A phase II study of radical surgery followed by postoperative chemotherapy with S-1 for gastric carcinoma with free cancer cells in the peritoneal cavity (CCOG0301 study)

Kodera, Yasuhiro; Ito, Seiji; Mochizuki, Yoshinari; Kondo, Ken; Koshikawa, Katsumi; Suzuki, Norihiko; Kojima, Hiroshi; Kojima, Taiki; Matsui, Takanori; Takase, Tsunenobu; Tsuboi, Kenji; Fujiwara, Michitaka; Nakao, Akimasa

doi:10.1016/j.ejso.2009.03.003

Cited by 54 publications

(46 citation statements)

References 22 publications

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“…To this end, the most recent TNM classification has included IFCC detection as part of the staging process, denoting M1 disease [6]. Traditionally, these patients were considered only for palliation [7]; however, newer strategies have employed more aggressive multimodal therapies in the neoadjuvant [7,8] and adjuvant settings [9][10][11][12] with some evidence of improved outcome [7,8,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

et al. 2011

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Background There is lack of uniformity in the utilization of peritoneal cytology in gastric cancer management. The identification of intraperitoneal free cancer cells (IFCCs) is believed to confer poor prognosis. However, while some of these patients are palliated, others may undergo more aggressive therapies. In this review, we aimed to identify and synthesize findings on the use of peritoneal cytology in predicting peritoneal recurrence and overall survival in curative gastric cancer patients. Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. We determined the accuracy, sensitivity, and specificity of peritoneal cytology in predicting peritoneal recurrence based on four techniques-conventional cytology, immunoassay, immunohistochemistry, and reverse transcriptase-polymerase chain reaction. Recurrence rates and overall survival rates for curative patients were determined, based on positivity or negativity for IFCCs. Results Twenty-eight articles were included. All four techniques showed wide variations in accuracy, sensitivity, and specificity in predicting peritoneal recurrence. Recurrence rates for patients positive for IFCCs ranged from 11.1 to 100%, while those negative for IFCCs had recurrence rates of 0-51%. Overall survival was significantly reduced for patients with positive IFCCs. Short follow-up periods and possible duplication of results may limit result interpretation. Conclusion The presence of IFCCs appears to increase the risk of peritoneal recurrence and is associated with worse overall survival in gastric cancer patients. Further incorporation of peritoneal cytology in clinical decisionmaking in gastric cancer depends on the development of a consistently accurate and rapid IFCC detection method.

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Section: Introductionmentioning

confidence: 99%

A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

et al. 2011

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“…A number of nonrandomized cohort studies had inadequacies in population recruitment, and one study utilized a historical control group [13]. This study, by Kodera et al, lacks any information on baseline characteristics of the control group, and there were limited outcome data for this group.…”

Section: Quality Of Studiesmentioning

confidence: 99%

“…In addition, there were four prospective cohort studies [10][11][12][13] with one remaining retrospective cohort study [14].…”

Section: Quality Of Studiesmentioning

confidence: 99%

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

et al. 2014

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Gastric cancer patients with positive peritoneal cytology as the only marker of metastatic disease have poor prognoses. There is no universal consensus on the most appropriate treatment regimen for this particular patient group. We reviewed and analyzed published data to determine the optimal treatment regimen for patients with peritoneal cytology-positive gastric adenocarcinomas. Six electronic databases were explored [PubMed, Cochrane (Systematic Reviews and Controlled Trials), PROSPERO, DARE, and EMBASE]. The primary outcome was overall survival with secondary outcomes including patterns of recurrence and treatment-related morbidity. Six studies were included for data extraction. There was no significant heterogeneity between studies. The use of S1 monotherapy was associated with a significant survival benefit (HR 0.48; 95 % CI 0.32-0.70; p = 0.0002). Intraoperative intraperitoneal chemotherapy (IIPC) with adjuvant chemotherapy showed a trend toward improvement in overall survival (HR 0.70; 95 % CI 0.47-1.04; p = 0.08). A recent randomized controlled trial examining extensive intraperitoneal lavage (EIPL) with IIPC showed a significant improvement in overall survival (5-year overall survival, 43.8 % for EIPL-IPC group compared with 4.6 % for IPC group). However, these promising results need to be validated in larger prospective randomized trials.

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“…More recently, S‐1 was found to significantly decrease the incidence of recurrence of peritoneal disease in a pivotal randomized trial comparing postoperative S‐1 with surgery alone for stage II/III cancer 39. Furthermore, in a one‐arm study to explore efficacy of postoperative S‐1 for patients with CY1/P0 or CY1/P1 status (here, P1 denotes a few deposits that could easily be coresected), the 5‐year survival rate was 26% whereas there was no long‐term survivor among the historical controls 40. Thus, it was after the classification of S‐1 that surgeons began to continue with gastrectomy for the CY1 population with some confidence 41, 42.…”

Section: Peritoneal Metastasismentioning

confidence: 99%

Surgery with curative intent for stage IV gastric cancer: Is it a reality of illusion?

Kodera

2018

Annals of Gastroent Surgery

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Gastric cancer with metastases outside of the regional lymph nodes is deemed oncologically unresectable. Nevertheless, some metastatic lesions are technically resectable by applying established surgical techniques such as para‐aortic lymphadenectomy and hepatectomy. At the time of compilation of the Japanese gastric cancer treatment guidelines version 4, systematic reviews were conducted to see whether it is feasible to make any recommendation to dissect both the primary and metastatic lesions with intent to cure, possibly as part of multimodality treatment. Long‐term survivors were found among carefully selected groups of patients both in prospective and retrospective studies. In addition, there is a growing list of publications reporting encouraging outcomes of gastrectomy conducted after exceptionally good response to chemotherapy, usually among patients who underwent R0 resection. This type of surgery is often referred to as conversion surgery. It is sometimes difficult to define a clear borderline between curative surgery scheduled after neoadjuvant chemotherapy and the conversion surgery. This review summarizes what we knew after the literature reviews conducted at the time of compiling the Japanese guidelines and in addition reflects some new findings obtained thereafter through clinical trials and retrospective studies. Metastases were divided into three categories based on the major metastatic pathways: lymphatic, hematogenous, and peritoneal. In each of these categories, there were findings that could provide hope for patients with metastatic disease. These findings implied that the surgical technique that we already use could become more useful upon further developments in antineoplastic agents and drug delivery.

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A phase II study of radical surgery followed by postoperative chemotherapy with S-1 for gastric carcinoma with free cancer cells in the peritoneal cavity (CCOG0301 study)

Cited by 54 publications

References 22 publications

A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer

A systematic review and meta-analysis of gastric cancer treatment in patients with positive peritoneal cytology

Surgery with curative intent for stage IV gastric cancer: Is it a reality of illusion?

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