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Ramachandran R, Grantham T, Parvataneni S, Budh D, Gollapalli S, Reddy M, Gaduputi V. Gastric Cancer: Clinical Features, Screening, Diagnosis, Treatment, and Prevention. J Community Hosp Intern Med Perspect 2024; 14:49-57. [PMID: 38966500 PMCID: PMC11221451 DOI: 10.55729/2000-9666.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 07/06/2024] Open
Abstract
The objective of this article is to highlight the clinical features, screening, diagnosis, treatment, and prevention of gastric cancer (GC). Early GC is often asymptomatic leading to frequent delays in diagnosis. Weight loss and persistent abdominal pain are the most common symptoms at initial diagnosis. The diagnosis of GC typically involves a combination of endoscopy, biopsy, and imaging studies. Endoscopic resection techniques are emerging as successful treatment options for early GC. Treatment options for advanced GC include surgery and chemotherapy. The first line chemotherapy for advanced GC consists of doublet therapy with a combination of platinum and fluoropyrimidines. Trastuzumab, a monoclonal antibody, is used in the treatment of human epidermal growth factor 2 positive GCs. Antiangiogenic agents and immunotherapy are also useful in the treatment of GC. Currently there are no GC screening guidelines in the United States, but they exist in other regions where there is increased prevalence of GC. Prevention strategies for GC include Helicobacter pylori eradication and adoption of a healthy diet consisting of fruits and vegetables.
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Affiliation(s)
| | - Tyler Grantham
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305,
USA
| | - Swetha Parvataneni
- Department of Internal Medicine, Geisinger Lewistown Hospital, 400 Highland Ave, Lewistown, PA 17044,
USA
| | - Deepa Budh
- Department of Internal Medicine, St. Barnabas Hospital, 4422 3rd Avenue, Bronx, NY 10457,
USA
| | - Sindhu Gollapalli
- Department of Internal Medicine, St. Barnabas Hospital, 4422 3rd Avenue, Bronx, NY 10457,
USA
| | - Madhavi Reddy
- Department of Gastroenterology, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201,
USA
| | - Vinaya Gaduputi
- Department of Gastroenterology, Blanchard Valley Health System, 1900 S Main St, Findlay, OH 45840,
USA
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Wang W, Shi B, He C, Wu S, Zhu L, Jiang J, Wang L, Lin L, Ye J, Zhang H. Euclidean distance-based Raman spectroscopy (EDRS) for the prognosis analysis of gastric cancer: A solution to tumor heterogeneity. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 288:122163. [PMID: 36462319 DOI: 10.1016/j.saa.2022.122163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The prognosis analysis of gastric cancer is critical for selection of treatments and development of advanced therapeutic methods. A prognosis approach that is accurate, fast, convenient, and of low cost for gastric cancers is in high demand. Raman spectroscopy is a label-free and non-destructive technique to provide molecular fingerprints of biological samples, holding promises for cancer prognosis. However, the major challenge of gastric cancer prognosis lies in the widely existing tumor heterogeneity, which leads to unexpected spectral variations within one type of samples. In this work, we have developed the Euclidean distance (ED)-based Raman spectroscopy (EDRS) method for the prognosis analysis of gastric cancer to eliminate the influence of tumor heterogeneity. Raman spectra were first collected on the slices of paraffin-preserved tumor tissues from gastric cancer patients. A standard spectrum to represent the 'worst prognostic tumor cells' was then established. The similarity between each spectrum of tissues and the standard spectrum was assessed by ED, to provide a direct assessment on the prognosis status. We have successfully classified the patients into poor and favorable prognosis groups, either based on the averaged regional ED values (sensitivity of 75 %, specificity of 96.8 %), or based on the minimal ED values at the patient level (sensitivity of 90 %, specificity of 100 %). EDRS was also investigated for survival analysis (AUC = 0.955), much better than the commonly applied post-neoadjuvant therapy (ypTNM) category (AUC = 0.718). Our work highlights EDRS as a rapid, accurate, low-cost and robust tool for heterogeneous cancer-related prognosis assessment and survival prediction, providing new insights for spectroscopic tumor analysis.
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Affiliation(s)
- Wenfang Wang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Bowen Shi
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Chang He
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Siyi Wu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Jiang Jiang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Lingyun Wang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China
| | - Li Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China.
| | - Jian Ye
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, PR China.
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, PR China.
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Sun J, Nan Q. Survival benefit of surgical resection for stage IV gastric cancer: A SEER-based propensity score-matched analysis. Front Surg 2022; 9:927030. [PMID: 36386506 PMCID: PMC9640680 DOI: 10.3389/fsurg.2022.927030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/03/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is a major malignancy worldwide, and its incidence and mortality rate are increasing year by year. Clinical guidelines mainly use palliative drug combination therapy for stage IV gastric cancer. In accordance with some small sample studies, surgery can prolong survival. There is no uniform treatment plan for stage IV gastric cancer. This study focused on collecting evidence of the survival benefit of cancer-directed surgery (CDS) for patients with stage IV gastric cancer by analyzing data from a large sample. METHODS Data on patients with stage IV gastric cancer diagnosed between 2010 and 2015 was extracted and divided into CDS and no-CDS groups using the large dataset in the Surveillance, Epidemiology, and End Results (SEER) database. With bias between the two groups minimized by propensity score matching (PSM), the prognostic role of CDS was studied by the Cox proportional risk model and Kaplan-Meier. RESULTS A total of 6,284 patients with stage IV gastric cancer were included, including 514 patients with CDS who were matched with no-CDS patients according to propensity score (1:1), resulting in the inclusion of 432 patients each in the CDS and no-CDS groups. The results showed that CDS appeared to prolong the median survival time for stage IV gastric cancer (from 6 months to 10 months). Multifactorial analysis showed that poorly differentiated tumors (grades III-IV) significantly affected patient survival, and chemotherapy was a protective prognostic factor. CONCLUSION The findings support that CDS can provide a survival benefit for stage IV gastric cancer. However, a combination of age, underlying physical status, tumor histology, and metastatic status should be considered when making decisions about CDS, which will aid in clinical decision-making.
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Affiliation(s)
- Jianhui Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Institute of Digestive Diseases, Kunming, China
- Graduate School of Kunming Medical University, Kunming, China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Institute of Digestive Diseases, Kunming, China
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S-1 Combined With Apatinib and Trans-arterial Chemotherapy and Embolization for Conversion Therapy of Unresectable Locally Advanced Gastric Cancer. J Surg Res 2021; 270:162-168. [PMID: 34673305 DOI: 10.1016/j.jss.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Conversion therapy is a promising option for unresectable locally advanced gastric cancer (GC) patients. This study aimed to investigate the feasibility and efficacy of conversion therapy based on S-1, apatinib combined with transarterial chemotherapy and embolization (TACE). MATERIALS AND METHODS Twenty eligible unresectable locally advanced GC patients were enrolled in this single-arm, single-center, prospective clinical trial. Apatinib was administered orally at 0.5 g once daily and continuously for 58 d, while S-1 twice daily on d 1-14 was given at a dose calculated according to the body surface area and repeated every 3 wk for three cycles. TACE (oxaliplatin 80 mg/m2 and etoposide 80 mg/m2) was performed on d 1 and was repeated on d 31. RESULTS Nineteen patients completed conversion therapy and no treatment-related deaths occurred. The objective response rate (ORR) was 94.7% (18/19) and noncurative factors had resolved in 13 patients (68.4%) based on imaging estimation. 18 patients received laparoscopic examination and 12 cases underwent definitive surgery. Based on the intraoperative and postoperative pathological examination, 10 patients received radical resection (R0 + D2/D2+). The patients who underwent the conversion surgery had a superior median overall survival (OS) compared with those who did not (P = 0.010). CONCLUSIONS S-1 combined with apatinib and TACE regimen is feasible for preoperative treating initial unresectable locally advanced GC patients with high rates of objective response and radical resection which may provide a survival benefit.
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Li Y, Xie D, Chen X, Hu T, Lu S, Han Y. Prognostic Value of the Site of Distant Metastasis and Surgical Interventions in Metastatic Gastric Cancer: A Population-Based Study. Technol Cancer Res Treat 2020; 19:1533033820964131. [PMID: 33111644 PMCID: PMC7607730 DOI: 10.1177/1533033820964131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies on the prognostic significance of site-specific distant metastasis, multiple-site metastases, and the impact of surgery of the primary tumor and metastatic lesion on survival outcomes of patients with metastatic gastric cancer (GC) remain elusive. Therefore, this study aimed to investigate the prognostic significance of the site of distant metastasis among patients with metastatic GC. Furthermore, the effect of surgery of the primary tumor and metastatic lesion on the prognosis of metastatic GC was also analyzed. METHODS The data of 4,221 eligible patients, who were diagnosed with metastatic GC between 2010 and 2015, were identified from the Surveillance Epidemiology and End Results (SEER) database. Multivariate logistic regression analysis was performed to assess the association between potential prognostic factors, including the site of metastasis and surgery, and survival of patients with metastatic GC. Overall survival (OS) and cause-specific survival (CSS) were determined using the Kaplan-Meier survival curves and differences were assessed using the Log-rank test. RESULTS Out of the total 4,221 GC patients with definite organ metastases, 3312 patients had single-site metastasis while 909 patients had multiple-site metastases. GC patients with single-site metastasis of liver or lung exhibited better CSS and OS compared to those with bone metastasis. Furthermore, GC patients with liver metastasis benefited from surgery of both the primary and metastatic lesions, while those with lung metastasis benefited from surgery of metastasis resection only. Multivariate Cox regression analysis revealed that GC patients with single-site metastasis, well-differentiated tumors, GC patients who underwent surgery of the primary tumor and those who received chemotherapy exhibited favorable prognosis. CONCLUSIONS The site of metastasis was an independent prognostic factor for metastatic GC. Surgery had survival benefits in certain cases of metastatic GC; however, further studies are warranted to clarify these benefits in carefully selected patients.
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Affiliation(s)
- Yinghua Li
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Danna Xie
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaojing Chen
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Teng Hu
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Simin Lu
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yunwei Han
- The Oncology Department, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Zhang X, Huang H, Wei Z, Zhu Z, Yang D, Fu H, Xu J, Hu Z, Zhang Y, You Q, Huang X, Yan R, Wang W, Cai Q. Comparison of Docetaxel + Oxaliplatin + S-1 vs Oxalipatin + S-1 as Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Propensity Score Matched Analysis. Cancer Manag Res 2020; 12:6641-6653. [PMID: 32801898 PMCID: PMC7398747 DOI: 10.2147/cmar.s258360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background What is the optimal neoadjuvant chemotherapy (NAC) regimen for locally advanced gastric cancer (LAGC) remains debatable. The objective of this study was to compare the efficacy of docetaxel+oxaliplatin+S-1 (DOS) vs oxaliplatin+S-1 (SOX) as NAC for LAGC. Methods Data of 248 LAGC patients who received either DOS or SOX as NAC in our hospital between January 2010 and January 2018 were reviewed retrospectively. Propensity score matched (PSM) analysis was applied to minimize the selection bias in both groups. Prognostic factors were screened by univariate and multivariate Cox regression analyses. Results Of the 248 LAGC patients included, 180 patients were subjected to the PSM analysis. Patients in DOS group showed a better tumor response to NAC, higher radical resection rate and R0 resection rate than those in SOX group. The overall survival (OS) rate in DOS group was better than that in SOX group, although the overall incidence of Grade 3/4 NAC-related toxicity in DOS group was higher, as represented by leukopenia and neutropenia. Multivariate analysis revealed that the NAC regimen, cTNM stage and the R0 resection rate were independent prognostic factors. In addition, patients with TLND less than 16 population showed a worse OS rate. Subgroup analysis indicated that patients benefited from the addition of docetaxel regardless of the clinical T stage, but those with high clinical N stages (N2-3) did not. Conclusion DOS is a safe and feasible NAC regimen for LAGC, which is worth popularizing in clinical practice.
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Affiliation(s)
- Xin Zhang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Hejing Huang
- Department of Ultrasound, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Ziran Wei
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Zhenxin Zhu
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Dejun Yang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Hongbing Fu
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jiapeng Xu
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Zunqi Hu
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yu Zhang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qing You
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Xin Huang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Ronglin Yan
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Weimin Wang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qingping Cai
- Department of Gastrointestinal Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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Kim HS, Koom WS, Baek SE, Kim HI, Jung M, Beom SH, Kang B, Kim H, Chang JS, Choi YY, Son T, Cheong JH, Noh SH, Kim EH, Park JC, Shin SK, Lee SK, Lee YC, Shin SJ, Chung H, Jung I, Chung HC, Lim JS, Hyung WJ, Rha SY. Phase II trial of preoperative sequential chemotherapy followed by chemoradiotherapy for high-risk gastric cancer. Radiother Oncol 2019; 140:143-149. [PMID: 31302344 DOI: 10.1016/j.radonc.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/10/2019] [Accepted: 06/20/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the safety and efficacy of preoperative chemotherapy (CTx) followed by chemoradiotherapy (CCRT) for high-risk gastric cancer (GC). METHODS AND MATERIALS The inclusion criteria were as follows: (1) Borrmann type 4; (2) large Borrmann type 3 (≥8 cm); (3) single bulky (≥3 cm × 1) or multiple lymph nodes (≥1.5 cm × 3). Patients received two 21-day courses of induction CTx of TS-1 (35 mg/m2, p.o, twice daily on days 1-14), docetaxel (30 mg/m2, i.v., days 1 and 8), and cisplatin (30 mg/m2, i.v., days 1 and 8) followed by CCRT (two courses of TS-1 and cisplatin in combination with 45 Gy radiation). RESULTS Forty-two patients were enrolled between March 2014 and February 2016, and 39 of these completed sequential CTx and CCRT. Among the 33 patients who underwent R0 resection, the pathologic response rate was 39.4% [no residual carcinoma (n = 5, 15.2%), with 1-10% residual carcinoma (n = 8, 24.2%)]. Overall, 4 patients (12.1%) were pathologic stage 0, 7 (21.2%) were stage I, 10 (30.3%) were stage II, and 12 (36.4%) were stage III. The overall survival rate at 3 years was 77.9% for stages 0 and I, 66.8% for stages II-III, and 33.3% for unresectable cases (P = 0.001). Toxicity was mild to moderate with grade 4 neutropenia (n = 1) and neutropenic fever (n = 1) as the most prominent side-effects. CONCLUSIONS Sequential CTx and CCRT prior to surgery are feasible and effective for high-risk GC. TRIAL REGISTRATION NUMBER NCT02495493.
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Affiliation(s)
- Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song-Ee Baek
- Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taeil Son
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea
| | - Sung Kwan Shin
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea
| | - Yong Chan Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea
| | - Su-Jin Shin
- Departments of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Sciences, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Sciences, Seoul, Republic of Korea.
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Su Z, Shu K, Kang M, Wang G. Pathological complete response from oral chemotherapy combined with trans-arterial chemotherapy and embolization in an unresectable gastric cancer patient: A case report. Medicine (Baltimore) 2019; 98:e16075. [PMID: 31232946 PMCID: PMC6636947 DOI: 10.1097/md.0000000000016075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Gastric cancer is still one of the most common cancer in East Asia. More than 70% gastric cancer patients are diagnosed at an advanced stage in China. Moreover, about 10% cases are unresectable which usually suffer a poor prognosis with a median survival time of 5 to 12 months. In recent years, some clinical studies found that many unresectable gastric cancer cases could get opportunity for surgery after treatment that improve prognosis significantly PATIENT CONCERNS:: 64-year-old male patient was admitted with upper abdominal pain. Upper gastrointestinal endoscopy showed a large ulcerated tumor located from the cardia to the anterior wall of the upper gastric body. Histopathological examination showed it was moderately differentiated adenocarcinoma. Computed tomography (CT) scan image showed a large bulging mass with internal ulcer at the lesser curvature wall, left gastric artery and coeliac trunk were surrounded by fused lymph nodes. DIAGNOSES Based on the histopathological examination and imaging findings, patient was diagnosed advanced gastric cancer and hardly to resect radically. INTERVENTION Oral chemotherapy combined with trans-arterial chemotherapy and embolization (TACE) was initiated. Eight weeks after initial therapy, radical laparoscopy-assisted total gastrectomy with D2 lymph node dissection and Roux-en-Y anastomosis were performed successfully. OUTCOMES Patient was discharged on postoperative day 11 without complications. Histological analysis of the specimen and resected 31 lymph nodes revealed no malignancy. The patient experienced a pathological complete response (pCR). LESSONS In this case, oral chemotherapy combined with TACE which was rarely reported in the treatment of unresectable gastric cancer achieves a great therapeutic benefit. Although further clinical studies will be needed to establish, it may be a potent strategy for degrading stage and supplying a new chance for surgery.
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Affiliation(s)
- Zhaoran Su
- Department of Gastrointestinal Surgery
- Department of Digestive Endoscopy
| | - Kuanshan Shu
- Department of Gastrointestinal Surgery
- Department of Digestive Endoscopy
| | - Min Kang
- Department of Pathology, People's Hospital of Tongling City, Tongling, Anhui, People's Republic of China
| | - Guihe Wang
- Department of Gastrointestinal Surgery
- Department of Digestive Endoscopy
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Günes-Bayir A, Kocyigit A, Güler EM, Bilgin MG, Ergün İS, Dadak A. Effects of carvacrol on human fibroblast (WS-1) and gastric adenocarcinoma (AGS) cells in vitro and on Wistar rats in vivo. Mol Cell Biochem 2018; 448:237-249. [PMID: 29442269 DOI: 10.1007/s11010-018-3329-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/07/2018] [Indexed: 02/06/2023]
Abstract
Carvacrol is a natural phenolic compound found in essential oils of Lamiaceae species. In the present study, an attempt has been made to elucidate the mechanism behind the anti-cancer potential of carvacrol on human gastric adenocarcinomas (AGS) by comparing its effects on cancer cells AGS to those on normal human fibroblast (WS-1) cells, in vitro. Cytotoxicity, reactive oxygen species (ROS) generation, glutathione (GSH) levels, genotoxicity, and apoptotic effects of carvacrol (0-600 µM) were studied in both cell lines. Additionally, the effect of high dose carvacrol (100 mg/kg BW) on the oxidative status was investigated in vivo. For this purpose, carvacrol was administered orally to male Wistar rats over a period of 60 days. Rats were weighed regularly. At the end of the experiment, rats were euthanized. Blood and stomach tissues were collected for biochemical and pathological examinations. The in vitro results showed significant differences in cell viability of AGS compared to WS-1 cells exposed to carvacrol. Also the extent of ROS generation, GSH reduction and DNA damage differed significantly between the cell lines studied (P ≤ 0.001). The differences observed were statistically significant at all concentrations applied (P ≤ 0.001). The results found in AGS cells were mirrored in the pathohistological findings obtained from animals of the in vivo experimental group. Changes in body weight, and oxidative stress index for plasma and stomach tissues of animals in this group were found to differ statistically significant from those found in the control group of Wistar rats (P ≤ 0.001). The data obtained from our present study uncovered that carvacrol has the potential to cause toxic effects in both, AGS and WS-1 cells but more effectively in cancer cells than in normal cells. The carvacrol-mediated responses observed in the in vitro and in vivo experiments presented suggest a double-edged pro-oxidative effect. Via this mechanism carvacrol induced cytotoxicity, apoptosis, and DNA damage in a dose-dependent manner in both cancer and normal cells and these activities were higher in cancer cells than those of normal cells.
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Affiliation(s)
- Ayse Günes-Bayir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bezmialem Vakif University, Silahtarağa Caddesi No: 189, Eyüp, 34065, Istanbul, Turkey.
| | - Abdurrahim Kocyigit
- Department of Medical Biochemistry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Eray Metin Güler
- Department of Medical Biochemistry, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Gültekin Bilgin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bezmialem Vakif University, Silahtarağa Caddesi No: 189, Eyüp, 34065, Istanbul, Turkey
| | - İlyas Samet Ergün
- Department of Pathology Laboratory, Vocational School for Health Services, Bezmialem Vakif University, Istanbul, Turkey
| | - Agnes Dadak
- Institute of Pharmacology, Department for Biomedical Sciences, University of Veterinary Medicine Vienna, Vienna, Austria
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Tomasello G, Chiesa MD, Buti S, Brighenti M, Negri F, Rovere RK, Martinotti M, Buononato M, Brunelli A, Lazzarelli S, Donati G, Passalacqua R. Dose-dense Chemotherapy in Metastatic Gastric Cancer with a Modified Docetaxel-Cisplatin-5-Fluorouracil Regimen. TUMORI JOURNAL 2018; 96:48-53. [DOI: 10.1177/030089161009600108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Previous studies have reported that in early breast cancer, lymphomas and advanced bladder cancer, dose-dense chemotherapy may be more effective than conventional treatments. In metastatic gastric cancer, chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TCF) q3w is very active, and, even though there is no international consensus on the subject, it is the regimen of choice of many European centers as first-line chemotherapy in this subset of patients. Based on these studies, we tested for the first time the feasibility and activity of an intensified dose-dense TCF regimen (q2w) modifying the 5-fluorouracil infusion with l-folinic acid/5-fluorouracil according to the “De Gramont regimen”. Methods and study design Patients with histologically confirmed measurable metastatic gastric cancer, ECOG performance status ≤1, and not previously treated for advanced disease received docetaxel, 85 mg/m2 (75 mg/m2 after the first 6 patients, 70 mg/m2 after the 19th patient) on day 1, cisplatin, 75 mg/m2 on day 1 (60 mg/m2 after the 19th patient), l-folinic acid, 100 mg/m2 on days 1 and 2, followed by 5-fluorouracil, 400 mg/m2 bolus on days 1 and 2 and then 600 mg/m2 as a 22-h continuous infusion on days 1 and 2, every 14 days, plus pegfilgrastim, 6 mg on day 3. Patients aged ≥65 years received the same schedule with a dose reduction of 30%. Results Thirty-two consecutive patients were enrolled (63% male, 37% female); median age, 64 years (range, 40–81). A median of 4 cycles (range, 1–7) per patient was administered. Eleven of 32 patients (34%) required a dose reduction, mostly for hematological grade III-IV toxicity and severe asthenia. Twelve patients (38%) completed the first 4 cycles of therapy within 7 weeks, thereby finishing without delay the initially planned dose-density schedule. Twenty-eight patients were evaluated for response (1 early suspension after the first cycle because of toxicity, 3 deaths before response evaluation due to progression of disease). There were 3 complete responses (9%), 15 partial responses (47%), 7 stable disease (22%) and 3 progression of disease (9%), for an overall response rate, by intention to treat, of 56% (95% CI, 39–73). The most frequent grade 3–4 toxicities were: neutropenia (53%), thrombocytopenia (34%), anemia (16%) febrile neutropenia (22%), asthenia (38%) and diarrhea (19%). Median time to progression was 9.1 months (95% CI, 6.0–12.2); median overall survival was 10.1 months (95% CI, 8.8–12.2). Conclusions A dose-dense TCF regimen in metastatic gastric cancer is feasible, with activity comparable to previous results achieved with epirubicin-based chemotherapy and TCF q3wk in terms of overall survival and time to progression, and deserves to be further tested in randomized phase III studies.
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Affiliation(s)
- Gianluca Tomasello
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Matteo Dalla Chiesa
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Sebastiano Buti
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Matteo Brighenti
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Federica Negri
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Rodrigo Kraft Rovere
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Mario Martinotti
- Surgery Division, Azienda Istituti
Ospitalieri di Cremona, Cremona, Italy
| | - Massimo Buononato
- Surgery Division, Azienda Istituti
Ospitalieri di Cremona, Cremona, Italy
| | - Antonio Brunelli
- Surgery Division, Azienda Istituti
Ospitalieri di Cremona, Cremona, Italy
| | - Silvia Lazzarelli
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Gianvito Donati
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Rodolfo Passalacqua
- Medical Oncology Division, Azienda
Istituti Ospitalieri di Cremona, Cremona, Italy
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Effects of natural phenolic compound carvacrol on the human gastric adenocarcinoma (AGS) cells in vitro. Anticancer Drugs 2017; 28:522-530. [PMID: 28244942 DOI: 10.1097/cad.0000000000000491] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastric cancer (GC) is the most common cause of morbidity and mortality because of cancer. Medicinal plants containing polyphenolic compounds have gained importance in anticancer treatment. In this context, carvacrol is a main component of many plants in the family Lamiaceae that are frequently used in folk medicine and a good candidate to investigate for GC treatment. The present study aimed to explore the cytotoxic, genotoxic, apoptotic, and reactive oxygen species (ROS)-generating effects of carvacrol on gastric adenocarcinoma in vitro. For these purposes, human gastric adenocarcinoma (AGS) cells were used and analyzed after 24 h of exposure to carvacrol with different concentrations. The cytotoxicity, ROS generation, glutathione (GSH) level, and genotoxicity were investigated by the ATP cell viability assay, 2',7'-dichlorodihydrofluorescein-diacetate assay, GSH/GSSG-Glo assay, and comet assay, respectively. Apoptosis induction was detected by acridine orange/ethidium bromide staining and western blotting at below the half-maximal growth inhibitory concentration value. Carvacrol showed cytotoxic, genotoxic, apoptotic, ROS generating, and GSH-reducing effects on AGS cells in a dose-dependent manner. There was a close negative relationship between cell viability and ROS level. Carvacrol inhibited the proliferation of AGS cells, suggesting that it could be a novel and strong anticancer agent against the human gastric adenocarcinoma. These results support the interest of natural diet components in the development of therapeutic products for diseases.
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13
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Will molecular target agents enable the multidisciplinary treatment in stage IV gastric cancer? Eur J Surg Oncol 2017; 43:1835-1845. [PMID: 28888797 DOI: 10.1016/j.ejso.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 02/06/2023] Open
Abstract
A detailed molecular characterization of gastric cancer has been revealed by global initiatives and a number of new molecular agents are under investigation. Currently only trastuzumab, a monoclonal antibody for human epidermal growth factor receptor 2 (HER2), is clinically used for HER2 positive advanced gastric cancer patients and ramucirumab, a monoclonal antibody directed against the extracellular ligand-binding domain of vascular endothelial growth factor receptor (VEGFR)2, can be used in second line. However, despite the progress in gastric cancer treatment, the prognosis of stage IV gastric cancer patients remains dismal. To achieve a remarkable improvement in the prognosis of patients, a multidisciplinary treatment approach with the help of effective molecular target agents should be considered. So far the role of multidisciplinary treatment for stage IV gastric cancer is still uncertain due to limited available data and absence of long-lasting tumor control with systemic therapy. Herein, an overview of the latest developments of molecular targeted agents for gastric cancer in advanced stages, in the perioperative setting and in oligometastatic disease is provided. The possibility of a multidisciplinary strategy using molecular target agents and surgery for stage IV gastric cancer is also assessed.
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Abstract
OPINION STATEMENT Two cycles of neoadjuvant cisplatin and fluoropyrimidine (CF) and 6 cycles of perioperative CF with or without epirubicin are an evidence-based approach in operable esophageal and esophagogastric junctional adenocarcinomas. Three-drug regimens with anthracycline or taxane are associated with significantly higher tumor regression rates, with an expected increase in toxicity. In order to achieve an R0 resection and consequently a survival advantage, in selected patients having a risk of a threatened margin or incomplete resection, chemotherapy might be continued beyond 2 cycles if a response has been demonstrated. In metastatic setting, multidrug combination regimens have demonstrated a significant survival benefit when compared to single-agent regimes. A three-drug regimen should be considered for fit patients and/or when a response is required for symptom control. The expected increase in toxicity needs to be carefully considered and discussed with patients. The choice to use a taxane in first-line setting may limit the options of second-line treatment to irinotecan-containing regimens and also precludes the use of anthracyclines in the first line. For this reason, we prefer to reserve taxane-based therapy for the second-line setting.
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15
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Spiegel D, Palta M, Uronis H. Role of Chemotherapy and Radiation Therapy in the Management of Gastric Adenocarcinoma. Surg Clin North Am 2017; 97:421-435. [PMID: 28325195 DOI: 10.1016/j.suc.2016.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Gastric adenocarcinoma is the fifth most common cancer worldwide and is often diagnosed at a late stage with nearly 50% of patients having locally advanced, unresectable, or metastatic disease at the time of presentation. Efforts to improve outcomes in patients with resected and unresectable gastric cancer with various chemotherapy and radiation regimens are ongoing. Appropriate evaluation and management is often not straightforward and requires the input of a multidisciplinary team. There is no consensus as to the best approach for treatment of gastric cancer; however, the available data and our institutional approach to the management of gastric cancer are discussed.
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Affiliation(s)
- Daphna Spiegel
- Department of Radiation Oncology, Duke University, DUMC Box 3085, Durham, NC 27710, USA
| | - Manisha Palta
- Department of Radiation Oncology, Duke University, DUMC Box 3085, Durham, NC 27710, USA
| | - Hope Uronis
- Division of Medical Oncology, Duke University, DUMC Box 2823, Durham, NC 27710, USA.
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Kagedan DJ, Frankul F, El-Sedfy A, McGregor C, Elmi M, Zagorski B, Dixon ME, Mahar AL, Vasilevska-Ristovska J, Helyer L, Rowsell C, Swallow CJ, Law CH, Coburn NG. Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer. ACTA ACUST UNITED AC 2016; 23:273-9. [PMID: 27536178 DOI: 10.3747/co.23.3124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Before undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery. METHODS In a provincial cancer registry, 2414 patients with ga diagnosed during 2005-2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases. RESULTS Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407). CONCLUSIONS Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy.
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Affiliation(s)
- D J Kagedan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - F Frankul
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - A El-Sedfy
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, U.S.A
| | - C McGregor
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON
| | - M Elmi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - B Zagorski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - M E Dixon
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY, U.S.A
| | - A L Mahar
- Department of Public Health Sciences, Queen's University, Kingston, ON
| | | | - L Helyer
- Division of General Surgery, Dalhousie University, Halifax, NS
| | - C Rowsell
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - C J Swallow
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON
| | - C H Law
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - N G Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON; Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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17
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Abstract
Unresectable gastric cancer cases are often diagnosed at a far advanced stage, which are hard to resect radically and suffer a poor prognosis. Therefore, palliative chemotherapy is recommended as the main treatment by the current clinical guidelines for gastric cancer. Fortunately, in recent years some clinical studies revealed that after treatment with chemotherapy, radiotherapy, targeted therapy, interventional therapy, hyperthermic intraperitoneal chemotherapy (HIPEC) and so on, and multidisciplinary assessment, many unresectable gastric cancer cases could be converted into resectable cases, which consequently prolongs their survival time and improves their quality of life significantly. In the present review, we summarize the status and progress of treatment for unresectable gastric cancer, as well as the strategy and case selection for conversion therapy.
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18
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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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19
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Pan WR, Chen YLS, Hsu HC, Chen WJ. Antimicrobial peptide GW-H1-induced apoptosis of human gastric cancer AGS cell line is enhanced by suppression of autophagy. Mol Cell Biochem 2014; 400:77-86. [DOI: 10.1007/s11010-014-2264-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/29/2014] [Indexed: 12/13/2022]
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20
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Sun LB, Zhao GJ, Ding DY, Song B, Hou RZ, Li YC. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute. World J Surg Oncol 2014; 12:280. [PMID: 25200958 PMCID: PMC4177253 DOI: 10.1186/1477-7819-12-280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/02/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gastric cancer is the third leading cause of cancer-related mortality in China, and the long-term survival for locally advanced gastric cancer is very poor. Simple surgery cannot yield an ideal result because of the high recurrence rate after tumor resection. Preoperative chemotherapy could help to reduce tumor volume, improve the R0 resection rate (no residual tumor after surgery), and decrease the risk of local tumor recurrence. The aim of this study was to evaluate the influence of pathological differentiation in the effect of preoperative chemotherapy for patients with locally advanced gastric cancer. METHODS Patients with locally advanced gastric cancer (n = 32) received preoperative chemotherapy under the XELOX (capecitabine plus oxaliplatin) regimen. According to pathological examination, patients' tumors were classified into better (well and moderate) and poorly differentiated (lower differentiated and undifferentiated) groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups of patients. Morphological changes and toxic reactions were monitored after chemotherapy. RESULTS The results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% versus 25%, P = 0.000). The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% versus 25% P = 0.000). A significant shrinking of tumor and necrosis of tumor tissues caused by chemotherapy could be observed. CONCLUSIONS In conclusion, the better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy under the XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for the better differentiated group.
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Affiliation(s)
- Li-Bo Sun
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Guo-Jie Zhao
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Da-Yong Ding
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Bin Song
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Rui-Zhi Hou
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
| | - Yong-Chao Li
- >Department of Gastrointestinal Surgery, China-Japan Union Hospital, Jilin University, No. 126, Xiantai Street, Changchun, 130033 China
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Abstract
BACKGROUND Although its incidence has been steadily decreasing in Western countries, gastric cancer remains a leading cause of cancer deaths worldwide. The detection rate of early-stage cancers is improving; nevertheless, the majority of cases is still diagnosed at later stages with a poor prognosis. Furthermore, the results that can be achieved with surgery have reached a plateau of effectiveness. SUMMARY Neoadjuvant chemotherapy was successfully introduced first in patients with non-curatively resectable disease. In the last decade, neoadjuvant chemotherapy has also been established in potentially curatively resectable cases and has become the state-of-the-art treatment. Esophagogastric junction (EGJ) tumors are not optimally treated with chemotherapy alone, and combined radiochemotherapy (RCT) seems to yield superior outcomes. KEY MESSAGE The use of neoadjuvant therapy has been successfully established in patients with curatively resectable disease. Neoadjuvant chemotherapy is now a cornerstone in the treatment of gastric cancer and cancer of the EGJ, although further work is needed in order to define the optimal combination regimen. PRACTICAL IMPLICATIONS Neoadjuvant chemotherapy is currently the gold standard for the treatment of gastric cancer and cancer of the EGJ. Several independent studies have shown the benefits of using combination regimens that included cisplatin and 5-fluorouracil, though recently the use of the EOX (epirubicin, oxaliplatin and capecitabine) regimen has been widely accepted in this setting. Tumors of the EGJ benefit from neoadjuvant treatment with combined RCT. It should be noted that the optimal neoadjuvant regimen in EGJ tumors has not yet been defined, and the survival advantage of neoadjuvant RCT over neoadjuvant chemotherapy remains to be established in this patient population.
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Affiliation(s)
- Markus Menges
- Department of Internal Medicine 2, Diakonie-Hospital, Schwäbisch Hall, Recklinghausen, Germany
| | - Thomas Hoehler
- Department of Internal Medicine 1, Prosper Hospital, Recklinghausen, Germany
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22
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Wu JR, Tang WZ, Chen X, Xie YT, Chen SY, Peng QL, Xie L, Deng Y, Li TJ, He Y, Wang J, Li S, Qin X. S-1-based therapy versus S-1 monotherapy in advanced gastric cancer: a meta-analysis. Tumour Biol 2014; 35:3283-93. [PMID: 24390661 DOI: 10.1007/s13277-013-1429-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/13/2013] [Indexed: 12/14/2022] Open
Abstract
This study aimed to derive a more precise estimate of the prognostic significance of S-1-based therapy over S-1 monotherapy in patients with advanced gastric cancer (AGC), including overall survival (OS) time, progression-free survival (PFS) time, objective response rate (ORR), and adverse events (AEs). Studies stratifying OS, PFS, ORR, and AEs in AGC patients in an S-1-based therapy versus an S-1 monotherapy setting were eligible for analysis by systematic computerized PubMed, Embase and Cochrane Library searches. Data from these studies were pooled using STATA package version 11.0. Six studies that investigated outcomes in a total of 913 AGC cases, of which 443 (48.5%) received S-1-based therapy and 470 (51.5%) received S-1 monotherapy, were included in the meta-analysis. Median OS and median PFS were significantly prolonged in AGC patients receiving S-1-based therapy compared with those receiving S-1 monotherapy (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.71-0.96, P = 0.015, and HR 0.69, 95% CI 0.60-0.80, P = 0.000, respectively). The ORR favored patients with S-1-based therapy (OR 1.65, 95% CI 1.34-2.06, P = 0.000). Higher incidence of grade 3/4 neutropenia was found in patients with S-1-based therapy (P = 0.000). For the Asian population, S-1-based therapy significantly improved OS and PFS and enhanced ORR in comparison to S-1 monotherapy. The safety profile was poorer in patients with S-1-based therapy, but could be considerable between the S-1-based therapy and S-1 monotherapy group. Our conclusion needs to be confirmed via high-quality trials and the results need to be reproduced in other regions and populations.
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Affiliation(s)
- Jun-Rong Wu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
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Pan WR, Chen PW, Chen YLS, Hsu HC, Lin CC, Chen WJ. Bovine lactoferricin B induces apoptosis of human gastric cancer cell line AGS by inhibition of autophagy at a late stage. J Dairy Sci 2013; 96:7511-20. [PMID: 24140317 DOI: 10.3168/jds.2013-7285] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/02/2013] [Indexed: 01/14/2023]
Abstract
Gastric cancer is one of the most common malignant cancers, with poor prognosis and high mortality rates worldwide. Therefore, development of an effective therapeutic method without side effects is an urgent need. It has been reported that cationic antimicrobial peptides can selectively bind to negatively charged prokaryotic and cancer cell membranes and exert cytotoxicity without causing severe drug resistance. In the current study, we prepared a series of peptide fragments derived from bovine lactoferrin and evaluated their anticancer potency toward the gastric cancer cell line AGS. Cell viability assay revealed that a 25-AA peptide fragment, lactoferricin B25 (LFcinB25), exhibited the most potent anticancer capability against AGS cells. Lactoferricin B25 selectively inhibited AGS cell growth in a dose-dependent manner, exhibiting a half-maximal inhibitory concentration (IC50) value of 64 μM. Flow cytometry showed a notable increment of the sub-G1 populations of the cell cycle, indicating the induction of apoptosis by LFcinB25. Western blot analysis further revealed that upon LFcinB25 treatment for 2 to 6h, apoptosis-related caspases-3, 7, 8, 9, and poly(ADP-ribose) polymerase (PARP) were cleaved and activated, whereas autophagy-related LC3-II and beclin-1 were concomitantly increased. Thus, both apoptosis and autophagy are involved in the early stage of LFcinB25-induced cell death of AGS cells. However, upon treatment with LFcinB25 for 12 to 24h, LC3-II began to decrease, whereas cleaved beclin-1 increased in a time-dependent manner, suggesting that consecutive activation of caspases cleaved beclin-1 to inhibit autophagy, thus enhancing apoptosis at the final stage. These findings provide support for future application of LFcinB25 as a potential therapeutic agent for gastric cancer.
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Affiliation(s)
- W-R Pan
- Department of Biotechnology and Animal Science, National Ilan University, 1 Shen-Lung Road Sec.1, Ilan 26047, Taiwan, Republic of China
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Potential Therapeutic Role of Hispidulin in Gastric Cancer through Induction of Apoptosis via NAG-1 Signaling. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:518301. [PMID: 24159347 PMCID: PMC3789485 DOI: 10.1155/2013/518301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/07/2013] [Accepted: 06/09/2013] [Indexed: 01/05/2023]
Abstract
Gastric cancer is one of the most common malignant cancers due to poor prognoses and high mortality rates worldwide. However, an effective chemotherapeutic drug without side effects remains lacking. Saussurea involucrata (SI) Kar. et Kir., also known as snow lotus, grows in mountainous rocky habitats at 2600 m elevation in the Tian Shan and A'er Tai regions of China. The ethyl acetate extract of SI had been shown to inhibit proliferation and induce apoptosis in various tumor cells. In this study, we demonstrated that Hispidulin, active ingredients in SI, inhibits the growth of AGS gastric cancer cells. After Hispidulin treatment, NAG-1 remained highly expressed, whereas COX-2 expression was downregulated. Flow cytometric analysis indicated that Hispidulin induces G1/S phase arrest and apoptosis in time- and concentration-dependent manners. G1/S arrest correlated with upregulated p21/WAF1 and p16 and downregulated cyclin D1 and cyclin E, independent of p53 pathway. In addition, Hispidulin can elevate Egr-1 expression and ERK1/2 activity, whereas ERK1/2 inhibitor markedly attenuated NAG-1 mediated apoptosis. Taken together, Hispidulin can efficiently activate ERK1/2 signaling followed by NAG-1 constitutive expression and trigger cell cycle arrest as well as apoptosis in cancer cell. It can be a potential compound for combination therapy of gastric cancer in the future.
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Lu Z, Lu M, Zhang X, Li J, Zhou J, Gong J, Gao J, Li J, Zhang X, Li Y, Shen L. Advanced or metastatic gastric cancer in elderly patients: clinicopathological, prognostic factors and treatments. Clin Transl Oncol 2012; 15:376-83. [PMID: 23054754 DOI: 10.1007/s12094-012-0938-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/30/2012] [Indexed: 01/29/2023]
Abstract
PURPOSE To analyze the clinicopathological features, prognostic factors, treatment efficacy and safety among elderly patients with advanced or metastatic gastric cancer. METHODS Three hundred and nineteen patients aged 65 years and older, diagnosed with advanced or metastatic gastric cancer, were followed and data were retrospectively collected, reviewed and analyzed. RESULTS The elderly patients carried specific clinicopathological characteristics. Body mass index (BMI), number of metastatic lesions, ascites, Karnofsky performance score (KPS), tumor differentiation grade, lactate dehydrogenase (LDH) level, local treatment, and chemotherapy were the independent prognostic factors. Serum LDH level was superior to the serum CEA level in the prognosis of advanced or metastatic gastric cancer in older patients. Cisplatin-based regimen, chemotherapy cycles, metastatic lesions, LDH level, and supraclavicular lymph node metastasis were the independent prognostic factors in 220 patients receiving chemotherapy. The toxicity was mild and tolerable. CONCLUSION KPS, BMI and a well-differentiated histopathology were factors favoring longer survival, whereas elevated serum LDH and a greater number of metastatic lesions were associated with poor prognosis among those elderly patients. Cisplatin-based chemotherapy provided survival benefits and mild toxicity.
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Affiliation(s)
- Z Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, 100142, China
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Lu Z, Lu M, Zhang X, Li J, Zhou J, Gong J, Gao J, Li J, Zhang X, Li Y, Shen L. Advanced or metastatic gastric cancer in elderly patients: clinicopathological, prognostic factors and treatments. Clin Transl Oncol 2012; 139:2111-6. [PMID: 23054754 DOI: 10.1007/s00432-013-1537-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To analyze the clinicopathological features, prognostic factors, treatment efficacy and safety among elderly patients with advanced or metastatic gastric cancer. METHODS Three hundred and nineteen patients aged 65 years and older, diagnosed with advanced or metastatic gastric cancer, were followed and data were retrospectively collected, reviewed and analyzed. RESULTS The elderly patients carried specific clinicopathological characteristics. Body mass index (BMI), number of metastatic lesions, ascites, Karnofsky performance score (KPS), tumor differentiation grade, lactate dehydrogenase (LDH) level, local treatment, and chemotherapy were the independent prognostic factors. Serum LDH level was superior to the serum CEA level in the prognosis of advanced or metastatic gastric cancer in older patients. Cisplatin-based regimen, chemotherapy cycles, metastatic lesions, LDH level, and supraclavicular lymph node metastasis were the independent prognostic factors in 220 patients receiving chemotherapy. The toxicity was mild and tolerable. CONCLUSION KPS, BMI and a well-differentiated histopathology were factors favoring longer survival, whereas elevated serum LDH and a greater number of metastatic lesions were associated with poor prognosis among those elderly patients. Cisplatin-based chemotherapy provided survival benefits and mild toxicity.
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Affiliation(s)
- Z Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, 100142, China
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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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Nakayama A, Alladin KP, Igbokwe O, White JD. Systematic review: generating evidence-based guidelines on the concurrent use of dietary antioxidants and chemotherapy or radiotherapy. Cancer Invest 2011; 29:655-67. [PMID: 22085269 PMCID: PMC3666569 DOI: 10.3109/07357907.2011.626479] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The risk-benefit ratio for concurrent use of dietary antioxidants with chemotherapy or radiation therapy is a controversial topic. In this review, the medical literature on concurrent antioxidant use with chemotherapy or radiotherapy was assessed and further steps for generating evidence-based guidelines are suggested. The clinical cancer research community should cooperate and focus new studies on the use of a specific combination of antioxidant and chemotherapy or radiotherapy, and determine optimal doses for a specific cancer setting. Mechanistic studies on the interaction between antioxidants and conventional cancer therapy could lead to novel biomarkers for assessing dose adequacy.
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Affiliation(s)
- Akiko Nakayama
- Preferred Staffing Group, Inc., Washington, District of Columbia, USA
| | - Karen P. Alladin
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, Bethesda, Maryland, USA
| | - Obianuju Igbokwe
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, Bethesda, Maryland, USA
| | - Jeffrey D. White
- Office of Cancer Complementary and Alternative Medicine, National Cancer Institute, Bethesda, Maryland, USA
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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: 78] [Impact Index Per Article: 6.0] [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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Phase II trial of induction irinotecan-cisplatin followed by concurrent irinotecan-cisplatin and radiotherapy for unresectable, locally advanced gastric and oesophageal-gastric junction adenocarcinoma. Cancer Chemother Pharmacol 2010; 67:75-82. [PMID: 20198372 DOI: 10.1007/s00280-010-1285-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/09/2010] [Indexed: 12/26/2022]
Abstract
PURPOSE The prognosis of patients with unresectable M0 gastric cancer remains very poor. We performed a phase II trial to explore the efficacy and toxicity of induction irinotecan-cisplatin (IC) followed by concurrent irinotecan-cisplatin and radiotherapy (IC/RT) in this setting. METHODS AND MATERIALS Patients with unresectable M0 gastric (GC) or oesophageal-gastric junction (EGJC) adenocarcinomas were treated with two courses of IC (irinotecan, 65 mg/m(2); cisplatin, 30 mg/m(2) on days 1 and 8 every 21 days) followed by IC/RT (daily radiotherapy-45 Gy-with concurrent IC: irinotecan, 65 mg/m(2), and cisplatin, 30 mg/m(2), on days 1, 8, 15, and 22). Resectability was reassessed after this treatment, and surgical resection was performed if feasible. The primary endpoint was the R0 resection rate after induction treatment. RESULTS Seventeen patients were included in the study (EGJC: 6; GC: 11). An R0 resection was achieved in only 5 patients (29%), and according to the design of the trial (Simon's optimal two-stage) accrual of patients was terminated after the first stage. No patient died during IC, whereas 3 patients (24%) died during IC/RT and one of 5 resected patients (20%) died during the first 30 days after resection. The median survival was 10.5 months, and the actuarial 2-year survival rate was 27%. CONCLUSIONS Induction IC followed by IC/RT showed poor efficacy and significant toxicity in patients with unresectable GC/EGJC.
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Makino T, Fujiwara Y, Takiguchi S, Miyata H, Yamasaki M, Nakajima K, Nishida T, Mori M, Doki Y. The utility of pre-operative peritoneal lavage examination in serosa-invading gastric cancer patients. Surgery 2010; 148:96-102. [PMID: 20096433 DOI: 10.1016/j.surg.2009.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 11/25/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Peritoneal dissemination is frequently found during laparotomy in patients with serosa-invading gastric cancer. Detection of exfoliated cancer cells in abdominal lavage cytology is indicative of stage IV because of its strong association with peritoneal dissemination. Herein we have described peritoneal lavage cytology using a bedside procedure under local anesthesia. METHODS A prospective study of 113 patients with serosa-invading gastric cancer but without peritoneal metastases was performed. A drainage tube was inserted into the abdominal cavity for peritoneal lavage. Patients with negative cytology (CY0) were scheduled for curative gastrectomy. RESULTS The bedside procedure was performed safely without any complications. Lavage cytology identified CY1 in 35 (31.0%) patients and CY0 in 78 (69.0%) patients. Patients with CY0 underwent laparotomy and peritoneal lavage cytology, and 9 were found to have peritoneal disease (3 with operative CY1, 4 with peritoneal dissemination, and 2 with both operative CY1 and peritoneal dissemination). Two other patients had small, distant metastases. Finally, curative gastrectomy was achieved in 67 (59.3%) patients, but not in 46 (40.7%) patients. Thus, our bedside, pre-operative peritoneal lavage detected 76.1% (35/46) of noncurative disease before operative with a false-negative rate for detecting peritoneal disease of 20.5% (9/44). Patients with pre-operative CY1 had a poorer prognosis than pre-operative CY0 (2-year cause-specific survival 26.6% vs 82.6%). CONCLUSION Pre-operative bedside peritoneal lavage under local anesthesia followed by cytology is a simple and safe method for the pre-operative diagnosis of peritoneal dissemination and may help to reduce unexpected, noncurative surgery.
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Affiliation(s)
- Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
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Sym SJ, Chang HM, Ryu MH, Lee JL, Kim TW, Yook JH, Oh ST, Kim BS, Kang YK. Neoadjuvant docetaxel, capecitabine and cisplatin (DXP) in patients with unresectable locally advanced or metastatic gastric cancer. Ann Surg Oncol 2009; 17:1024-32. [PMID: 19941081 DOI: 10.1245/s10434-009-0838-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND This phase II study was conducted to evaluate the efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin and capecitabine (DXP) in patients with unresectable locally advanced and/or intra-abdominal metastatic gastric cancers. METHODS Patients with advanced gastric cancer (AGC), clinically unresectable because of local invasion or limited intra-abdominal metastasis in para-aortic lymph nodes and/or the peritoneum based on multidetector row computed tomography, were enrolled. DXP consisted of docetaxel 60 mg/m(2) i.v. and cisplatin 60 mg/m(2) i.v. on day 1, and capecitabine 937.5 mg/m(2) twice daily p.o. on days 1-14 every 21 days. Surgery was performed after 4-6 cycles of DXP. RESULTS Thirty-six (74%) of the 49 patients enrolled underwent surgery, and 31 (63%) had an R0 resection. R0 resection was possible in 15 of 21 patients (71%) with unresectable locally advanced lesions, 12 of 17 patients (70%) with para-aortic lymph node metastasis but only 4 of 11 patients (36%) with peritoneal metastasis. Grade 3/4 toxicities included neutropenia (69%), febrile neutropenia (4%) and hand-foot syndrome (8%). CONCLUSIONS Neoadjuvant DXP may offer a reasonable chance of curative surgery in AGC patients with unresectable locally advanced or para-aortic lymph node metastasis.
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Affiliation(s)
- Sun Jin Sym
- Division of Oncology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gastric cancer. Crit Rev Oncol Hematol 2009; 71:127-64. [PMID: 19230702 DOI: 10.1016/j.critrevonc.2009.01.004] [Citation(s) in RCA: 318] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 01/08/2009] [Accepted: 01/15/2009] [Indexed: 02/08/2023] Open
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Cervantes A, Roselló S, Roda D, Rodríguez-Braun E. The treatment of advanced gastric cancer: current strategies and future perspectives. Ann Oncol 2008; 19 Suppl 5:v103-7. [DOI: 10.1093/annonc/mdn321] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Menges M, Hoehler T. Current strategies in systemic treatment of gastric cancer and cancer of the gastroesophageal junction. J Cancer Res Clin Oncol 2008; 135:29-38. [PMID: 18523800 DOI: 10.1007/s00432-008-0425-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 05/16/2008] [Indexed: 12/13/2022]
Abstract
Gastric cancer is a major health issue and a leading cause of death worldwide. The results of standard therapy remain unsatisfactory mainly because of diagnosis at the late stage of disease. Innovative strategies such as neoadjuvant chemotherapy in locally advanced cancer have improved the outcome even in operable cases. Whether an adjuvant radiochemotherapy is of benefit after curative resection including systematic lymphadenectomy remains yet unclear. Some progress has been made in the palliative setting by introducing new substances. This review examines recent advances in the systemic treatment of gastric and gastroesophageal junction cancer.
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Affiliation(s)
- Markus Menges
- Department of Internal Medicine, Diakonie-Klinikum gGmbH, Diakoniestr.10, 74523, Schwaebisch Hall, Germany.
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Jung JY, Rha SY, Ahn JB, Yang WI, Noh SH, Chung HC, Jeung HC. S-1 monotherapy as a neoadjuvant treatment for locally advanced gastric cancer. Korean J Intern Med 2008; 23:37-41. [PMID: 18363278 PMCID: PMC2686958 DOI: 10.3904/kjim.2008.23.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
S-1, a novel oral fluoropyrimidine, is an effective therapeutic agent for gastric cancer. Herein, we report a case with locally advanced gastric cancer that achieved a curative resection after S-1 monotherapy as neoadjuvant treatment. A 68-year-old man was diagnosed with gastric cancer and massive lymphadenopathy involving the perigastric, celiac axis and splenic hilum. His clinical stage was cT3N2H0P0M0. Considering his relatively poor performance (ECOG 2, severe weight loss) and advanced age, we started the patient on S-1 monotherapy at a dose of 35 mg/m2 bid for 4 consecutive weeks followed by a 2-week rest. Follow-up study after 4 treatment cycles revealed disappearance of the lymphadenopathy of the perigastric and celiac axis with diminished extension of the stomach mass. The patient had a partial response (PR) with a 72% tumor reduction, according to the Response Evaluation Criteria in Solid Tumors (RECIST). His performance status was improved to an ECOG 1 and he gained 7 kg. A curative (R0) resection was achieved with a radical total gastrectomy and D2 dissection. The pathological stage was pT3N2M0, stage IIIB. In conclusion, S-1 neoadjuvant chemotherapy aided in the treatment of gastric cancer in this patient.
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Affiliation(s)
- Jong Yul Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Joong Bae Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Cheol Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hei-Cheul Jeung
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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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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Cascinu S, Labianca R, Barone C, Santoro A, Carnaghi C, Cassano A, Beretta GD, Catalano V, Bertetto O, Barni S, Frontini L, Aitini E, Rota S, Torri V, Floriani I, Pozzo C, Rimassa L, Mosconi S, Giordani P, Ardizzoia A, Foa P, Rabbi C, Chiara S, Gasparini G, Nardi M, Mansutti M, Arnoldi E, Piazza E, Cortesi E, Pucci F, Silva RR, Sobrero A, Ravaioli A. Adjuvant treatment of high-risk, radically resected gastric cancer patients with 5-fluorouracil, leucovorin, cisplatin, and epidoxorubicin in a randomized controlled trial. J Natl Cancer Inst 2007; 99:601-7. [PMID: 17440161 DOI: 10.1093/jnci/djk131] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Promising findings obtained using a weekly regimen of 5-fluorouracil (5-FU), epidoxorubicin, leucovorin (LV), and cisplatin (PELFw) to treat locally advanced and metastatic gastric cancer prompted the Italian Group for the Study of Digestive Tract Cancer (GISCAD) to investigate the efficacy of this regimen as adjuvant treatment for high-risk radically resected gastric cancer patients. METHODS From January 1998 to January 2003, 400 gastric cancer patients at high risk for recurrence including patients with serosal invasion (stage pT3 N0) and/or lymph node metastasis (stage pT2 or pT3 N1, N2, or N3), were enrolled in a trial of adjuvant chemotherapies; 201 patients were randomly assigned to receive the PELFw regimen, consisting of eight weekly administrations of cisplatin (40 mg/m2), LV (250 mg/m2), epidoxorubicin (35 mg/m2), 5-FU (500 mg/m2), and glutathione (1.5 g/m2) with the support of filgrastim, and 196 patients were assigned to a regimen consisting of six monthly administrations of a 5-day course of 5-FU (375 mg/m2 daily) and LV (20 mg/m2 daily, 5-FU/LV). Disease-free and overall survival were estimated and compared between arms using hazard ratios (HRs) and Kaplan-Meier estimates. All statistical tests were two-sided. RESULTS The 5-year survival rates were 52% in the PELFw arm and 50% in the 5-FU/LV arm. Compared with the 5-FU/LV regimen, the PELFw regimen did not reduce the risk of death (HR = 0.95, 95% confidence interval [CI] = 0.70 to 1.29) or relapse (HR = 0.98, 95% CI = 0.75 to 1.29). Less than 10% of patients in either arm experienced a grade 3 or 4 toxic episode. Neutropenia (occurring more often in the PELFw arm) and diarrhea and mucositis (more prevalent in the 5-FU/LV arm) were the most common serious side effects. Nevertheless, only 19 patients (9.4%) completed the treatment in the PELFw arm and 85 (43%) patients completed the treatment in the 5-FU/LV arm. CONCLUSIONS Our study found no benefit from an intensive weekly chemotherapy in gastric cancer. The extent of toxicity experienced by the patients in the adjuvant setting suggests that, in gastric cancer, chemotherapy may be more safely administered preoperatively.
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Affiliation(s)
- Stefano Cascinu
- Universita' Politecnica delle Marche, Via Conca 60020 Ancona, Italy.
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Kobayashi O, Tsuburaya A, Yoshikawa T, Osaragi T, Murakami H, Yoshida T, Sairenji M. The efficacy of gastrectomy for large gastric cancer. Int J Clin Oncol 2006; 11:44-50. [PMID: 16508728 DOI: 10.1007/s10147-005-0535-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Accepted: 09/20/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND Large gastric cancer (LGC) is frequently associated with extended disease, and the role of surgical resection has been debated. We investigated the efficacy of surgical treatment for LGC. METHODS The size of LGC was defined as 8 cm or greater. Four hundred and fifteen patients with LGC who underwent gastrectomy were included. The clinicopathological features, the status of the residual tumor, the incidence and patterns of relapse, and the survival were analyzed. RESULTS Macroscopically, diffuse-type tumors were dominant (60%). The numbers of patients with tumors of T3 or greater, lymph node involvement, and peritoneal metastases were 356 (86%), 359 (87%), and 126 (30%), respectively. One hundred and eighty-eight patients (45%) underwent incomplete tumor resection (R2). The R2/R0 (no residual tumor) ratio was greater than 1 in patients with type 4 tumors and N1 or greater metastasis and in those with type 3 tumors and N2 or greater metastasis. In contrast, T2, type 2, and type 5 tumors were more likely to be completely resected. The 5-year survival for all 415 patients was 26%. The survival rates were inversely related to the tumor type, size, and lymph node metastasis. In the 216 patients with R0, the 5-year survivals of those with pN (International Union Against Cancer [UICC] classification) 0, 1, 2, and 3 were 66%, 56%, 36%, and 5%, respectively (P = 0.001). In 96 of these 216 patients (44%) the tumor recurred, and peritoneal metastasis was the most frequent mode of recurrence (48%). By Cox's proportional hazard model, the tumor size was an independent prognostic factor. CONCLUSION The chance of achieving R0 resection for LGC is low, except for T2, type 2, or type 5 tumors. Primary resection should be avoided for other types of LGC.
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Affiliation(s)
- Osamu Kobayashi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Yokohama, 241-0815, Japan.
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Santini D, Graziano F, Catalano V, Di Seri M, Testa E, Baldelli AM, Giordani P, La Cesa A, Spalletta B, Vincenzi B, Russo A, Caraglia M, Virzi V, Cascinu S, Tonini G. Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial. BMC Cancer 2006; 6:125. [PMID: 16686939 PMCID: PMC1475875 DOI: 10.1186/1471-2407-6-125] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 05/10/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients have been often excluded from or underrepresented in the study populations of combination chemotherapy trials. The primary end point of this study was to determine the response rate and the toxicity of the weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) regimen in elderly patients with advanced gastric cancer. The secondary objective was to measure the time to disease progression and the survival time. METHODS Chemotherapy-naive patients with advanced gastric cancer aged 70 or older were considered eligible for study entry. Patients received weekly oxaliplatin 40 mg/m2, fluorouracil 500 mg/m2 and folinic acid 250 mg/m2. All drugs were given intravenously on a day-1 schedule. RESULTS A total of 42 elderly patients were enrolled. Median age was 73 years and all patients had metastatic disease. The response rate according to RECIST criteria was 45.2% (95% CIs: 30%-56%) with two complete responses, 17 partial responses, 13 stable diseases and 10 progressions, for an overall tumor rate control of 76.2% (32 patients). Toxicity was generally mild and only three patients discontinued treatment because of treatment related adverse events. The most common treatment-related grade 3/4 adverse events were fatigue (7.1%), diarrhoea (4.8%), mucositis (2.4%), neurotoxicity (2.4%) and neutropenia (4.8%). The median response duration was 5.3 months (95% CIs: 2.13 - 7.34), the median time to disease progression was 5.0 months (95% CIs: 3.75 - 6.25) and the median survival time was 9.0 months (95% CIs: 6.18 - 11.82). CONCLUSION OXALF represents an active and well-tolerated treatment modality for elderly patients with locally advanced and metastatic gastric cancer.
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Affiliation(s)
- D Santini
- Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - F Graziano
- Medical Oncology, Civic Hospital, Urbino, Italy
| | - V Catalano
- Medical Oncology, Civic Hospital, Pesaro, Italy
| | - M Di Seri
- Medical Oncology, University La Sapienza, Rome, Italy
| | - E Testa
- Medical Oncology, Civic Hospital, Urbino, Italy
| | - AM Baldelli
- Medical Oncology, Civic Hospital, Pesaro, Italy
| | - P Giordani
- Medical Oncology, Civic Hospital, Pesaro, Italy
| | - A La Cesa
- Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - B Spalletta
- Medical Oncology, University La Sapienza, Rome, Italy
| | - B Vincenzi
- Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - A Russo
- Medical Oncology, University of Palermo, Italy
| | - M Caraglia
- National Cancer Institute Fondazione "G. Pascale", Experimental Oncology, Department, Experimental Pharmacology Unit, Naples, Italy
| | - V Virzi
- Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - S Cascinu
- Division of Medical Oncology, University of Ancona, Ancona, Italy
| | - G Tonini
- Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Adhoute X, Smith D, Vendrely V, Rault A, Sa Cunha A, Legoux JL, Belleannée G, De Lédinghen V, Couzigou P, Masson B. Subsequent resection of locally advanced pancreatic carcinoma after chemoradiotherapy. ACTA ACUST UNITED AC 2006; 30:224-30. [PMID: 16565654 DOI: 10.1016/s0399-8320(06)73157-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the possibility of subsequent resection of locally advanced pancreatic adenocarcinoma after chemotherapy and external-beam radiotherapy. PATIENTS AND METHODS Between January 1996 and January 2001, 33 consecutive patients (18 males and 15 women, mean age 63 years) with locally advanced PA were treated with chemotherapy and concurrent external-beam radiotherapy. Radiotherapy delivered 45-50.4 Gy, in a classical manner (N=27) or on a split-course (N=6). Chemotherapy was made of 5FU by continuous infusion for all patients during 5 weeks and cisplatin at the 1st and 5th weeks (N=22). Tumor resectability was reassessed at the end of the chemoradiotherapy; surgical resection of tumour was attempted in patients whose tumor demonstrated reduction in size, and supplementary radiotherapy of 10 to 15 Gy was delivered to the others. RESULTS Thirty-nine percent of patients experienced grade 3 acute toxicity. WHO criteria response to chemoradiotherapy four weeks after the end of treatment were: 4 partial responders (12%), 6 minor responders (18%), 14 stable disease (42%), 9 progression (28%). Ten patients underwent exploratory laparotomy, in one case vascular encasement did not allow for tumor resection, and in another patient, there was peritoneal carcinomatosis. In the 8 remaining patients, surgical (R0) resection was possible. In one patient histological examination showed fibrosis with no residual tumour. After a median follow-up period of 40 months, median survival was 16 months (66% and 37% of survival at 1 and 2 years respectively). In operated and non-operated patients, survival rates at 24 months were 73% and 12.5% respectively. At 1 year, 80% of the patients treated with radiochemotherapy developed recurrence, metastatic recurrence in 88%. Initial laparotomy, split course radiotherapy were poor outcome factors whereas chemotherapy appears to be a favorable outcome factor. CONCLUSION Subsequent resection of locally advanced pancreatic adenocarcinoma is possible after chemoradiotherapy allowing for a prolonged survival in some patients.
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Affiliation(s)
- Xavier Adhoute
- Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux
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Abstract
Although the incidence of gastric cancer is decreasing, it remains a significant source of cancer-related mortality. Surgery remains the best chance for cure from gastric cancer. Adjuvant and neoadjuvant therapy have played increasing roles in attempting to reduce the disease-specific mortality and prolong survival. In this article, the authors review the literature and summarize the salient points regarding the roles of adjuvant and neoadjuvant therapy for gastric cancer.
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Affiliation(s)
- Ricardo J Gonzalez
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 444, 1515 Holcombe Boulevard, Houston, TX 77030-5235, USA
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43
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Lee YT, Ng EKW, Hung LCT, Chung SCS, Ching JYL, Chan WY, Chu WC, Sung JJ. Accuracy of endoscopic ultrasonography in diagnosing ascites and predicting peritoneal metastases in gastric cancer patients. Gut 2005; 54:1541-5. [PMID: 15955787 PMCID: PMC1774738 DOI: 10.1136/gut.2004.055772] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Preoperative diagnosis of peritoneal metastases (PM) is difficult in patients with gastric cancer (GC). AIMS To assess the accuracy of endoscopic ultrasonography (EUS) in diagnosing ascites and its predictability for the presence of PM in GC patients. SUBJECTS Consecutive patients with newly diagnosed GC from 1998 to 2004 were studied. METHODS All patients underwent EUS, ultrasound (US), and computed tomography (CT) scan for preoperative staging and the presence of ascites. The results were compared with operative findings. The diagnosis of PM was confirmed by histopathology or peritoneal fluid cytology. RESULTS A total of 301 patients were recruited and in 250 patients the presence of ascites (n = 93) and PM (n = 71) were confirmed. EUS was more sensitive (87.1%) than combined US and CT scan examinations (16.1%) and operative findings (laparoscopy or laparotomy) (40.9%) in diagnosing ascites. Sensitivity, specificity, positive and negative predictive values, and accuracy for predicting the presence of PM were 73%, 84%, 64%, 89%, and 81% by EUS; 18%, 99%, 87%, 75%, and 76% by combining US and CT scan; and 77%, 94%, 83%, 91%, and 89% by operative findings, respectively. In multivariate logistic regression analysis, EUS detected ascites was the only significant independent predictor for the presence of PM (p<0.001; odds ratio 4.7 (95% confidence interval 2.0-11.2)). CONCLUSION EUS is a sensitive method for diagnosing ascites which is an important predictive factor for the presence of PM in GC patients.
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Affiliation(s)
- Y T Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China.
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Shih PH, Yeh CT, Yen GC. Effects of anthocyanidin on the inhibition of proliferation and induction of apoptosis in human gastric adenocarcinoma cells. Food Chem Toxicol 2005; 43:1557-66. [PMID: 15964118 DOI: 10.1016/j.fct.2005.05.001] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Revised: 05/03/2005] [Accepted: 05/04/2005] [Indexed: 02/06/2023]
Abstract
Anthocyanins are naturally occurring reddish pigments that abundant in fruits and vegetables. To investigate the mechanistic basis for the anti-tumor properties of anthocyanins, five aglycone (cyanidin, delphinidin, malvidin, pelargonidin, and peonidin) and four glycosylated (cyanidin-3-glucoside, malvidin-3-glucoside, pelargonidin-3-glucoside and peonidin-3-glucoside) anthocyanins were used to examine their effects on cell cycle progression and induction of apoptosis in human gastric adenocarcinoma AGS cells. The data from cell viability assay showed that malvidin exhibited the most potent anti-proliferation effect on AGS cells in a time- and dose-dependent manner (P<0.05). This event is accompanied the arrest of AGS cells at the G0/G1 phase by malvidin at the tested concentrations of 0-200 microM. Cellular uptake of anthocyanin and anthocyanidin was confirmed by HPLC analysis and the intracellular accumulation of malvidin (24.9+/-1.1 microM/mg protein) was observed when treatment of AGS cells with malvidin for 12 h. In addition, an accumulation of AGS cells in sub-G1 phase (20% and 30% increase for 100 and 200 microM of malvidin, respectively) was observed as well as by the appearance of a fraction of cells with an aneudiploid DNA content. The occurrence of apoptosis induced by malvidin was confirmed by morphological and biochemical features, including apoptotic bodies formation, caspase-3 activation and poly(ADP-ribose) polymerase proteolysis. Furthermore, the mitochondrial membrane potential of apoptotic cells after treatment with malvidin was significantly lost and resulted in the elevation of Bax/Bcl-2 ratio for 1.6-fold against control for 100 microM treatment. In addition, the malvidin treatment significantly increased the p38 kinase expression and inhibited the ERK activity, and the effects of malvidin on caspase-3 activation were blocked, respectively, by the ERK and p38 inhibitors. These findings suggest that growth inhibition and cytotoxicity of AGS cells by malvidin is involved in the induction of apoptosis rather than necrosis.
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Affiliation(s)
- Ping-Hsiao Shih
- Department of Food Science, National Chung Hsing University, 250 Kuokuang Road, Taichung 40227, Taiwan
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45
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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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46
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Lin WL, Li DG, Chen Q, Lu HM. Clinical and experimental study of oxaliplatin in treating human gastric carcinoma. World J Gastroenterol 2004; 10:2911-5. [PMID: 15334700 PMCID: PMC4572132 DOI: 10.3748/wjg.v10.i19.2911] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To evaluate the therapeutic effectiveness of oxaliplatin on human gastric carcinoma and to explore its mechanisms.
METHODS: Twenty-two cases of stage IV gastric carcinoma received 4-6 (mean 4.6) cycles of first line combined chemotherapy with oxaliplatin (oxaliplatin 85 mg/m2, iv, gtt, 1 h, d 1; leukovorin 200 mg/m2, iv, gtt, 1 h, d 1 and d 2; 5-FU 300 mg/m2,iv, d 1 and d 2, 5-FU, continuous iv, gtt, 48 h; 1 cycle/2 wk). Response rate, progression-free survival (PFS), total survival time, toxic side effects were evaluated. The inhibitory effect of oxaliplatin on human gastric cell line SGC-7901 was detected and IC50 was calculated by MTT. Transmission electron microscopy, flow cytometry and TUNEL were performed to evaluate the apoptosis of cell line induced by the drug. The expression of Caspase-3 m-RNA was detected by RT-PCR. AC-DEVD-CHO, a Caspase-3 specific inhibitor, was used to elucidate the role of activated Caspase-3 in the process of apoptosis induced by oxaliplatin.
RESULTS: Total response (complete and partial) occurred in 9 (40.9%) patients. Mean PFS was 4.2 mo and mean total survival time was 7.2 mo. Cumulative neurotoxicity (all grade I-II), vomiting and diarrhea, myelosuppression appeared in 93.5%, 20%, 32.9% patients, respectively. IC50 was calculated to be 0.71 mg/L by MTT assay. A maximal inhibitory rate reached 85.3%. Apoptosis index was elevated after incubated with 1 mmol/L oxaliplatin for 30 min, but without statistic significance (P > 0.05). However it could be detected at a much higher degree both by flowcytometry and by TUNEL with a statistical significance (68.47% ± 7.92% and 8.23% ± 2.67%, respectively, P < 0.05) after incubated with 1 mmol/L oxaliplatin for 2 d. By means of RT-PCR, we detected an enhancement of Caspase-3 m-RNA expression induced by oxaliplatin which was also in positive correlation with the apoptotic level. AC-DEVD-CHO, a Caspase-3 specific inhibitor, could significantly inhibit and delay apoptosis induced by oxaliplatin.
CONCLUSION: Oxaliplatin is effective and well-tolerated in patients with advanced gastric carcinoma. Oxaliplatin could significantly inhibit the growth of human gastric cell line SGC-7901. The induction of Caspase-3 m-RNA expression, activation of Caspase-3 and promotion of apoptosis may be some of the therapeutic mechanisms of oxaliplatin on gastric carcinoma. Annexin-V-fluorescein labeling flow cytometry is much more sensitive than TUNEL in detecting early stage apoptosis.
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Affiliation(s)
- Wan-Long Lin
- Department of Gastroenterology, Affiliated Xinhua Hospital, Shanghai Second Medical University, Shanghai 200092, China.
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