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Chidambaram S, Sounderajah V, Maynard N, Owen R, Markar SR. Evaluation of tumor regression by neoadjuvant chemotherapy regimens for esophageal adenocarcinoma: a systematic review and meta-analysis. Dis Esophagus 2022; 36:6712698. [PMID: 36151055 PMCID: PMC9885734 DOI: 10.1093/dote/doac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/31/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
Locally advanced esophageal adenocarcinomas (EACs) are treated with multimodal therapy, namely surgery, neoadjuvant chemotherapy (NAC) or chemoradiotherapy (CRT) depending on patient and tumor level factors. Yet, there is little consensus on choice of the optimum systemic therapy. To compare the pathological complete response (pCR) after FLOT, non-FLOT-based chemotherapy and chemoradiotherapy regimes in patients with EACs. A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. Studies were included if they had investigated the use of chemo(radio)therapy regimens in the neoadjuvant setting for EAC and reported the pCR rates. A meta-analysis of proportions was performed to compare the pooled pCR rates between FLOT, non-FLOT and CRT cohorts. We included 22 studies that described tumor regression post-NAC. Altogether, 1,056 patients had undergone FLOT or DCF regimes, while 1,610 patients had received ECF or ECX. The pCR rates ranged from 3.3% to 54% for FLOT regimes, while pCR ranged between 0% and 31% for ECF/ECX protocols. Pooled random-effects meta-meta-analysis of proportions showed a statistically significant higher incidence of pCR in FLOT-based chemotherapy at 0.148 (95%CI: 0.080, 0.259) compared with non-FLOT-based chemotherapy at 0.074 (95%CI: 0.042, 0.129). However, pCR rates were significantly highest at 0.250 (95%CI: 0.202, 0.306) for CRT. The use of enhanced FLOT-based regimens have improved the pCR rates for chemotherapeutic regimes but still falls short of pathological outcomes from CRT. Further work can characterize clinical responses to neoadjuvant therapy and determine whether an organ-preservation strategy is feasible.
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Affiliation(s)
| | | | - Nick Maynard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Richard Owen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sheraz R Markar
- Address correspondence to: Mr Sheraz R. Markar MBChB, PhD (Imperial), PhD (Karolinska), FRCS, Department of Surgery, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
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Sugimura K, Yamasaki M, Yasuda T, Yano M, Hirao M, Fujitani K, Kimura Y, Miyata H, Motoori M, Takeno A, Shiraishi O, Makino T, Kii T, Tanaka K, Satoh T, Mori M, Doki Y. Long-term results of a randomized controlled trial comparing neoadjuvant Adriamycin, cisplatin, and 5-fluorouracil vs docetaxel, cisplatin, and 5-fluorouracil followed by surgery for esophageal cancer (OGSG1003). Ann Gastroenterol Surg 2021; 5:75-82. [PMID: 33532683 PMCID: PMC7832970 DOI: 10.1002/ags3.12388] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/06/2020] [Accepted: 07/24/2020] [Indexed: 12/24/2022] Open
Abstract
AIM The aim is to report the long-term outcomes of preoperative cisplatin and fluorouracil plus docetaxel (DCF) vs Adriamycin (ACF) for resectable esophageal squamous cell carcinoma (ESCC). Previously, this trial showed that DCF is associated with prolonged recurrence-free survival (RFS). METHODS Patients were randomly assigned to two cycles of ACF (35 mg/m2 of Adriamycin, 70 mg/m2 of cisplatin intravenously on day 1, and 700 mg/m2 of fluorouracil infusion for 7 days) every 4 weeks or DCF (70 mg/m2 of docetaxel, 70 mg/m2 of cisplatin intravenously on day 1, and 700 mg/m2 of fluorouracil infusion for 5 days) every 3 weeks, followed by surgery. The primary endpoint was RFS. The secondary endpoint was overall survival (OS). RESULTS Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, 162 of whom were eligible and randomly assigned to the two groups. The median follow-up for surviving patients was 69.8 months. The 5-year RFS was significantly better in the DCF group than in the ACF group (59.9% vs 40.7%, hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.35-0.86; P = .009) and the 5-year OS was significantly better in the DCF group than in the ACF group (63.5% vs 49.4%, HR, 0.61; 95% CI, 0.38-0.96; P = .03). The benefit of DCF chemotherapy on survival was significantly greater in the subgroups with more advanced clinical T and N stage. CONCLUSIONS Cisplatin and fluorouracil plus docetaxel are associated with better RFS and OS than ACF in resectable ESCC patients.
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Affiliation(s)
- Keijiro Sugimura
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Makoto Yamasaki
- Departments of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Takushi Yasuda
- Department of SurgeryKinki University Faculty of MedicineOsaka SayamaOsakaJapan
| | - Masahiko Yano
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Motohiro Hirao
- Department of SurgeryNational Hospital OrganizationOsaka National HospitalOsakaJapan
| | | | - Yutaka Kimura
- Department of SurgeryKinki University Faculty of MedicineOsaka SayamaOsakaJapan
| | - Hiroshi Miyata
- Department of SurgeryOsaka International Cancer InstituteOsakaJapan
| | | | | | - Osamu Shiraishi
- Department of SurgeryKinki University Faculty of MedicineOsaka SayamaOsakaJapan
| | - Tomoki Makino
- Departments of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Takayuki Kii
- Cancer Chemotherapy CenterOsaka Medical College HospitalOsakaJapan
| | - Koji Tanaka
- Departments of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Taro Satoh
- Department of Frontier Science for Cancer and ChemotherapyOsaka University Graduate School of MedicineSuitaJapan
| | - Masaki Mori
- Department of Surgery and ScienceGraduate School of Medical SciencesKyusyu UniversityFukuokaJapan
| | - Yuichiro Doki
- Departments of Gastroenterological SurgeryGraduate School of MedicineOsaka UniversitySuitaJapan
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Sakin A, Sahin S, Sakin A, Aldemir MN, Bayram I, Kotan C. The Effect of Obesity on Response to Neoadjuvant Therapy in Locally Advanced Gastric Cancer. Asian Pac J Cancer Prev 2020; 21:2723-2731. [PMID: 32986374 PMCID: PMC7779463 DOI: 10.31557/apjcp.2020.21.9.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: The effect of obesity on response to neoadjuvant chemotherapy (NACT) remains unknown. We aimed to investigate the effect of obesity on response to NACT and survival in locally-advanced gastric cancer (GC). Methods: From 2010 to 2019, 142 GC patients with clinical stage III disease who underwent curative surgery after NACT were enrolled. Patients were divided into 3 groups according to body mass index (BMI) as follows; BMI < 25 kg/m2, BMI = 25-30 kg/m2, and BMI > 30 kg/m2. The Mandard tumor regression grading system was used for tumor regression grade (TRG). Results: Of the 142 GC patients, 45(31.7%) were female. The median age was 58 years. BMI was < 25 kg/m2 in 60 (42.3%) patients, 25-30 kg/m2 in 44 (31%) patients, and > 30kg/m2 in 38 (26.8%) patients. The numbers of patients with TRGI-II, TRGIII, and TRGIV-V were 35 (24.6%), 44 (31%), and 63 (44.4%), respectively. There was no statistically significant difference among BMI groups in terms of disease-free survival (DFS) and overall survival (OS) (p = 0.919 and p = 0.398, respectively). According to TRG groups; mDFS was 46 months in TRG I-II, 28 months in TRG III, and 18 months in TRG IV-V (p<0.001). In multivariate analysis, presence of perineural invasion and lymphovascular invasion were the factors affecting TRG. Conclusion: In our study, we found that pre-treatment obesity did not affect the TRG in clinical stage III GC patients. However, a better TRG status was associated with improved survival.
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Affiliation(s)
- Aysegul Sakin
- Department of Internal medicine, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Suleyman Sahin
- Department of Medical Oncology, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Mehmet Naci Aldemir
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Irfan Bayram
- Department of Pathology, Yuzuncu Yil University Medical School, 65030, Van, Turkey
| | - Cetin Kotan
- Department of General surgery, Yuzuncu Yil University Medical School, 65030, Van, Turkey
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Wang XZ, Zeng ZY, Ye X, Sun J, Zhang ZM, Kang WM. Interpretation of the development of neoadjuvant therapy for gastric cancer based on the vicissitudes of the NCCN guidelines. World J Gastrointest Oncol 2020; 12:37-53. [PMID: 31966912 PMCID: PMC6960069 DOI: 10.4251/wjgo.v12.i1.37] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/09/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer is one of the most common digestive system tumors in China, and locally advanced gastric cancer (LAGC) accounts for a high proportion of newly diagnosed cases. Although surgery is the main treatment for gastric cancer, surgical excision alone cannot achieve satisfactory outcomes in LAGC patients. Neoadjuvant therapy (NAT) has gradually become the standard treatment for patients with LAGC, and this treatment can not only achieve tumor downstaging and improve surgical rate and the R0 resection rate, but it also significantly improves the long-term prognosis of patients. Peri/preoperative neoadjuvant chemotherapy and preoperative chemoradiotherapy are both recommended according to a large number of studies, and the regimens have also been evolved in the past decades. Since the NCCN guidelines for gastric cancer are one of the most authoritative evidence-based guidelines worldwide, here, we demonstrate the development course and major breakthroughs of NAT for gastric cancer based on the vicissitudes of the NCCN guidelines from 2007 to 2019, and also discuss the future of NAT.
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Affiliation(s)
- Xian-Ze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zi-Mu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Wei-Ming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Hu SB, Liu CH, Wang X, Dong YW, Zhao L, Liu HF, Cao Y, Zhong DR, Liu W, Li YL, Gao WS, Bai CM, Shang ZH, Li XY. Pathological evaluation of neoadjuvant chemotherapy in advanced gastric cancer. World J Surg Oncol 2019; 17:3. [PMID: 30606195 PMCID: PMC6317221 DOI: 10.1186/s12957-018-1534-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023] Open
Abstract
Background Although pathological evaluation has been considered an effective evaluation method, some problems still exist in practice. Therefore, we explored whether there are more reasonable and practical pathological evaluation criteria for neoadjuvant chemotherapy in patients with advanced gastric cancer. Here, we aim to determine pathological judgment criteria for neoadjuvant chemotherapy in patients with advanced gastric cancer. Methods Eighty-seven patients with cT2–4 or cN+ were enrolled in this study. Pathological factors for overall survival (OS) were investigated using univariate and multivariate analyses, and the pathological criteria for neoadjuvant chemotherapy were then determined. Results A total of 87 patients underwent 3–4 cycles of neoadjuvant chemotherapy, with 67 (77.0%), 15 (17.2%), and 5 (5.8%) receiving Folfox6, Xelox, and SOX regimens, respectively. All patients showed different levels of graded histological regression (GHR) of the primary tumor, with a ≥ 50% regression rate of 50.6%. The univariate analysis showed that GHR ≥ 50% (p = 0.022), 66.7% (p = 0.013), and 90% (p = 0.028) were significantly correlated with OS. The multivariate analysis demonstrated that ypTNM (II/III) stage was significantly associated with OS compared with ypTNM (0+I) stage [HR = 3.553, 95% CI 1.886–6.617; HR = 3.576, 95% CI 1.908–6.703, respectively] and that the Lauren classification of diffuse type was also an independent risk factor for OS compared with the intestinal type (HR = 3.843, 95% CI 1.443–10.237). Conclusions The Lauren classification and ypTNM stage after neoadjuvant chemotherapy are independent prognostic factors in advanced gastric cancer. A GHR ≥ 50%/< 50% can be used as the primary criterion for advanced gastric cancer after neoadjuvant chemotherapy to determine postoperative adjuvant chemotherapy regimens.
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Affiliation(s)
- Shen-Bao Hu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Chun-Hao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiang Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yun-Wei Dong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hong-Feng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ding-Rong Zhong
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yan-Long Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Wei-Sheng Gao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Chun-Mei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zhong-Hua Shang
- Department of General Surgery, Second Clinical Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiao-Yi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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Mancino G, Bozzetti F, Schicchi A, Schiavo M, Spinelli P, Andreola S. Preoperative Endoscopic Ultrasonography in Patients with Gastric Cancer. TUMORI JOURNAL 2018; 86:139-41. [PMID: 10855851 DOI: 10.1177/030089160008600206] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background There is a need to assess the accuracy of endoscopic ultrasonography (EUS) in the diagnosis and staging of gastric cancer, especially in the early and very advanced stages of the disease when the therapeutic approach is still controversial. Methods A retrospective study was performed on 79 patients with gastric cancer in order to compare the stage defined by preoperative EUS with that assessed histopathologically. All patients underwent laparotomy for final diagnosis, staging, and eventually treatment. The results of EUS were correlated with the histologic findings of the resected specimens. Results In the uT1 group, which corresponds to early gastric cancer, the diagnosis was histologically confirmed in 85.7% of the cases. In patients with advanced tumors defined as uT3-uT4, i.e., tumors infiltrating the serosa or neighboring structures, the diagnostic concordance was 91.1%. In contrast, concordance for less advanced lesions confined to the muscular layer was only 31.2%. As regards the lymph nodes, they were defined metastatic in 31 patients and confirmed to be histologically involved in 77.4%. In contrast, when the lymph nodes were assessed as negative at EUS, they proved to be metastatic in more than half the cases. Conclusions From the data it appears that EUS has proven to be valuable in correctly staging most of the patients. EUS shows not only tumor depth and local spread but also the passage from a pathologic to a normal wall and lymph node metastasis. EUS appears to represent an important advance in the staging and follow-up of patients with gastric cancer. Instruments and techniques will continue to evolve, but the next level of research should be designed to show that the improved staging provided by EUS has clinical utility and can affect patient outcome. It is noteworthy that the highest accuracy of EUS has been shown in those conditions (uT1 and uT3-4) which currently are under consideration for a therapeutic approach that differs from the standard one.
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Affiliation(s)
- G Mancino
- Centro Riferimento Oncologico della Basilicata, Rionero in Vulture PZ, Milan, Italy
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Yamasaki M, Yasuda T, Yano M, Hirao M, Kobayashi K, Fujitani K, Tamura S, Kimura Y, Miyata H, Motoori M, Shiraishi O, Makino T, Satoh T, Mori M, Doki Y. Multicenter randomized phase II study of cisplatin and fluorouracil plus docetaxel (DCF) compared with cisplatin and fluorouracil plus Adriamycin (ACF) as preoperative chemotherapy for resectable esophageal squamous cell carcinoma (OGSG1003). Ann Oncol 2017; 28:116-120. [PMID: 27687307 DOI: 10.1093/annonc/mdw439] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This phase II trial evaluated the efficacy of cisplatin and fluorouracil (CF)-based combination neoadjuvant chemotherapy on the outcome of patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). We compared the recurrence-free survival (RFS) associated with CF plus Adriamycin (ACF) with that associated with CF plus docetaxel (DCF) to select an alternative regimen in a new phase III trial investigating the optimal neoadjuvant treatment of patients with ESCC. PATIENTS AND METHODS Patients with resectable advanced ESCC were randomly assigned to either ACF (Adriamycin 35 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 7 days) every 4 weeks or DCF (docetaxel 70 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 5 days) every 3 weeks. Surgery was scheduled after completion of two cycles of chemotherapy. The primary end point was RFS, analyzed by the intention-to-treat. RESULTS Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, all of whom were eligible and randomly assigned to the two groups (81 to the ACF group and 81 to the DCF group). The R0 resection rates for the ACF and DCF groups were equivalent (95.9% versus 96.2%, P = 0.93). The 2-year RFS and overall survival rates for DCF versus ACF were 64.1% versus 42.9% (hazard ratio 0.53, 95% confidence interval 0.33-0.83, P = 0.0057) and 78.6% versus 65.4% (P = 0.08), respectively. CONCLUSION Compared with ACF, DCF chemotherapy was associated with prolonged RFS for patients with resectable advanced ESCC. Thus, DCF chemotherapy has potential as a standard neoadjuvant therapy for resectable ESCC. CLINICAL TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry of Japan (identification number UMIN000004555/000004616).
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Affiliation(s)
- M Yamasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - T Yasuda
- Department of Surgery, Kinki University School of Medicine, Osaka Sayama, Osaka
| | - M Yano
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka
| | - M Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka
| | - K Kobayashi
- Department of Surgery, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers, Hyogo
| | - K Fujitani
- Department of Surgery, Osaka General Medical Center, Osaka
| | - S Tamura
- Department of Surgery, Kansai Rosai Hospital, Hyogo
| | - Y Kimura
- Department of Gastroenterological Surgery, Nippon Telegraph and Telephone Public Corporation West Osaka Hospital, Osaka
| | - H Miyata
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka
| | - M Motoori
- Department of Surgery, Osaka General Medical Center, Osaka
| | - O Shiraishi
- Department of Surgery, Kinki University School of Medicine, Osaka Sayama, Osaka
| | - T Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - T Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - Y Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
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Biondi A, Lirosi MC, D’Ugo D, Fico V, Ricci R, Santullo F, Rizzuto A, Cananzi FCM, Persiani R. Neo-adjuvant chemo(radio)therapy in gastric cancer: Current status and future perspectives. World J Gastrointest Oncol 2015; 7:389-400. [PMID: 26690252 PMCID: PMC4678386 DOI: 10.4251/wjgo.v7.i12.389] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/03/2015] [Accepted: 10/15/2015] [Indexed: 02/05/2023] Open
Abstract
In the last 20 years, several clinical trials on neoadjuvant chemotherapy and chemo-radiotherapy as a therapeutic approach for locally advanced gastric cancer have been performed. Even if more data are necessary to define the roles of these approaches, the results of preoperative treatments in the combined treatment of gastric adenocarcinoma are encouraging because this approach has led to a higher rate of curative surgical resection. Owing to the results of most recent randomized phase III studies, neoadjuvant chemotherapy for locally advanced resectable gastric cancer has satisfied the determination of level I evidence. Remaining concerns pertain to the choice of the optimal therapy regimen, strict patient selection by accurate pre-operative staging, standardization of surgical procedures, and valid criteria for response evaluation. New well-designed trials will be necessary to find the best therapeutic approach in pre-operative settings and the best way to combine old-generation chemotherapeutic drugs with new-generation molecules.
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Zhang C, Li G, Fan C, Xu J, Cao J, Liu S, Li N. Comparison of efficacy of different route of administration of chemotherapy on unresectable, advanced gastric cancer. World J Surg Oncol 2012; 10:162. [PMID: 22891660 PMCID: PMC3499231 DOI: 10.1186/1477-7819-10-162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/20/2012] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study was to compare the efficacy of two neoadjuvant chemotherapies (FLEEOX and XELOX) with different routes of administration for unresectable gastric cancer. Methods A total of 85 patients with unresectable gastric cancer hospitalized from January 2007 to December 2009 received neoadjuvant chemotherapy. The FLEEOX group (48 patients) received the FLEEOX regimen(fluorouracil, leucovorin,
http://epirubicin, epotoside, and oxaliplatin), which combined arterial with venous administration for one or two cycles, while the XELOX group (37 patients) received XELOX (capecitabine plus oxaliplatin) via venous administration for two to four cycles. The clinical response and overall survival of the two groups were compared. Results In the FLEEOX group, the clinical response rate (RR) of chemotherapy was 85.4% (41 of 48 patients) and the median survival time was 25 months. The 1-year and 2-year disease-free survival (DFS) rates were 85.4% and 45.8%, respectively. In the XELOX group, the clinical RR was 59.5% and the median survival time was 9 months, while the 1-year and 2-year survival rates were 35.2% and 8.3%, respectively. The clinical RR, the R0 resection rate, the median survival time, and the 1-year and 2-year DFS rates were significantly better (P < 0.05) in the FLEEOX group than in the XELOX group. In addition, there were no significant differences in the rates of toxic and adverse reactions or post-operative complications between the two groups. Conclusions For patients with a preoperative diagnosis of unresectable gastric cancer, the efficacy of the FLEEOX regimen, which combines arterial with venous administration, was better than that of the XELOX regimen, using venous administration only. This combination of arterial and venous administration could be useful for improving the efficacy of neoadjuvant chemotherapy for gastric cancer.
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Affiliation(s)
- Caihua Zhang
- Research Institute of General Surgery, Jinling Hospital, Clinical Medicine School of Nanjing University, 305 East Zhongshan Road, Nanjing 210002, China
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Homann N, Pauligk C, Luley K, Werner Kraus T, Bruch HP, Atmaca A, Noack F, Altmannsberger HM, Jäger E, Al-Batran SE. Pathological complete remission in patients with oesophagogastric cancer receiving preoperative 5-fluorouracil, oxaliplatin and docetaxel. Int J Cancer 2011; 130:1706-13. [PMID: 21618509 DOI: 10.1002/ijc.26180] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 03/22/2011] [Indexed: 12/14/2022]
Abstract
The aim of this study was to determine the pathological complete remission (pCR) rate, and its relationship to clinical outcome, in patients with adenocarcinoma of the stomach or oesophagogastric junction receiving preoperative 5-fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) every 2 weeks. Data from these patients who received at least one cycle of preoperative FLOT followed by surgery were prospectively collected in three German centres. Outcome analyses were conducted and tumour samples were evaluated for pathological remission by a central pathologist. A total of 46 patients were included in this analysis. All patients had clinical T3- and/or N+-stages and 11 (23.9%) had distant metastases (M1). After a median of 4 (range 2-8) preoperative cycles, 8 of 46 patients (17.4%) achieved a pCR. The pCR rate was highest in tumours of intestinal type histology (30.8%) and in those located in the oesophagogastric junction (30.4%) and lowest in patients with diffuse/mixed type tumours (0%) or tumours located in the stomach (4.3%; p < 0.05 for both comparisons). Patients with pCR had 100% probability of overall and disease-free survival (DFS) during the observation period, which was significantly higher (p = 0.037 and p = 0.009, respectively) than the survival probability in patients without pCR. In conclusion, treatment intensification using FLOT was associated with significant pCR rates in patients with oesophagogastric cancer. The distribution of pCR appeared to be significantly different according to histological type and location of the tumours.
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Affiliation(s)
- Nils Homann
- Department of Medicine II, Klinikum Wolfsburg, Wolfsburg, Germany
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Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, Genève J, Lasser P, Rougier P. Perioperative Chemotherapy Compared With Surgery Alone for Resectable Gastroesophageal Adenocarcinoma: An FNCLCC and FFCD Multicenter Phase III Trial. J Clin Oncol 2011; 29:1715-21. [PMID: 21444866 DOI: 10.1200/jco.2010.33.0597] [Citation(s) in RCA: 1394] [Impact Index Per Article: 107.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PurposeAfter curative resection, the prognosis of gastroesophageal adenocarcinoma is poor. This phase III trial was designed to evaluate the benefit in overall survival (OS) of perioperative fluorouracil plus cisplatin in resectable gastroesophageal adenocarcinoma.Patients and MethodsOverall, 224 patients with resectable adenocarcinoma of the lower esophagus, gastroesophageal junction (GEJ), or stomach were randomly assigned to either perioperative chemotherapy and surgery (CS group; n = 113) or surgery alone (S group; n = 111). Chemotherapy consisted of two or three preoperative cycles of intravenous cisplatin (100 mg/m2) on day 1, and a continuous intravenous infusion of fluorouracil (800 mg/m2/d) for 5 consecutive days (days 1 to 5) every 28 days and three or four postoperative cycles of the same regimen. The primary end point was OS.ResultsCompared with the S group, the CS group had a better OS (5-year rate 38% v 24%; hazard ratio [HR] for death: 0.69; 95% CI, 0.50 to 0.95; P = .02); and a better disease-free survival (5-year rate: 34% v 19%; HR, 0.65; 95% CI, 0.48 to 0.89; P = .003). In the multivariable analysis, the favorable prognostic factors for survival were perioperative chemotherapy (P = .01) and stomach tumor localization (P < .01). Perioperative chemotherapy significantly improved the curative resection rate (84% v 73%; P = .04). Grade 3 to 4 toxicity occurred in 38% of CS patients (mainly neutropenia) but postoperative morbidity was similar in the two groups.ConclusionIn patients with resectable adenocarcinoma of the lower esophagus, GEJ, or stomach, perioperative chemotherapy using fluorouracil plus cisplatin significantly increased the curative resection rate, disease-free survival, and OS.
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Affiliation(s)
- Marc Ychou
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Valérie Boige
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Jean-Pierre Pignon
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Thierry Conroy
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Olivier Bouché
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Gilles Lebreton
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Muriel Ducourtieux
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Laurent Bedenne
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Jean-Michel Fabre
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Bernard Saint-Aubert
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Jean Genève
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Philippe Lasser
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
| | - Philippe Rougier
- From the Centre Val d'Aurelle; Centre Hospitalier Universitaire Saint-Eloi, Montpellier; Institut de Cancérologie Gustave Roussy, Villejuif; Centre Alexis Vautrin et Centre Hospitalier Universitaire, Nancy; Centre Hospitalier Universitaire Robert Debré, Reims; Centre Hospitalier Universitaire Côte de Nacre, Caen; Centre Hospitalier Universitaire, Dijon; Fédération Nationale des Centres de Lutte contre le Cancer – Bureau d'Etudes Cliniques et Thérapeutiques; and the Hôpital Européen Georges Pompidou,
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12
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Solimando DA, Waddell JA. Epirubicin, Cisplatin, and Fluorouracil (ECF) Regimen. Hosp Pharm 2009. [DOI: 10.1310/hpj4412-1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparing, dispensing, and administering antineoplastic therapy and to the agents, commercially available and investigational, used to treat malignant diseases.
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13
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Abstract
Despite the recent decline in the incidence of gastric cancer in North America and Western Europe, treatment remains a challenging problem for oncologists. Surgery is the primary modality for managing early-stage disease, but most patients who undergo a curative resection develop locoregional or distant recurrence. Consequently, there has been great interest in evaluating strategies to prevent recurrences and improve overall mortality. This article is a review of data on adjuvant and neoadjuvant treatment approaches for gastric cancer, including radiotherapy, chemotherapy, and chemoradiotherapy. Compared with surgery alone, the North American Intergroup 0116 trial demonstrated a clear survival benefit with the administration of a postoperative regimen of 5-fluorouracil, leucovorin, and external beam radiation therapy, and these findings have made concurrent chemoradiation a standard of care in patients with resected gastric cancer. More recently, the British Medical Research Council Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC) study found that preoperative and postoperative administration of epirubicin, cisplatin, and 5-fluorouracil significantly improved survival beyond surgery alone. Thus, after decades of negative studies, 2 successful strategies in localized gastric cancer are now available. Ongoing and proposed trials include the current Intergroup study (Cancer and Leukemia Group B 80101), which is assessing the role of a potentially more active postoperative chemoradiation regimen. The proposed MAGIC-B study will examine the role of adding bevacizumab to perioperative chemotherapy, and the planned CRITICS study by the Dutch Gastric Cancer Group will evaluate the role of postoperative chemoradiation in combination with preoperative chemotherapy.
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Affiliation(s)
- Kimmie Ng
- Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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14
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Abstract
Although gastric cancer is still a worldwide major public health concern, it remains relatively uncommon in the Western countries. Despite improvement in surgical morbidity and mortality, as well as significant advancement of chemotherapy and radiotherapy options, the survival for gastric cancer has not significantly improved over the past decades. In the United States, standard of care for localized resectable gastric cancer is with adjuvant chemoradiotherapy. In this article, we summarize salient randomized and phase II and III clinical trials representing current treatment for gastric cancer.
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Affiliation(s)
- Alexandria T Phan
- University of Texas MD Anderson Cancer Center, GI Medical Oncology Department, 1515 Holcombe Boulevard, Mailbox 426, Houston, TX 77030, USA.
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15
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Abstract
The incidence of adenocarcinomas of the gastroesophageal junction has increased in recent years. These tumors possess distinct pathophysiologic characteristics. Although the consensus is that an R0 resection (complete microscopic and macroscopic resection) is the goal when operating for curative intent, much controversy remains regarding other aspects of patient management. There is lack of consensus regarding the type of surgery to perform, the role and extent of lymphadenectomy, and the role of neoadjuvant therapy. Utilizing an evidence-based approach, this review article provides an overview of the management of gastroesophageal junction carcinomas with particular emphasis on current areas of controversy.
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Affiliation(s)
- Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, Massachusetts 02114, USA
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16
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Satoh S, Hasegawa S, Ozaki N, Okabe H, Watanabe G, Nagayama S, Fukushima M, Takabayashi A, Sakai Y. Retrospective analysis of 45 consecutive patients with advanced gastric cancer treated with neoadjuvant chemotherapy using an S-1/CDDP combination. Gastric Cancer 2006; 9:129-35. [PMID: 16767369 DOI: 10.1007/s10120-006-0369-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 02/14/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standard treatment for highly advanced gastric cancer (AGC) has not been established yet. Neoadjuvant chemotherapy (NAC) represents a promising approach, which may improve the prognosis of AGC. In this study, we analyzed the feasibility and efficacy of NAC with S-1 (TS-1)/cisplatin CDDP in order to design appropriate clinical trials for AGC. METHODS Results for a series of 45 consecutive patients with AGC treated with S-1/CDDP induction chemotherapy since January 2002 were analyzed retrospectively. RESULTS The primary tumor was resected in 36 of the 45 patients (resectability, 80.0%). Progression of the disease during chemotherapy was observed in 1 patient only (2.2%). No treatment-related deaths occurred, and serious adverse effects (grade 3-4) were noted in only 2.2% of the patients. The overall median survival time was 1.82 years. Especially noteworthy is that, in patients with highly advanced disease (pretreatment [c]-stage IV; n = 27), resectability was 66.7% and curative (R0) resection was possible in 10 patients. The median survival times for c-stage IV patients who had total, curative, and noncurative resections were 20.8, 22.3 and 12.6 months, respectively. R0 resection was possible for all c-stage III patients (n = 17), with a 2-year overall survival of 90.9%. The downstaging rate was 55.6% (20/36), resulting in a significantly improved prognosis for the downstaged patients (P = 0.012). CONCLUSION Induction chemotherapy using S-1/CDDP for AGC appears to be a safe and promising treatment. We have therefore started two independent multiinstitutional clinical trials to evaluate the efficacy of this treatment.
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Affiliation(s)
- Seiji Satoh
- Department of Surgery, Kyoto University Hospital, Kyoto 606-8507, Japan
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17
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Forshaw MJ, Gossage JA, Chrystal K, Cheong K, Atkinson S, Botha A, Harper PG, Mason RC. Neoadjuvant chemotherapy for locally advanced carcinoma of the lower oesophagus and oesophago-gastric junction. Eur J Surg Oncol 2006; 32:1114-8. [PMID: 16621430 DOI: 10.1016/j.ejso.2006.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 02/01/2006] [Accepted: 02/08/2006] [Indexed: 11/24/2022] Open
Abstract
AIMS To evaluate a single unit's experience with neoadjuvant chemotherapy for treating locally advanced non-metastatic initially resectable and unresectable oesophago-gastric cancer. METHODS The medical records of all patients with either locally advanced carcinoma of the lower oesophagus or cardia treated with neoadjuvant chemotherapy between August 1999 and January 2003 were reviewed. RESULTS Sixty-four patients with initially resectable tumours (T2-3 or N+) and 38 patients with initially unresectable tumours (T4 or M1a) received neoadjuvant chemotherapy (83% combination Epirubicin, Cisplatin and 5-Fluorouracil). Symptomatic grade III/IV toxicity was observed in 33% of patients. Chemotherapy was not completed in 20 patients because of death (5.9%) and inadequate tumour response/toxicity (13.7%). Forty-three patients (67.3%) with initially resectable tumours and 19 patients (50%) with initially unresectable tumours underwent surgery. CONCLUSIONS Chemotherapy in this study was associated with appreciable toxicity. Patients with initially unresectable locally advanced disease can be downstaged with neoadjuvant chemotherapy.
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Affiliation(s)
- M J Forshaw
- Department of General Surgery, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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18
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Scartozzi M, Berardi R, Pierantoni C, Cascinu S. Pre-operative treatment modalities in gastric cancer patients. Ann Oncol 2005; 16 Suppl 4:iv106-109. [PMID: 15923409 DOI: 10.1093/annonc/mdi918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Scartozzi
- Clinica di Oncologia Medica, Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti, via Conca 60 020, Ancona, Italy
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19
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Tait DM. Multi-modality treatment in oesophageal cancer: a curse for radiotherapy progress. Radiother Oncol 2004; 73:115-7. [PMID: 15542157 DOI: 10.1016/j.radonc.2004.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Accepted: 08/11/2004] [Indexed: 10/26/2022]
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20
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Cascinu S, Scartozzi M, Labianca R, Catalano V, Silva RR, Barni S, Zaniboni A, D'Angelo A, Salvagni S, Martignoni G, Beretta GD, Graziano F, Berardi R, Franciosi V. High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer 2004; 90:1521-5. [PMID: 15083179 PMCID: PMC2409717 DOI: 10.1038/sj.bjc.6601752] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the role of a weekly preoperative chemotherapy in locally advanced, unresectable gastric cancer. In all, 82 patients with an Eastern Oncology Cooperative Group PS <or=2 and normal cardiac function were enrolled onto the study. Surgical unresectability was confirmed in 52 patients (63%) at laparotomy, and in 30 (27%) cases by CT scan of the abdomen and endoscopic ultrasonography. Chemotherapy treatment was: cisplatin 40 mg x m(-2); 5-fluorouracil 500 mg x m(-2); epidoxorubicin 35 mg x m(-2); 6S-leucovorin 250 mg x m(-2) and glutathione 1.5 g x m(-2) (PELF). One cycle consisted of 8 weekly treatments. Response to chemotherapy was observed in 40 of 82 patients (49%): six (7%) complete and 34 (41%) partial responses, and in four (5%) cases a complete pathological response was confirmed. Of the 40 responding patients, 37 (45%) had potentially curative surgery. Grade 3/4 leucopenia and thrombocytopenia occurred in three and two patients. At a median follow-up of 48 months, 25 of the 37 resected patients (68%) were alive and 24 (65%) were disease free. The median and 4-year survival for the whole group was 17 months and 31%, respectively. The median survival was 12 months for inoperable patients and it was not reached in resected patients.
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Affiliation(s)
- S Cascinu
- Clinica di Oncologia, Università Politecnica delle Marche-Azienda Ospedaliera Umberto I, via Conca, Ancona 60020, Italy.
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21
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Bataille F, Rümmele P, Dietmaier W, Gaag D, Klebl F, Reichle A, Wild P, Hofstädter F, Hartmann A. Alterations in p53 predict response to preoperative high dose chemotherapy in patients with gastric cancer. Mol Pathol 2004; 56:286-92. [PMID: 14514923 PMCID: PMC1187340 DOI: 10.1136/mp.56.5.286] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To evaluate the usefulness of molecular markers in predicting histopathological and clinical response to preoperative high dose chemotherapy (HDCT) and survival of patients with advanced gastric cancer. METHODS In a phase II trial, 25 patients with metastatic gastric cancer received preoperative tandem HDCT consisting of etoposide, cisplatin, and mitomycin, followed by autologous bone marrow transplantation to achieve surgical resectability. Samples before and after treatment, from normal and tumour tissue, were characterised histopathologically, and both p53 and BAX expression was analysed by immunohistochemistry. Pretreatment formalin fixed, paraffin wax embedded samples from normal and tumour tissue were microdissected, and the extracted DNA was preamplified using improved primer extension preamplification polymerase chain reaction. Detection of microsatellite instability (MSI) or loss of heterozygosity (LOH) was performed using markers for p53, BAX, BAT25, BAT26, D2S123, D17S250, and APC. Exons 5-9 of the p53 gene were sequenced directly on ABI 373. RESULTS Four parameters were significantly associated with response to chemotherapy and prolonged overall survival: positive p53 immunostaining, positive p53 mutation status before chemotherapy, strong histological regression induced by preoperative HDCT, and surgical treatment. Patients's sex or age, tumour location or stage, lymph node status, Lauren classification, MSI, or LOH did not influence duration of survival significantly in this high risk population. CONCLUSION Positive p53 immunostaining and p53 mutation status in pretreatment tumour biopsies might be useful molecular predictors of response and prognosis in patients with advanced gastric cancer treated by preoperative HDCT.
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Affiliation(s)
- F Bataille
- Department of Pathology, University of Regensburg, 93042 Regensburg, Germany.
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22
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Reichle A, Bolder U, Bataille F, Messmann H, Wagner H, Zaiss M, Wild P, Hofstädter F, Andreesen R, Jauch KW. A multimodal treatment approach including high-dose chemotherapy in very advanced gastric cancer: evidence for control of metastatic disease. Bone Marrow Transplant 2003; 32:665-71. [PMID: 13130313 DOI: 10.1038/sj.bmt.1704203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present multimodal treatment approach was designed to achieve prolonged tumor control in advanced gastric cancer. A total of 26 patients with stage IV gastric cancer (metastatic disease n=25), ECOG performance status 0-3 and laparoscopically evaluated peritoneal status received a modified EAP schedule to prove chemosensitivity and to mobilize autologous peripheral blood stem cells (aPBSC). Patients without progressive disease proceeded to tandem high-dose chemotherapy (HD-CT) and aPBSCT. Patients with >50% reduction of the target lesion received a second cycle of HD-CT. Responders were selected for local R0 resections (D2 resection) according clinical criteria. Of 26 patients, 20(77%) achieved partial remission after dose-intensive chemotherapy: local R0 resection was achieved in 12 out of 14 patients selected for surgery (46% of all patients). Eight of these R0-resected patients initially had peritoneal carcinomatosis. With a median follow-up of 3.2 years, four patients are still alive. The median overall survival was 8.4 months (CI 2.5-14.4 months), for histologic regression grade 3 (seven out of 25 patients, 28%) 29 months (CI 12-46 months). The combined treatment approach is tolerable and feasible in advanced disease and opens a therapeutic window for a significant proportion of patients, even in cases with histologically proven peritoneal carcinomatosis.
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Affiliation(s)
- A Reichle
- Department of Hematology and Oncology, University of Regensberg, Germany.
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23
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Abstract
The past decade has seen many advances in knowledge about gastric cancer. Notably, tumour biology and lymphatic spread are now better understood, and treatment by surgical and medical oncologists has become more standardised. Since refrigerators have replaced other methods of food conservation, Helicobacter pylori has become a factor in the cause of gastric cancer. Cancers that arise at the oesophagogastric junction might be further examples of wealth-associated disease. To tailor treatment better, the western hemisphere needs to borrow from the East by establishing screening programmes for early diagnosis, through careful surgical resection, and through detailed analysis of tumour spread. In Europe and the USA, most patients reach treatment with cancers already at an advanced stage. For these patients, three important randomised trials are underway that evaluate combined therapy. Cytostatic drugs, especially angiogenesis inhibitors have proved disappointing; however, basic research efforts to detect familial gastric cancers and to assess minimally residual disease look more hopeful.
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Janunger KG, Hafström L, Glimelius B. Chemotherapy in gastric cancer: a review and updated meta-analysis. THE EUROPEAN JOURNAL OF SURGERY = ACTA CHIRURGICA 2003; 168:597-608. [PMID: 12699095 DOI: 10.1080/11024150201680005] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED The five years survival rate for patients with gastric cancer is 15-25%. With the aim of improving survival, chemotherapy has been used in different adjuvant settings. Similarly, but with the aim of improving quality of life and prolonging life, chemotherapy has been used extensively in metastatic disease. In this review we have included studies of systemic and intraperitoneal chemotherapy given before, during or after operation and for advanced disease. A meta-analysis has been made on the 21 randomised studies that used adjuvant systemic chemotherapy postoperatively. A significant survival benefit for the patients treated postoperatively compared with controls was identified (odds ratio (OR) 0.84, 95% confidence interval (CI) 0.74 to 0.96). When western and Asian studies were analysed separately we found no survival benefit for the treated patients in the western groups (OR 0.96 (95 CI 0.83 to 1.12)). Flaws in the conduct of several trials made it difficult to draw firm conclusions, including the exclusion of a small but clinically meaningful survival benefit. Preoperative or neoadjuvant chemotherapy has shown effects in some patients, but no significant benefit was found in the few randomised studies. The few studies that reported intraperitoneal therapy showed no detectable survival benefit either. In patients with advanced disease, four small randomised studies found significantly longer survival in the treated patients. The survival benefit is in the range of 3-9 months, and there were also improvements of the quality of life. Several drug combinations have been tested, however, with no confirmed superiority for a particular regimen. CONCLUSIONS Adjuvant chemotherapy cannot be recommended as a routine because of the lack of confirmed beneficial effects. Some patients with advanced disease will have a clinically important benefit from palliative chemotherapy, so this can be recommended for patients who are otherwise in good health.
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Affiliation(s)
- Karl-Gunnar Janunger
- Department of Surgical and Perioperative Sciences--Surgery, University Hospital, Umeå, Sweden.
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25
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Menges M, Schmidt C, Lindemann W, Ridwelski K, Pueschel W, Jüngling B, Feifel G, Schilling M, Stallmach A, Zeitz M. Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate. J Cancer Res Clin Oncol 2003; 129:423-9. [PMID: 12836016 DOI: 10.1007/s00432-003-0467-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Accepted: 05/23/2003] [Indexed: 01/29/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy in locally advanced gastric cancer is effective, but is often associated with severe side effects, including fatal outcome. This study evaluates a combination of cisplatin, folinic acid and 5-fluorouracil (PLF) in terms of efficacy (R-0 resection rate) and toxicity. METHODS Twenty-five patients with locally advanced gastric cancer who after extensive staging were deemed not suitable for curative resection underwent neoadjuvant chemotherapy. Three or four cycles of cisplatin (50 mg/m(2) days 1 and 15), folinic acid (200 mg/m(2) days 1, 8, 15 and 22), and 5-fluorouracil (2,000 mg/m(2 ) days 1, 8, 15 and 22) were administered. Cases with progressive disease were taken off the study. Two weeks after finishing chemotherapy resection was performed and all patients were enrolled in a structured follow-up. RESULTS Of the patients, 22/25 finished chemotherapy and 20 of those underwent laparotomy. In 13/25 patients (52%) a R-0 resection and in three cases a R-1 resection were achieved. Four patients stayed irresectable. During 76 completed cycles of chemotherapy we observed five cases of WHO grade-III toxicity and no grade-IV toxicity. CONCLUSIONS The presented PLF protocol yields R-0 resection rates comparable to protocols like EAP (etoposide, adriamycin, platinum), but with a better safety profile allowing administration in an outpatient setting. Our study supports PLF as a reference neoadjuvant treatment for gastric cancer even outside of clinical studies.
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Affiliation(s)
- Markus Menges
- Department of Internal Medicine II, Saarland University, 66421, Homburg, Germany.
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Hu JK, Chen ZX, Zhou ZG, Zhang B, Tian J, Chen JP, Wang L, Wang CH, Chen HY, Li YP. Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials. World J Gastroenterol 2002; 8:1023-8. [PMID: 12439918 PMCID: PMC4656373 DOI: 10.3748/wjg.v8.i6.1023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the safety and efficacy of different intravenous chemotherapeutic regimens in patients with gastric carcinomas who had undergone gastrectomy.
METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Language was restricted to Chinese and English. RCTs were identified from Medline and Embase (1980-2001/4), and Chinese Bio-medicine Database (1990-2001/1). Literature references were checked at the same time. We included randomized and quasi-randomized trials comparing the efficacy of intravenous chemotherapy after gastrectomy with that of surgery alone in patients with confirmed gastric carcinomas who had undergone gastrectomy. Selection criteria were: randomized or quasi-randomized trials with following-up results; Trials could be double-blind, single-blind or not blind; Chemotherapy groups were given intravenous chemotherapy after gastrectomy without neo-adjuvant chemotherapy, intraperitoneal hyperthermic perfusion, radiotherapy or chemoimmunotherapy; Controlled group included those receiving gastrectomy alone. The following data were extracted: the number of survival and death by the end of the follow-up; the different agents and doses of the intravenous chemotherapy; the baseline of the chemotherapy group and the controlled arm; the serious adverse events; the statistical consideration; cost-effectiveness analysis. The statistical analysis was performed by RevMan4.1 software which was provided by the Cochrane Collaboration. A P value of < 0.05 was considered statistically significant. Meta-analysis was done with random effects model. Heterogeneity was checked by chi-square test. Sensitivity analysis was performed by excluding the trials in which Jadad-scale was only 1 score. The result was expressed with odds ratio (OR) for the categorical variable.
RESULTS: Fourteen trials involving 4543 patients were included. Meta-analysis was done with random effects model Heterogeneity and sensitivity analysis were performed also. The effect of intravenous chemotherapy after gastrectomy was better than surgery alone (odds ratio 0.56, 95%CI 0.40-0.79). There was a significant difference between the two groups by u-test (P = 0.0008). Sensitivity analysis revealed the same difference (odds ratio 0.81, 95%CI 0.70-0.94). Of fourteen trials, only three studies were of high quality according to the Jadad-scale (with three score). There was one meta-analysis trial and the others, about ten trials, were of low quality. There was no trial which mentioned sample-size calculation, allocation concealment, intention-to-treat analysis. Most of the trials didn’t describe the blind-procedure. There were five trials which detailed the side-effects according to the toxicity grade by WHO standard. The side-effects halting treatment were haematologic and biochemical toxicity, debilitating nausea and vomiting. There were two patients died of chemotherapy toxicity.
CONCLUSION: Based on the review, intravenous chemotherapy after gastrectomy may have positive treatment effect on gastric cancer. However, the evidence is not strong because of the general low methodologic quality of the RCTs. Therefore, we can’t make the conclusion that intravenous chemotherapy after gastrectomy may have better treatment effect on gastric cancer than that of surgery alone. Rigorously designed, randomised, double-blind, placebo-controlled trials are required.
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Affiliation(s)
- Jian-Kun Hu
- General Surgery Department, West China Hospital of SiChuan University, Chengdu 610041, Sichuan Province, China.
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Cascinu S, Labianca R, Daniele B, Beretta G, Salvagni S. Survival and quality of life in gastrointestinal tumors: two different end points? Ann Oncol 2002; 12 Suppl 3:S31-6. [PMID: 11804382 DOI: 10.1093/annonc/12.suppl_3.s31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In gastrointestinal tumors, the traditional end point of medical treatment was represented mainly by survival. In the last few years, however, there has been an increasing awareness about the role of quality of life. DESIGN This paper seeks to discuss these two important end points and their relationship in colorectal, gastric, pancreatic and liver cancers. RESULTS Chemotherapy has doubled survival in comparison with best supportive care in gastrointestinal tumors. A subjective response, represented by a decrease in cancer-related symptoms is expected in about half of the symptomatic patients in colorectal and gastric cancer. In pancreatic cancer, the positive results in terms of clinical benefit helped define the role of chemotherapy. Although clinical benefit does not represent a validated tool to measure quality of life, it can be a first step in the definition of new, simpler tools to assess this end point. The frequent presence of a serious concomitant disease, liver cirrhosis, in patients with hepatocellular carcinoma (HCC) usually prevents the use of chemotherapy in these tumors, which are often treated with locoregional treatments. Unfortunately, their impact on the survival and quality of life of these patients has never been adequately assessed. CONCLUSIONS In many gastrointestinal cancers, chemotherapy can produce a survival gain and an improvement in the quality of life. Further studies assessing new drugs and/or combinations should focus on these aspects and their relationships. In particular, the impact of treatments of HCC on both survival and quality of life must be investigated by well-designed prospective trials. When assessing the value of a particular anticancer treatment, it is important to consider the impact it may have not only on survival but also on quality of life. This is particularly so for cancer patients, whose life expectancy may be short.
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Affiliation(s)
- S Cascinu
- Medical Department, Azienda Ospedaliera di Parma, Italy.
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Cascinu S. La Gestione Del Paziente Con Carcinoma Gastrico. TUMORI JOURNAL 2002. [DOI: 10.1177/03008916020011s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Boyle M, Franceschi D, Robinson D, Livingstone A. Neoadjuvant Therapy for Esophageal Cancer: Standard of Care or Elusive Myth? Am Surg 2001. [DOI: 10.1177/000313480106701010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although surgical resection as the sole treatment modality for esophageal carcinoma has historically been associated with poor survival rates, improvements have recently been reported using varied neoadjuvant chemo-radiation protocols. This study evaluates the outcome of patients undergoing surgery for esophageal carcinoma at the University of Miami/Jackson Memorial Hospital between July 1991 and June 1996. Seventy-two patients underwent esophageal resection; 51 males and 21 females with a median age of 62.5 years (range = 42–82). Histology was equally distributed between adenocarcinoma (36 patients; 50%) and squamous cell carcinoma (36 patients; 50%). Pathological stage distribution consisted of 6 stage 0 (8%), 10 stage I (14%), 23 stage II (32%), 31 stage III (43%), and 2 stage IV (3%) lesions. Patients were divided into three groups according to the type of preoperative treatment; Group 1 (n = 44); surgery alone; Group 2 (n = 18); neoadjuvant 5-fluorouracil based chemotherapy, and Group 3 (n = 9); neoadjuvant 5-fluorouracil based chemotherapy in conjunction with external beam radiation (XRT). One patient received preoperative XRT alone. All survivors were followed for a minimum of 1 year and statistical analysis was performed using Kaplan-Meier curves, log-rank, and chi-square tests. In the 28 patients receiving any form of neoadjuvant therapy only one patient had a pathological complete response (CR) (3.5%). The overall 5 year and median survival rates were 18 per cent and 20.5 months (range = 0–73), respectively. Individual treatment group survival rates at 5 years were 28% for Group 1; 21% for Group 2; and 0% for Group 3, showing no survival difference between Groups 1 and 2; Group 3 fared significantly worse than the other two, probably as a result of the high operative mortality in this group. These results indicate that surgical resection continues to be an important treatment modality for esophageal carcinoma. Neoadjuvant chemotherapy in our experience failed to improve these survival rates and pre-operative chemoradiation was associated with a high perioperative mortality rate. Chemotherapy regimens with higher CRs may further improve these survival rates.
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Affiliation(s)
- M.J. Boyle
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - D. Franceschi
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - D.S. Robinson
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - A.S. Livingstone
- Department of Surgery, Sylvester Comprehensive Cancer Center, Miami, Florida
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Abstract
BACKGROUND Oesophageal cancer carries a poor prognosis. The 5-year survival rate following resection ranges from 10 to 35 per cent. Recent evidence suggests that the addition of non-surgical treatments to surgery may improve resection rates, reduce the risk of recurrence and improve survival. This review examines the role of preoperative chemoradiotherapy (CRT) in oesophageal cancer. METHODS A Medline-based literature review (1980-2000) was performed using the key words 'neoadjuvant or preoperative' and 'chemoradiotherapy or radiochemotherapy'. Additional literature was obtained from original papers and published meeting abstracts. RESULTS Forty-six non-randomized and six randomized trials of preoperative CRT were found. Resection rates, pathological complete response (pCR), treatment-related mortality rates and relapse patterns are documented. Improved 5-year survival rates approaching 60 per cent may be achieved following pCR. Three of the six randomized trials show a benefit in either overall survival or disease-free survival compared with surgery alone. Treatment-related toxicity can be significant. CONCLUSION Preoperative CRT may improve survival. Emerging evidence suggests that CRT alone can achieve similar survival rates to surgery alone. New imaging modalities may help to select which patients require surgery. Larger randomized trials of preoperative CRT or chemotherapy are needed to define optimal regimens and produce higher pCR rates with acceptable toxicity.
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Affiliation(s)
- J I Geh
- Queen Elizabeth Hospital, Birmingham, Cookridge Hospital, Leeds and Mount Vernon Hospital, Northwood, UK
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Geh JI, Glynne-Jones R, Kwok QS, Banerji U, Livingstone JI, Townsend ER, Harrison RA, Mitchell IC. Preoperative ECF chemotherapy in gastro-oesophageal adenocarcinoma. Clin Oncol (R Coll Radiol) 2001; 12:182-7. [PMID: 10942336 DOI: 10.1053/clon.2000.9147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epirubicin, cisplatin and continuous 5-fluorouracil (5-FU) infusion (ECF) has been reported to result in high clinical response rates in advanced gastro-oesophageal adenocarcinoma and is currently the 'gold standard' chemotherapy regimen for this tumour site. Despite this, its role as preoperative (neoadjuvant) treatment is unproven and therefore remains under investigation. We report our experience using ECF (intravenous epirubicin 50 mg/m2 and cisplatin 60 mg/m2 every 3 weeks, with continuous infusion of 5-FU 200 mg/m2 per day) as preoperative treatment in locally advanced adenocarcinoma of the lower oesophagus, gastro-oesophageal junction and stomach. Of the 23 patients treated (median age 54 years), 19 had potentially resectable disease, four were unresectable and seven had radiological evidence of lymph node involvement. A median of four cycles of ECF was delivered (range 1-6). Ten of 12 patients (83%) with dysphagia reported improvement of symptoms. Clinical disease progression occurred in six patients (26%) during chemotherapy. WHO grade 3 or 4 toxicity occurred in six patients (26%): four haematological, one mucositis, one vomiting. Seventeen patients (74%) proceeded to surgery; 14 (61%) were resected and three were unresectable. There were two (12%) postoperative deaths from respiratory failure. Major pathological response was seen in three patients (13%): one pathological complete response, two microscopic residual disease. Two patients had Stage II (T2N(0-1)) disease and nine were Stage III (T(3-4)N(0-1)). None of the patients with initially unresectable disease was rendered resectable. After a median follow-up interval of 33 months (range 26-53), the overall median survival was 12 months and 2-year survival was 30%. All patients who were initially unresectable or had radiological evidence of lymph node involvement have died. Therefore, despite good symptomatic response rates, ECF chemotherapy given in the preoperative setting did not appear to improve the outcome of patients with unresectable or radiologically lymph node-positive gastro-oesophageal adenocarcinoma. The role of ECF chemotherapy in resectable tumours is unclear and is currently under investigation in the randomized MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) study.
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Affiliation(s)
- J I Geh
- Mount Vernon Hospital, Northwood, UK
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Cascinu S, Graziano F, Barni S, Labianca R, Comella G, Casaretti R, Frontini L, Catalano V, Baldelli AM, Catalano G. A phase II study of sequential chemotherapy with docetaxel after the weekly PELF regimen in advanced gastric cancer. A report from the Italian group for the study of digestive tract cancer. Br J Cancer 2001; 84:470-4. [PMID: 11207039 PMCID: PMC2363773 DOI: 10.1054/bjoc.2000.1631] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In advanced gastric cancer, we investigated feasibility and activity of sequential chemotherapy with docetaxel after an intensive weekly regimen consisting of cisplatin, epidoxorubicin, fluorouracil, leucovorin (PELF) plus filgrastim. Chemotherapy-naive patients with relapsed or metastatic gastric cancer received 8 weekly administrations of chemotherapy with cisplatin 40 mg/m(2), fluorouracil 500 mg/m(2), epidoxorubicin 35 mg/m(2), 6S-stereoisomer of leucovorin 250 mg/m(2) and glutathione 1.5 g/m(2). On the other days filgrastim 5 microg kg(-1) was administered by subcutaneous injection. Subsequently, patients with partial response or stable disease received 3 cycles of docetaxel 100 mg/m(2) every 3 weeks. 40 patients have been enrolled and they are evaluable for response and toxicity. After the PELF regimen, 3 patients achieved complete response, 13 patients showed partial response, 21 patients had stable disease and 3 patients progressed (40% response rate; 95% CI 25% to 55%). After docetaxel, 9 out 34 patients improved the outcome (26.5%); 7 patients with stable disease achieved partial response and 2 patients with partial response achieved complete response. The overall response rate in the 40 patients was 57.5% (95% CI, 42.5% to 72.5%). The PELF regimen did not cause any grade IV toxicity, the most frequent grade III acute side-effects were thrombocytopenia and vomiting which occurred in the 10% of 320 PELF cycles. Docetaxel caused grade III-IV neutropenia and thrombocytopenia in the 10% and the 19% of cycles respectively. Fatigue was a frequent side-effect during both PELF and docetaxel chemotherapy. The sequential application of docetaxel after PELF chemotherapy gained major objective responses with manageable toxicity. This strategy is worth of further investigation in the setting of palliative or neoadjuvant chemotherapy.
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Affiliation(s)
- S Cascinu
- Division of Medical Oncology, Azienda Ospedale di Parma, Italy
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Bowrey DJ, Clark GW, Roberts SA, Hawthorne AB, Maughan TS, Williams GT, Carey PD. Serial endoscopic ultrasound in the assessment of response to chemoradiotherapy for carcinoma of the esophagus. J Gastrointest Surg 1999; 3:462-7. [PMID: 10482701 DOI: 10.1016/s1091-255x(99)80098-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of the study was to assess whether endoscopic ultrasound (EUS) could accurately measure the locoregional response to chemoradiotherapy in patients with carcinoma of the esophagus. Seventeen patients with esophageal carcinoma underwent EUS examination before and on completion of chemoradiotherapy. The EUS findings were correlated with the results of histologic examination of the esophagectomy specimen. The accuracy of EUS in these patients was compared with the accuracy of EUS in a control group of 17 patients treated by surgery alone. In 16 of 17 patients EUS-determined tumor (T) stage was unchanged following treatment and in one patient there was T-stage progression. No patient demonstrated downstaging of the primary tumor according to classical EUS criteria. In 10 of 17 patients a reduction in maximum tumor depth of >/=2 mm was observed (range 2 to 18 mm). Histologic examination revealed that four patients with squamous cell carcinoma had experienced a complete pathologic response. These four patients had significantly lower posttreatment EUS tumor depths compared to patients without a complete response (5.0 vs. 9.0 mm; P <0.05). Based on the post-treatment EUS examination, the accuracy was 59% for T stage and 59&percnt for node (N) stage. The accuracy of EUS in patients treated by surgery alone was 94% for T stage and 94% for N stage, indicating a significant reduction in the accuracy of EUS in patients following chemoradiotherapy (P <0.05). The accuracy of EUS examination in patients with carcinoma of the esophagus treated by chemoradiotherapy was poor. EUS did not detect downstaging of the primary tumor, even in the presence of a complete pathologic response. EUS assessment of maximum tumor depth was a better measure of response to therapy.
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Affiliation(s)
- D J Bowrey
- Department of Surgery, University Hospital of Wales, Cardiff, Wales.
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Abstract
Currently, the most effective treatment of gastric cancer is surgical resection of the tumor with lymphadenectomy, which is the standard treatment in Japan. It is important to determine whether chemotherapy or immunochemotherapy regimens may prolong the survival of patients with gastric cancer. Although gastric cancer cells, in general, have a low sensitivity to chemotherapy and a low immunogenicity related to stimulation of immune competent cells, a new method including biochemical modulation and nonspecific immunopotentiation with biological response modifiers (BRMs) has permitted us to augment the clinical efficacy of immunochemotherapy for gastric cancer. Further, promising new drugs are being developed and await testing for their possible benefit in an adjuvant setting, and recent advances in molecular biology may open a new avenue for tumor antigen-specific immunotherapy for gastric cancer. We will review the current status of immunochemotherapy for gastric cancer and examine its clinical benefit for survival.
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Affiliation(s)
- T Toge
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, Joffe JK, Mackean M, Mansi J, Leahy M, Hill A, Oates J, Rao S, Nicolson M, Hickish T. Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer 1999; 80:269-72. [PMID: 10390007 PMCID: PMC2363002 DOI: 10.1038/sj.bjc.6690350] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We report the final results of a prospectively randomized study that compared the combination of epirubicin, cisplatin and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin and methotrexate (FAMTX) in previously untreated patients with advanced oesophagogastric cancer. Between 1992 and 1995, 274 patients with adenocarcinoma or undifferentiated carcinoma were randomized from eight oncology centres in the UK and analysed for response and survival. The overall response rate was 46% (95% confidence interval (CI), 37-55%) with ECF, and 21% (95% CI, 13-28%) with FAMTX (P = 0.00003). The median survival was 8.7 months with ECF and 6.1 months with FAMTX (P = 0.0005). The 2-year survival rates were 14% (95% CI, 8-20%) for the ECF arm, and 5% (95% CI, 2-10%) for the FAMTX arm (P = 0.03). Histologically complete surgical resection following chemotherapy was achieved in ten patients in the ECF arm (three pathological complete responses to chemotherapy) and three patients in the FAMTX arm (no pathological complete responses). The ECF regimen resulted in a response and survival advantage compared with FAMTX chemotherapy. The probability of long-term survival following surgical resection of residual disease is increased by this treatment. The high response rates seen with ECF support its use in the neoadjuvant setting.
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Affiliation(s)
- J S Waters
- Cancer Research Campaign, Section of Medicine and Gastrointestinal Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
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Affiliation(s)
- Stefano Cascinu
- Cattedra di Oncologia Medica, Università degli Studi di Messina, Messina; Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente (GISCAD)
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Cascinu S, Graziano F, Ferro ED, Staccioli MP, Ligi M, Carnevali A, Muretto P, Catalano G. Expression of p53 protein and resistance to preoperative chemotherapy in locally advanced gastric carcinoma. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19981101)83:9<1917::aid-cncr6>3.0.co;2-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cascinu S, Labianca R, Graziano F, Pancera G, Barni S, Frontini L, Luporini G, Cellerino R, Catalano G. Intensive weekly chemotherapy for locally advanced gastric cancer using 5-fluorouracil, cisplatin, epidoxorubicin, 6S-leucovorin, glutathione and filgrastim: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer 1998; 78:390-3. [PMID: 9703289 PMCID: PMC2063041 DOI: 10.1038/bjc.1998.505] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Local extension prevents curative resection in more than two-thirds of gastric cancer patients. Unfortunately, resectability is one of the main prognostic factors in these patients, and survival is longer when tumours are completely removed. Preoperative chemotherapy is an attractive concept for obtaining curative resection. Thirty-two locally advanced unresectable gastric cancer patients were enrolled in five Italian Group for the Study of Digestive Tract Cancer (GISCAD) centres. For 16 patients, surgical unresectability was based on computerized tomography scan evaluation of tumour size (four patients) and invasion of adjacent structures (12 patients), whereas in another 16 patients locally advanced disease was confirmed by laparotomy. They received weekly administration of cisplatin 40 mg m(-2), 5-fluorouracil 500 mg m(-2), epidoxorubicin 35 mg m(-2), 6S-stereoisomer of leucovorin 250 mg m(-2) and glutathione 1.5 g m(-2). From the day after to the day before each chemotherapy administration, filgrastim was administered by subcutaneous injection at a dose of 5 microg kg(-1). One cycle of therapy consisted of eight weekly treatments. Fifteen of 32 patients (47%) responded to chemotherapy, whereas 13 (41 %) had stable disease and four (12%) progressed on therapy. Of the 15 responding patients, 13 were completely resected after chemotherapy and two of them had a complete pathological response. Two clinically responding patients were found unresectable at operation because of peritoneal seeding. At a median follow-up from the start of treatment of 24 months (range 11-39 months), 10 of 13 resected patients are alive and eight are relapse free. Three patients died after 11, 12, and 14 months respectively. Toxicity was acceptable: side-effects consisted mainly of grade II National Cancer Institute common toxicity criteria (NCICTC) leucopenia and thrombocytopenia in ten patients. Neither treatment-related death nor surgical complications in patients undergoing surgery were observed. This weekly intensive regimen enabled resection in half of previously inoperable tumours with a moderate toxicity. It can be offered to patients with locally advanced unresectable gastric cancer to obtain curative resection.
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Affiliation(s)
- S Cascinu
- Division of Medical Oncology, S. Salvatore Hospital, Pesaro, Italy
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