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Perioperative chemotherapy and gastric cancer

Christoph Röcken
Gastric cancer is among the most common cancers worldwide. Despite declining incidences, the prognosis remains dismal in Western countries and is better in Asian countries with national cancer screening programs. Complete endoscopic or surgical resection of the primary tumor with or without lymphadenectomy offers the only chance of cure in the early stage of the disease. Survival of more locally advanced gastric cancers was improved by the introduction of perioperative, adjuvant and palliative chemotherapy...
March 2017: Expert Review of Molecular Diagnostics
Eduardo Henrique Cunha Neves Filho, Rosane Oliveira de Sant'Ana, Luiz Vianney Saldanha Cidrão Nunes, Adriana Pinheiro Bezerra Pires, Maria do Perpétuo Socorro Saldanha da Cunha
As the perioperative chemotherapy has been widely implemented on the management of gastric cancer patients, heterogeneity of clinical outcomes has been evidenced in parallel to different histopathological regression pattern of gastric cancer cells. Tumor histological response to preoperative therapy has been graded by various systems in order to categorize the amount of regressive changes induced by chemotherapy in relation to residual tumor. In this context, tumor regression grading (TRG) systems might provide important prognostic information as the variety of tumor response may imply on different clinical outcomes with impact in survival rates...
February 2017: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Tokunaga, Rie Makuuchi, Kei Iida, Kazuhide Nanri, Masashi Yoneyama, Masanori Terashima
BACKGROUND: The prevalence of deep venous thrombosis (DVT) in patients with gastric cancer before surgery is unknown. This study aimed to clarify the risk factors for DVT of the lower extremities in patients with gastric cancer before surgery and to evaluate the usefulness of ultrasonographic screening for prevention of postoperative pulmonary thromboembolism (PTE). METHODS: Patients who had undergone lower-extremity venous ultrasonography before surgery for gastric cancer were retrospectively analyzed...
December 16, 2016: Gastric Cancer
Salah-Eddin Al-Batran, Ralf D Hofheinz, Claudia Pauligk, Hans-Georg Kopp, Georg Martin Haag, Kim Barbara Luley, Johannes Meiler, Nils Homann, Sylvie Lorenzen, Harald Schmalenberg, Stephan Probst, Michael Koenigsmann, Matthias Egger, Nicole Prasnikar, Karel Caca, Jörg Trojan, Uwe M Martens, Andreas Block, Wolfgang Fischbach, Rolf Mahlberg, Michael Clemens, Gerald Illerhaus, Katja Zirlik, Dirk M Behringer, Wolff Schmiegel, Michael Pohl, Michael Heike, Ulrich Ronellenfitsch, Martin Schuler, Wolf O Bechstein, Alfred Königsrainer, Timo Gaiser, Peter Schirmacher, Wael Hozaeel, Alexander Reichart, Thorsten O Goetze, Mark Sievert, Elke Jäger, Stefan Mönig, Andrea Tannapfel
BACKGROUND: Docetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma, but has not yet been evaluated in the context of resectable patients. Here we report findings from the phase 2 part of the phase 2/3 FLOT4 trial, which compared histopathological regression in patients treated with a docetaxel-based triplet chemotherapy versus an anthracycline-based triplet chemotherapy before surgical resection. METHODS: In this randomised, open-label, phase 2/3 study, eligible participants were recruited from 28 German oncology centres...
December 2016: Lancet Oncology
Brian Badgwell
Surgical resection is the primary method of obtaining a potential cure for patients with gastric adenocarcinoma. However, chemotherapy or chemoradiotherapy offer significant improvement in survival over surgery alone. Much of the difficulty in deciding the optimal treatment strategy is choosing between perioperative chemotherapy or adjuvant chemoradiotherapy. Adding to the complexity is the potential for incorporating treatment strategies based on clinical trials performed in Asia. There is likely a difference in tumor biology between Eastern and Western patients with gastric adenocarcinoma, in addition to the clear differences in screening, pathologic assessment, and surgical technique...
October 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Florian Lordick, Masanori Terashima
From a global perspective, gastric cancer is one of the most common and lethal forms of cancer. The incidence of gastric cancer is very high in East Asia and varies considerably in countries of the Western hemisphere. Even after curative resection, the relapse rates are high in stages II and III. Therefore, adjuvant treatment with chemotherapy has been studied with positive results, especially in East Asian populations. In the Western World, where many locally advanced and borderline resectable gastric cancers are diagnosed, perioperative chemotherapy has become a standard of care...
August 2016: Best Practice & Research. Clinical Gastroenterology
Carlos León-Espinoza, Fernando López-Mozos, Roberto Marti-Obiol, Marina Garces-Albir, Joaquin Ortega-Serrano
AIM: To determine reproducibility of perioperative chemotherapy for gastric cancer (GC) on our settings by identifying patient's overall survival and comparing them to larger studies. METHODS: Retrospective analysis of our series, where we present our eleven-year's experience on GC managed according to perioperative approach of three preoperative chemotherapy cycles followed by surgery and finally three postoperative chemotherapy cycles. Chemotherapic scheme used was Xelox (Oxaliplatin and Capecitabine)...
August 15, 2016: World Journal of Gastrointestinal Pathophysiology
Yasushi Sato, Hiroyuki Ohnuma, Takayuki Nobuoka, Masahiro Hirakawa, Tamotsu Sagawa, Koshi Fujikawa, Yasuo Takahashi, Minami Shinya, Shinich Katsuki, Minoru Takahashi, Masahiro Maeda, Yutaka Okagawa, Uemura Naoki, Syouhei Kikuch, Koichi Okamoto, Hiroshi Miyamoto, Mitsuo Shimada, Takemasa Ichiro, Junji Kato, Tetsuji Takayama
BACKGROUND: Conversion therapy is an option for unresectable metastatic gastric cancer when distant metastases are controlled by chemotherapy; however, the feasibility and efficacy remain unclear. This study aimed to assess the feasibility and efficacy of conversion therapy in patients with initially unresectable gastric cancer treated with docetaxel, cisplatin, and S-1 (DCS) chemotherapy by evaluating clinical outcomes. METHODS: One hundred unresectable metastatic gastric cancer patients, enrolled in three DCS chemotherapy clinical trials, were retrospectively evaluated...
August 23, 2016: Gastric Cancer
Sven Lichthardt, Alexander Kerscher, Ulrich A Dietz, Christian Jurowich, Volker Kunzmann, Burkhard H A von Rahden, Christoph-Thomas Germer, Armin Wiegering
BACKGROUND: Multimodal treatment strategies - perioperative chemotherapy (CTx) and radical surgery - are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. METHODS: Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20)...
2016: BMC Cancer
G Créhange, F Huguet, L Quero, T V N'Guyen, X Mirabel, T Lacornerie
Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation...
September 2016: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Jun-Hua Zhao, Peng Gao, Yong-Xi Song, Jing-Xu Sun, Xiao-Wan Chen, Bin Ma, Yu-Chong Yang, Zhen-Ning Wang
BACKGROUND: The preferred chemotherapy method for gastric cancer continues to be matter of debate. We performed a meta-analysis to comparing prognosis and safety between perioperative chemotherapy and adjuvant chemotherapy to identify the better chemotherapy option for gastric cancer. METHODS: We searched the PubMed, EMBASE, Cochrane Library, and Ovid databases for eligible studies until February 2016. The main endpoints were prognostic value (hazard ratio [HR] for overall survival [OS] and 1-, 2-, 3-, and 5-year survival rate), response rate of chemotherapy, radical resection rate, post-operative complication rate, and adverse effects of chemotherapy...
2016: BMC Cancer
Daniel Reim, Andreas N Strobl, Christian Buchner, Rebekka Schirren, Werner Mueller, Peter Luppa, Donna Pauler Ankerst, Helmut Friess, Alexander Novotny
The influence of perioperative transfusion (PT) on outcome following surgery for gastric cancer (GC) remains controversial, with randomized trials lacking and observational series confounded by patient risk factors. This analysis determines the association between reception of leukocyte-depleted blood products and post-operative survival for GC.Data from 610 patients who underwent curative surgery for GC in a German tertiary care clinic from 2001 to 2013 were included. Kaplan-Meier survival curves and Cox proportional hazards regression were applied to determine the association of PT and clinical and patient risk factors for overall and relapse-free survival...
July 2016: Medicine (Baltimore)
Bryan A Chan, Raymond W Jang, Rebecca K S Wong, Carol J Swallow, Gail E Darling, Elena Elimova
Gastric cancer is a highly fatal malignancy, and surgery alone often does not provide a cure, even for relatively early stages of disease. Various approaches have been adopted around the world to improve surgical outcomes; however, there currently is no global consensus with regard to the extent of surgery or the timing and choice of chemotherapy and radiation. Here we review the evidence supporting current approaches to resectable gastric cancer, including discussion of the optimal extent of surgery and lymphadenectomy, adjuvant chemotherapy, postoperative chemotherapy with chemoradiation, and perioperative chemotherapy...
July 2016: Oncology (Williston Park, NY)
A H Hölscher, M Stahl, H Messmann, M Stuschke, H J Meyer, R Porschen
The current German S3 guideline represents the recommendations for the diagnosis and therapy of squamous cell carcinomas and adenocarcinomas of the esophagus based on evidence from the literature and interdisciplinary expert consensus. Esophagogastroscopy with biopsy, endosonography, and spiral CT scan of the neck, thorax, and abdomen are decisive in staging and the choice of therapy. For a curative approach, surgery, especially transthoracic esophagectomy and gastric pull-up, is the most important therapeutic option, except in the case of mucosal carcinomas or cervical squamous cell carcinomas...
October 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
J Spiliotis, E Halkia, E de Bree
Peritoneal carcinomatosis (ptc) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although ptc is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (crs) and intraoperative hyperthermic intraperitoneal chemotherapy (hipec) has successfully been used as locoregional treatment for selected patients with ptc from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei...
June 2016: Current Oncology
Emmanuelle Samalin, Marc Ychou
Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. While the incidence of gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction adenocarcinoma is rising rapidly in Western countries. Considering that surgical resection is currently the major curative treatment, and that the 5-year survival rate highly depends on the pTNM stage at diagnosis, gastroesophageal adenocarcinoma management is very challenging for oncologists. Several treatment strategies are being evaluated, and among them systemic chemotherapy, to decrease recurrences and improve overall survival...
June 10, 2016: World Journal of Clinical Oncology
Elizabeth C Smyth, Matteo Fassan, David Cunningham, William H Allum, Alicia F C Okines, Andrea Lampis, Jens C Hahne, Massimo Rugge, Clare Peckitt, Matthew Nankivell, Ruth Langley, Michele Ghidini, Chiara Braconi, Andrew Wotherspoon, Heike I Grabsch, Nicola Valeri
PURPOSE: The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial established perioperative epirubicin, cisplatin, and fluorouracil chemotherapy as a standard of care for patients with resectable esophagogastric cancer. However, identification of patients at risk for relapse remains challenging. We evaluated whether pathologic response and lymph node status after neoadjuvant chemotherapy are prognostic in patients treated in the MAGIC trial. MATERIALS AND METHODS: Pathologic regression was assessed in resection specimens by two independent pathologists using the Mandard tumor regression grading system (TRG)...
August 10, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
R Tanz, C El Mhadi, M Toreis, M R Khmamouch, T Mahfoud, A A Ali, H Errihani, M Ichou
BACKGROUND: Use of perioperative chemotherapy had significantly improved prognosis of localized gastric cancer. Two studies have validated this approach using cisplatin based chemotherapy despite important toxicities. We conducted this study with the aim to evaluate efficacy and toxicity of FOLFOX regimen in this setting. MATERIAL AND METHODS: This is a retrospective study including patients followed for gastric cancer in the Oncology Department of the military hospital Mohamed V in Rabat, Morocco over a period of 7 years from 2007 to 2013...
May 2016: Gulf Journal of Oncology
Leyla Kilic, Cetin Ordu, Ibrahim Yildiz, Fatma Sen, Serkan Keskin, Rumeysa Ciftci, Kezban Nur Pilanci
The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials...
May 15, 2016: World Journal of Gastrointestinal Oncology
H-T Wu, K-W Peng, Z-H Ji, J-H Sun, Q Zhang, X-J Yang, C-Q Huang, Y Li
BACKGROUND: This work was to evaluate the efficacy and safety of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with lobaplatin and docetaxel to treat peritoneal carcinomatosis (PC) from gastric cancer (GC). METHODS: A total of 50 consecutive GC PC patients treated by 52 CRS+HIPEC procedures with lobaplatin 50 mg/m(2) and docetaxel 60 mg/m(2) in 6000 mL of normal saline at (43 ± 0.5) °C for 60 min. The primary endpoint was overall survival (OS), and the secondary endpoints were perioperative safety profiles...
July 2016: European Journal of Surgical Oncology
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