 45 Gy (1.8 Gy/fraction, 5 d/wk). Patients with R1 or R2 resection received 10.8 Gy as a boost. Capecitabine was administered twice daily on every radiotherapy treatment day in a dose-escalation schedule (mg/m2) of 625 (level I, n = 6), 700 (level II, n = 6), 800 (level III, n = 6), 900 (level IV, n = 0) and 1000 (level V, n = 0). DLT was defined as grade 4 leukopenia or neutropenia, grade 3-4 thrombocytopenia or anemia and grade 3-4 non-hematological toxicity.
RESULTS: Between October 2007 and August 2009, 18 patients (12 men, 6 women; median age, 54 years) were enrolled in the study. The median number of positive LNs was 6, and total number of resected LNs was 19. Twelve patients underwent R0 resection (66.7%). Fifteen patients received adjuvant chemotherapy under the leucovorin, fluorouracil and oxaliplatin (FOLFOX4) regimen. Six patients each were enrolled at dose levels I, II and III. Grade 1-3 leukopenia (16 patients, 88.9%), anorexia (15, 83.3%) and nausea (15, 83.3%) were the most common toxicities. Grade 3 anorexia/nausea and grade 4 vomiting occurred in one level-I patient. Grade 3 anorexia and nausea occurred in one level-II patient. One level-III patient developed grade 4 neutropenia, while another developed grade 3 radiation esophagitis. No abnormal liver or renal function examinations were observed. Three patients did not finish chemoradiotherapy because of DLTs and two without DLTs received sequential boosts (total dose, 55.8 Gy).
CONCLUSION: The MTD of capecitabine was 800 mg/m2 twice daily concurrent with IMRT for gastric cancer after surgery. The DLTs were anorexia/nausea, vomiting, neutropenia and radiation esophagitis.
Collapse
|
536
|
Gu L, Liu L, Zhong L, Bai Y, Sui H, Wei X, Zhang W, Huang P, Gao D, Kong Y, Lou G. Cthrc1 overexpression is an independent prognostic marker in gastric cancer. Hum Pathol 2014; 45:1031-8. [PMID: 24746208 DOI: 10.1016/j.humpath.2013.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/21/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
Abstract
Collagen triple helix repeat containing 1 (CTHRC1) was identified as a novel gene expressed in the adventitia and neointima on arterial injury and was found to be overexpressed in several malignant tumors, such as breast cancer and malignant melanoma. However, the expression of Cthrc1 and its role in gastric cancer progression remain unknown. We investigated the expression of the Cthrc1 protein by immunohistochemistry in 30 normal tissues from the control subjects and 166 gastric carcinomas and analyzed its correlation with various clinicopathological features, including patient outcome. Cthrc1 immunoreactivity was overexpressed in gastric carcinoma cases compared with normal tissues (P < .001). High Cthrc1 expression was found in 108 (65.06%) of these 166 carcinomas and was positively correlated with the American Joint Committee on Cancer stage classification, depth of gastric wall invasion, lymph node metastasis, lymphovascular space involvement, and recurrence but not with age, tumor site, and carcinoembryonic antigen level. Patients with high Cthrc1 expression had significantly poorer overall survival and disease-free survival compared with patients with low expression of Cthrc1 (P = .001 and P = .002, respectively). Multivariate analysis showed that high Cthrc1 expression was an independent prognostic factor for both overall survival and disease-free survival of patients with gastric carcinoma (both P = .005). These results showed that high Cthrc1 expression was associated with progression and prognosis of gastric carcinoma.
Collapse
Affiliation(s)
- Lina Gu
- Department of Gynecology, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Lei Liu
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China.
| | - Lili Zhong
- Department of Pathology, The Affiliated First Hospital, Heilongjiang University of Chinese Medicine, Heping Road 24 of Xiangfang District, Harbin, Heilongjiang Province, 150081, China
| | - Yuxian Bai
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Hong Sui
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Xiaoli Wei
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Wenjie Zhang
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Peng Huang
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Dandan Gao
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Ying Kong
- Department of Internal Medicine, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
| | - Ge Lou
- Department of Gynecology, The Affiliated Tumor Hospital, Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China.
| |
Collapse
|
537
|
Hensel F, Timmermann W, von Rahden BHA, Rosenwald A, Brändlein S, Illert B. Ten-year follow-up of a prospective trial for the targeted therapy of gastric cancer with the human monoclonal antibody PAT-SC1. Oncol Rep 2014; 31:1059-66. [PMID: 24452482 PMCID: PMC3926647 DOI: 10.3892/or.2014.2987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/03/2013] [Indexed: 12/18/2022] Open
Abstract
The fully human monoclonal antibody PAT-SC1 is specific for an isoform of CD55 (decay-accelerating factor) designated CD55PAT-SC1. This antigen is expressed in the majority (80%) of gastric cancers (GCs), and the antibody induces tumour cell-specific apoptosis in vitro as well as in vivo. PAT-SC1, therefore, has been deemed promising as a therapeutic agent. Here, we describe the results of an academic clinical study performed in a neoadjuvant setting with resectable GC patients. Patients undergoing treatment for GC between 1997 and 2001 were tested for CD55PAT-SC1 expression. Fifty-one resectable patients that tested positively received a single administration of 20 mg PAT-SC1 48 h prior to surgery. They underwent standard surgery with either subtotal or total gastrectomy with bursectomy, omentectomy and a modified D2-lymphadenectomy, aimed at R0 resection. Primary endpoints of the present study were to evaluate side-effects of the PAT-SC1 antibody treatment and to evaluate histopathological effects such as tumour regression and induction of apoptosis. Long-term survival was a secondary endpoint. Administration of PAT-SC1 appeared safe with only reversible side-effects according to WHO grade I and II. Despite the low-dose of the antibody, 81.6% of the patients showed signs of increased apoptosis within the primary tumour and 60% showed signs of tumour cell regression. Comparison of the 10-year survival rates of the R0-resected CD55PAT-SC1-positive patients treated with the PAT-SC1 antibody with a historical collective of R0-resected CD55PAT-SC1-positive patients not treated with PAT-SC1 indicated a survival benefit in the treated patients. Furthermore, comparison of the patient survival of CD55PAT-SC1-positive vs. CD55PAT-SC1-negative groups suggested that CD55PAT-SC1 antigen expression is an independent predictor of poor survival in a Cox regression analysis. Antibody PAT-SC1 may be a useful additive therapeutic agent in the treatment of patients with CD55PAT-SC1-expressing GCs. In combination with radical standard surgery, PAT-SC1 given as an adjuvant or neoadjuvant immunotherapeutic agent induces apoptosis in tumour cells which may improve survival of these patients. Because of the human origin and its specific binding to the CD55PAT-SC1 antigen, PAT-SC1 was well tolerated in this trial.
Collapse
Affiliation(s)
| | | | - Burkhard H A von Rahden
- Department of General, Visceral, Vascular and Pediatric Surgery, University of Würzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stephanie Brändlein
- Institute of Pathology, University Hospital, University of Würzburg, Würzburg, Germany
| | | |
Collapse
|
538
|
Min C, Bangalore S, Jhawar S, Guo Y, Nicholson J, Formenti SC, Leichman LP, Du KL. Chemoradiation therapy versus chemotherapy alone for gastric cancer after R0 surgical resection: a meta-analysis of randomized trials. Oncology 2014; 86:79-85. [PMID: 24435019 DOI: 10.1159/000354641] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/19/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Current national guidelines include category 1 recommendations for perioperative chemotherapy or adjuvant chemoradiation with surgical resection for patients with stage IB-IIIB gastric cancer. We conducted a meta-analysis of randomized trials in which chemotherapy was prospectively tested against chemoradiation with surgical resection. METHODS We electronically searched PubMed and EMBASE for randomized, controlled clinical trials involving patients with gastric adenocarcinoma, status post-R0 resection. The interventions compared were adjuvant chemotherapy versus chemoradiation, with any chemotherapy regimen. The primary outcomes of interest were disease-free survival and overall survival. The Mantel-Haenszel random-effects model was used to calculate effect sizes. RESULTS Six trials that included 1,171 patients were evaluated; 599 were randomized to adjuvant chemoradiation and 572 to chemotherapy alone. Chemoradiation was associated with a significant increase in disease-free survival (odds ratio 1.48, 95% confidence interval 1.08-2.03) when compared to chemotherapy alone. However, there was no significant difference in overall survival (odds ratio 1.27, 95% confidence interval 0.95-1.71). Five trials found no statistically significant differences in toxicities between the two groups. CONCLUSION In patients with gastric cancer status post-R0 resection, adjuvant chemoradiation was associated with higher disease-free survival when compared to chemotherapy alone. It remains appropriate to design trials testing new systemic agents with radiotherapy.
Collapse
Affiliation(s)
- Christine Min
- New York University School of Medicine, New York, N.Y. USA
| | | | | | | | | | | | | | | |
Collapse
|
539
|
Michel P, Breysacher G, Mornex F, Seitz JF, Pere-Verge D, Martel-Lafay I, Faroux R, Chapet S, Sobhani I, Pezet D, Aparicio T, Nguyen S, Dousset B, Jouve JL, Maillard E. Feasibility of preoperative and postoperative chemoradiotherapy in gastric adenocarcinoma. Two phase II studies done in parallel. Fédération Francophone de Cancérologie Digestive 0308. Eur J Cancer 2014; 50:1076-83. [PMID: 24433843 DOI: 10.1016/j.ejca.2013.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND For resectable gastric cancer, both postoperative chemoradiotherapy and perioperative chemotherapy demonstrate high-level evidence for improved survival in Western populations. To evaluate the feasibility of pre- or postoperative chemoradiotherapy, we proposed two multicentre phase II studies. PATIENTS AND METHODS Patients with localised, histologically confirmed gastric cancer and Eastern Cooperative Oncology Group (ECOG) performance status <2 judged suitable for curative resection were eligible. Eligible patients were assigned to either preoperative chemoradiotherapy followed by surgical resection or surgical resection followed by chemoradiotherapy depending on each centre. Chemoradiotherapy regimen included four courses of FOLFIRI (5 Fluorouracil, Leucovorin, Irinotecan) regimen then Concurrent fluorouracil at 200 mg/m2/d by continuous infusion 5 days each week. A dose of 50 Gy in 25 fractions in the preoperative study, or 45 Gy in 25 fractions in the postoperative study, was delivered. The primary end-point for both studies was the proportion of patients, who completed the therapeutic sequence. RESULTS Between September 2007 and January 2010, 63 patients were included in both studies. The postoperative study was stopped for futility at the first step. In the preoperative study, 31 patients (73.8%, confidence interval (CI) 95%: 65.8-90.1%) received complete therapeutic sequence. Serum albumin and dietary restriction evaluated by QLQ-STO22 (Quality of Life-Stomach module) score were significantly linked with chemoradiotherapy feasibility in univariate analysis with respectively Odds-ratio (OR) 1.16 [CI 95%: 1.01-1.33] and 0.17 [0.03-0.89], p=0.04. Median overall survival time was 26.4 months in the preoperative study. CONCLUSION Feasibility of chemoradiotherapy was not achieved for these studies: 73.8% (CI 95%: 65.8-90.1) and 42.9% (CI 95%: 21.8-66%) in preoperative and postoperative settings respectively.
Collapse
Affiliation(s)
- Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, University of Rouen, 1 rue de Germont, 76031 Rouen, France.
| | | | | | | | | | | | | | | | - Iradj Sobhani
- Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Creteil, France
| | - Denis Pezet
- Centre Hospitalo-Universitaire, Clermont Ferrand, France
| | - Thomas Aparicio
- Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Bichat, France
| | | | - Bertrand Dousset
- Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Cochin, France
| | | | | |
Collapse
|
540
|
Mamon HJ, Tepper JE. Combination chemoradiation therapy: the whole is more than the sum of the parts. J Clin Oncol 2014; 32:367-9. [PMID: 24419110 DOI: 10.1200/jco.2013.54.3108] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Harvey J Mamon
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
| | | |
Collapse
|
541
|
Chemotherapeutic and targeted strategies for locally advanced and metastatic esophageal cancer. J Thorac Oncol 2014; 8:673-84. [PMID: 23591158 DOI: 10.1097/jto.0b013e31828b5172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION : Esophageal cancer represents a major health care problem worldwide and its prevalence is rapidly increasing. A key challenge in the treatment of both locally advanced and metastatic disease is to improve our understanding of the underlying molecular biology. Herein we discuss the most active chemotherapies and targeted agents for esophageal cancer, and explore potential differences in the disease between Eastern and Western countries. METHODS : We reviewed the literature for trials involving chemotherapy and targeted agents in locally advanced and metastatic disease in the last 20 years. The search was supplemented by a review of the abstracts presented at the annual American Society of Clinical Oncology meetings from 1992 to 2012. RESULTS : Neoadjuvant chemo-radiation followed by surgery remains standard of care for operable disease. Definitive chemo-radiation can be considered for locally advanced squamous cell tumors. Platinum-based combination chemotherapy is preferable in the first-line metastatic setting. Recently, HER2, EGFR, and VEGF-targeted agents have been extensively investigated as single agents or in combination with chemotherapy. Several new targets are being explored. CONCLUSIONS : There have been incremental improvements in our understanding of the molecular biology of esophageal cancer, and ethnic differences between Asian and Western populations are becoming apparent. Next-generation sequencing has failed to demonstrate significant oncogenic drivers; however, the addition of trastuzumab to chemotherapy for HER2-amplified tumors has been validated in the metastatic setting and is undergoing investigation in operable disease. Epigenetic therapeutics may provide additional benefit in future years for this difficult-to-treat disease.
Collapse
|
542
|
Matsuda S, Takahashi T, Fukada J, Fukuda K, Kawakubo H, Saikawa Y, Kawaguchi O, Takeuchi H, Shigematsu N, Kitagawa Y. Phase I study of neoadjuvant chemoradiotherapy with S-1 plus biweekly cisplatin for advanced gastric cancer patients with lymph node metastasis: -KOGC04-. Radiat Oncol 2014; 9:9. [PMID: 24398302 PMCID: PMC3904203 DOI: 10.1186/1748-717x-9-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/23/2013] [Indexed: 12/25/2022] Open
Abstract
Background In patients with highly advanced gastric cancer, the recurrence rate remains high and the prognosis disappointing. We previously reported a phase I study of a neoadjuvant chemoradiotherapy of S-1 plus weekly cisplatin. Although adequate safety and efficacy were reported, myelosuppression was frequently observed, leading to treatment delay in several cases. To decrease toxicity and improve efficacy, we planned a phase I study with a modified chemotherapy regimen with biweekly cisplatin. Methods Patients with advanced gastric cancer and lymph node metastasis who were treated by our institution between 2011 and 2012 were eligible for inclusion. The initial chemoradiotherapy schedule consisted of 6 weeks of S-1 orally administered on days 1–15 with an escalating dose of cisplatin administered on days 1 and 15. The starting dose (level 1) of cisplatin was 15 mg/m2, the second dose (level 2) was 20 mg/m2, and the third dose (level 3) was 25 mg/m2. Radiation of 40 Gy was administered in 20 fractions. After initial chemoradiotherapy, one cycle of combination chemotherapy with S-1 plus cisplatin was delivered. The second cycle was 42 days in duration and included S-1 administered on days 1–29 plus biweekly cisplatin administered on days 1, 15, and 29. After neoadjuvant treatment, a curative gastrectomy with extended (D2) lymph node dissection was planned. Results Nine patients were enrolled. At level 3, one patient had dose-limiting grade 3 diarrhea. Another patient experienced grade 3 nausea and intended to discontinue the treatment. Overall, because 2 of 3 patients experienced dose-limiting toxicity at level 3, we confirmed level 3 (Cisplatin 25 mg/m2) as the maximum tolerated dose and level 2 (Cisplatin 20 mg/m2) as the recommended dose (RD). The response rate was 78%, and 8 patients underwent curative gastrectomy. Resected specimens showed a histological response in 6 patients (75%), including one with a pathological complete response. Conclusions In this phase I trial, RD of cisplatin was identified as 20 mg/m2. Generally, S-1 plus biweekly cisplatin can be given safely with concurrent radiation. We have initiated a multicenter phase II trial to further confirm the efficacy and safety of this approach. Trial registration UMIN000008941
Collapse
Affiliation(s)
| | - Tsunehiro Takahashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
543
|
Dikken JL, Coit DG, Baser RE, Gönen M, Goodman KA, Brennan MF, Jansen EPM, Boot H, van de Velde CJH, Cats A, Verheij M. Performance of a nomogram predicting disease-specific survival after an R0 resection for gastric cancer in patients receiving postoperative chemoradiation therapy. Int J Radiat Oncol Biol Phys 2014; 88:624-9. [PMID: 24411620 DOI: 10.1016/j.ijrobp.2013.11.213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/20/2013] [Accepted: 11/09/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE The internationally validated Memorial Sloan-Kettering Cancer Center (MSKCC) gastric carcinoma nomogram was based on patients who underwent curative (R0) gastrectomy, without any other therapy. The purpose of the current study was to assess the performance of this gastric cancer nomogram in patients who received chemoradiation therapy after an R0 resection for gastric cancer. METHODS AND MATERIALS In a combined dataset of 76 patients from the Netherlands Cancer Institute (NKI), and 63 patients from MSKCC, who received postoperative chemoradiation therapy (CRT) after an R0 gastrectomy, the nomogram was validated by means of the concordance index (CI) and a calibration plot. RESULTS The concordance index for the nomogram was 0.64, which was lower than the CI of the nomogram for patients who received no adjuvant therapy (0.80). In the calibration plot, observed survival was approximately 20% higher than the nomogram-predicted survival for patients receiving postoperative CRT. CONCLUSIONS The MSKCC gastric carcinoma nomogram significantly underpredicted survival for patients in the current study, suggesting an impact of postoperative CRT on survival in patients who underwent an R0 resection for gastric cancer, which has been demonstrated by randomized controlled trials. This analysis stresses the need for updating nomograms with the incorporation of multimodal strategies.
Collapse
Affiliation(s)
- Johan L Dikken
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Karyn A Goodman
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edwin P M Jansen
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Henk Boot
- Department of Gastroenterology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Annemieke Cats
- Department of Gastroenterology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marcel Verheij
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| |
Collapse
|
544
|
Gastric cancer†: ESMO–ESSO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Radiother Oncol 2014; 110:189-94. [DOI: 10.1016/j.radonc.2013.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/21/2013] [Indexed: 01/30/2023]
|
545
|
The Impact of Preoperative Radiochemotherapy on Survival in Advanced Esophagogastric Junction Signet Ring Cell Adenocarcinoma. Ann Thorac Surg 2014; 97:303-10. [DOI: 10.1016/j.athoracsur.2013.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/25/2013] [Accepted: 09/04/2013] [Indexed: 12/15/2022]
|
546
|
Shen L, Shan YS, Hu HM, Price TJ, Sirohi B, Yeh KH, Yang YH, Sano T, Yang HK, Zhang X, Park SR, Fujii M, Kang YK, Chen LT. Management of gastric cancer in Asia: resource-stratified guidelines. Lancet Oncol 2013; 14:e535-47. [PMID: 24176572 DOI: 10.1016/s1470-2045(13)70436-4] [Citation(s) in RCA: 363] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gastric cancer is the fourth most common cancer globally, and is the second most common cause of death from cancer worldwide. About three-quarters of newly diagnosed cases in 2008 were from Asian countries. With a high mortality-to-incidence ratio, management of gastric cancer is challenging. We discuss evidence for optimum management of gastric cancer in aspects of screening and early detection, diagnosis, and staging; endoscopic and surgical intervention; and the concepts of perioperative, postoperative, and palliative chemotherapy and use of molecularly targeted therapy. Recommendations are formulated on the basis of the framework provided by the Breast Health Global Initiative, using the categories of basic, limited, enhanced, and maximum level. We aim to provide a stepwise strategy for management of gastric cancer applicable to different levels of health-care resources in Asian countries.
Collapse
Affiliation(s)
- Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
547
|
Isolated ovarian metastasis of gastric cancer: Krukenberg tumor. Contemp Oncol (Pozn) 2013; 17:515-9. [PMID: 24592139 PMCID: PMC3934036 DOI: 10.5114/wo.2013.37542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 04/17/2013] [Accepted: 05/08/2013] [Indexed: 01/31/2023] Open
Abstract
Introduction Gastric cancer, one of the most common cancers in the world, rarely metastasizes to the ovaries. Ovarian metastases of gastric signet ring cell cancer (SRCC) are referred to as Krukenberg tumors and account for 1–2% of all ovarian cancers. Here, we analyze the characteristics, treatment, and prognosis of patients with Krukenberg tumors. Material and methods We retrospectively analyzed the demographic characteristics, treatment modalities, progression-free survival (PFS), and overall survival (OS) of patients who were diagnosed with Krukenberg tumors of gastric cancer origin and who underwent treatment and follow-up between January 2005 and January 2012 in the Ankara Oncology Education and Research Hospital. Results Among 1755 patients diagnosed with gastric cancer between January 2005 and January 2012, eight patients (0.45%) with histopathologically identified Krukenberg tumors were enrolled. The median age of the eight patients was 42.2 years (range, 32–69 years). Two (25%) of the patients were stage 3A, two (25%) were stage 3C, and four (50%) were stage 4 at the time of diagnosis. The median PFS was 13.2 months (1–25 months), the median OS after the original diagnosis was 16.7 months (1–41 months), and the median OS after ovarian metastasis was 3.6 months (1–10 months). Discussion Krukenberg tumors were seen particularly in young patients and more frequently during the premenopausal period. The prognosis was poor. When only the ovaries were affected, metastasectomy prolonged the survival time.
Collapse
|
548
|
Stiekema J, Trip AK, Jansen EPM, Boot H, Cats A, Ponz OB, Verheij M, van Sandick JW. The Prognostic Significance of an R1 Resection in Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy. Ann Surg Oncol 2013; 21:1107-14. [DOI: 10.1245/s10434-013-3397-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Indexed: 12/19/2022]
|
549
|
Aggarwal A, Chopra S, Paul SN, Engineer R, Srivastava SK. Evaluation of internal target volume in patients undergoing image-guided intensity modulated adjuvant radiation for gastric cancers. Br J Radiol 2013; 87:20130583. [PMID: 24288401 DOI: 10.1259/bjr.20130583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate three-dimensional (3D) displacements of gastric remnant during adjuvant radiation. METHODS From January 2011 to September 2012, patients undergoing adjuvant image-guided intensity-modulated radiation on tomotherapy were included. Megavoltage CT (MVCT) data sets from daily treatment were coregistered with Day 1 MVCT. Residual stomach remnant was delineated on the data set, while the remaining were blinded to previous day contours. Gastric volume and centre of mass (COM) were determined for all data sets. The 3D deviation of COM was calculated for each fraction. Mean 3D and standard deviation (SD) were calculated for each patient and study population, and a 95% confidence interval (CI) was determined. Also, systematic and random errors for patient population and internal target volume (ITV) margin were calculated using the van Herk formula. RESULTS There were 119 images available for 15 patients. Mean volume of remnant was 319 cm(3) (146-454 cm(3)). Gastric remnant expanded in different directions with no specific directional expansion. Average deviations in mediolateral, superoinferior and anteroposterior directions were 9 mm (3-25 mm; SD, 5 mm), 6 mm (3-16 mm; SD, 4 mm) and 5 mm (1-10 mm; SD, 3 mm), respectively, with 95% CI of 18, 15 and 11 mm, and ITV margins of 19.2, 13.5 and 7.8 mm, respectively. CONCLUSION There is large variation in gastric remnant volume during the course of radiation. Large displacements observed in the present study necessitate the need to investigate adaptive techniques for optimizing intensity-modulated radiotherapy (IMRT) delivery. ADVANCES IN KNOWLEDGE An adaptive strategy needs to be developed to optimize IMRT delivery for adjuvant gastric irradiation.
Collapse
Affiliation(s)
- A Aggarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
| | | | | | | | | |
Collapse
|
550
|
Bittoni A, Scartozzi M, Giampieri R, Faloppi L, Bianconi M, Mandolesi A, Prete MD, Pistelli M, Cecchini L, Bearzi I, Cascinu S. Clinical evidence for three distinct gastric cancer subtypes: time for a new approach. PLoS One 2013; 8:e78544. [PMID: 24265697 PMCID: PMC3827058 DOI: 10.1371/journal.pone.0078544] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/19/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recently, a new classification for gastric cancer (GC) has been proposed, based on Lauren's histology and on anatomic tumour location, identifying three subtypes of disease: type 1 (proximal non diffuse GC), type 2 (diffuse GC) and type 3 (distal non diffuse GC). Aim of our analysis was to compare clinical outcome according to different GC subtypes (1,2,3) in metastatic GC patients receiving first-line chemotherapy. PATIENTS AND METHODS Advanced GC pts treated with a first-line combination chemotherapy were included in our analysis. Pts were divided in three subgroups (type 1, type 2 and type 3) as previously defined. RESULTS A total of 248 advanced GC pts were included: 45.2% belonged to type 2, 43.6% to type 3 and 11.2% to type 1. Patients received a fluoropyrimidine-based chemotherapy doublet or three drugs regimens including a platinum derivate and a fluoropyrimidine with the addition of an anthracycline, a taxane or mytomicin C. RR was higher in type 1 pts (RR = 46.1%) and type 3 (34,3%) compared to type 2 (20,4%), (p = 0.015). Type 2 presented a shorter PFS, median PFS = 4.2 months, compared to type 1, mPFS = 7.2 months, and type 3, mPFS = 5.9 months (p = 0.011) and also a shorter OS (p = 0.022). CONCLUSIONS Our analysis suggests that GC subtypes may be important predictors of benefit from chemotherapy in advanced GC patients. Future clinical trials should take in account these differences for a better stratification of patients.
Collapse
Affiliation(s)
- Alessandro Bittoni
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Mario Scartozzi
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
- * E-mail:
| | - Riccardo Giampieri
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Luca Faloppi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy
| | - Maristella Bianconi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Mandolesi
- Anatomia Patologica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Michela Del Prete
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy
| | - Mirco Pistelli
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Luca Cecchini
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Italo Bearzi
- Anatomia Patologica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| |
Collapse
|