Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

Ashraf, Noman; Hoffe, Sarah E.; Kim, Richard

doi:10.1634/theoncologist.2012-0462

Cited by 38 publications

(30 citation statements)

References 70 publications

(63 reference statements)

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“…In the West, the SWOG/INT0116 trial clearly showed that 5-FU-based postoperative concurrent CRT significantly improved the survival and decreased the rate of locoregional failure. However, the main criticism of this study is only 10 % of patients underwent D2 dissection, and radiotherapy may have compensated for suboptimal surgery [27]. In the East, D2 dissection has been confirmed to be superior to D0/D1 dissection for local advanced gastric cancer.…”

Section: Discussionmentioning

confidence: 82%

Phase I study of postoperative radiotherapy concurrent with S-1 in patients with gastric cancer

Meng

Peng

et al. 2015

Med Oncol

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Postoperative chemoradiotherapy (CRT) with concurrent 5-fluorouracil is the standard care for gastric cancer patients after curative surgery. The previous studies revealed that the subgroup of patients with high recurrence risk would benefit most from adjuvant CRT. S-1, a novel oral fluorouracil, has showed very effective in metastatic gastric cancer and became the standard option for gastric cancer with D2 dissection. The safety and dosage of S-1 combined with postoperative radiotherapy have not yet been evaluated. This study is to determine the maximum tolerate dose (MTD) and dose-limiting toxicity (DLT) of S-1 given concurrently with postoperative high-dose radiotherapy in gastric cancer. Patients with more advanced stage (pT4 and/or pN+) after R0 resection were recruited. Eligible patients received one cycle standard SOX (S-1 plus oxaliplatin) chemotherapy, then S-1 monotherapy with concurrent radiotherapy for 6 weeks, followed by additional three cycles of SOX. During the concurrent CRT, S-1 was administered on every radiotherapy treatment day according to a predefined dose-escalation schedule. Radiotherapy (3D-RT or IMRT) was given to a total dose of 50.4 Gy in 28 fractions. DLT was defined as grade 3 or 4 hematologic and non-hematologic toxicity. From March 2011 to October 2012, 21 patients were enrolled at five dose levels: 40 (n = 3), 50 (n = 3), 60 (n = 6), 70 (n = 6) and 80 mg/m(2)/day (n = 3). D2-dissection was performed in 18 patients (85.7 %) and 15 patients (71.4 %) had stage III disease. The most common dose-related toxicity was anorexia, nausea and vomiting, fatigue and leucopenia. DLT was occurred in one patient at 60 mg/m(2)/day (grade 3 fatigue), one patient at 70 mg/m(2)/day (grade 3 vomiting and anorexia), two patients at 80 mg/m(2)/day (one with grade 3 vomiting and anorexia; another with grade 3 febrile leucopenia). Four patients did not complete CRT as planned. Overall, this phase I study demonstrated that postoperative CRT with daily S-1 was feasible in gastric cancer and the MTD of S-1 concurrent with radiotherapy was 70 mg/m(2)/day. This S-1-based postoperative CRT will be investigated in a multicenter phase III study in West China.

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Section: Discussionmentioning

confidence: 82%

Phase I study of postoperative radiotherapy concurrent with S-1 in patients with gastric cancer

Meng

Peng

et al. 2015

Med Oncol

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“…Results from one region cannot necessarily be extrapolated to another. Significantly better outcomes have consistently been reported from Eastern countries compared with the West [13][14][15].…”

Section: The Challengementioning

confidence: 81%

Locally Advanced Gastroesophageal Junction Tumor: A Treatment Dilemma

2015

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Over the last several decades, the incidence of adenocarcinoma of the gastroesophageal junction (GEJ) has been increasing in developed countries. Although complete surgical resection remains the cornerstone of treatment for resectable disease, long-term outcomes are poor and recurrence rates are high with surgery alone in patients presenting with locally advanced disease. Multimodal therapy has been shown to improve survival; however, the optimal therapeutic approach remains controversial, and practices vary across the world.Preoperative chemoradiotherapy is generally used in the U.S., whereas perioperative chemotherapy without radiation is favored in most European countries. In this review, we discuss why the treatment of locally advanced GEJ tumors remains controversial, examine the evidence for various multimodal approaches, discuss their respective pros and cons, evaluate the role of radiation therapy, highlight some ongoing and planned clinical trials, and suggest areas that need further research. The Oncologist 2015;20:134-142 Implications for Practice: Despite increasing incidence of adenocarcinoma of the gastroesophageal junction in developed countries, the optimal therapeutic approach for locally advanced disease remains controversial. Outcomes are dismal with surgery alone. Multimodal therapy improves survival, but practices vary worldwide. Perioperative chemotherapy is the standard in most European countries, whereas preoperative chemoradiotherapy is favored in the United States. In this review, we discuss reasons for the controversy, examine the data for various multimodal approaches, summarize key ongoing and future trials, and provide evidence-based treatment recommendations.

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“…GC mainly results from the interaction between host factors (including inherited or acquired factors) and the environment, with risk factors including Helicobacter pylori infection, smoking, alcohol, salt, and obesity 6, 7. Despite that many improvements have been realized for prolonging survival in GC patients such as optimized screening schedules, advanced surgical techniques, novel drugs, and individual treatment strategy, the prognosis of GC is still far more from satisfactory with 5‐year overall survival (OS) ranging from 12% to 98% according to the malignancy degree 8, 9. Therefore, exploration of novel and feasible biomarkers for disease‐risk prediction, progression monitoring, and long‐term prognosis is essential for the management of GC.…”

Section: Introductionmentioning

confidence: 99%

The correlation of circulating pro‐angiogenic miRNAs’ expressions with disease risk, clinicopathological features, and survival profiles in gastric cancer

Peng

Liu

Zhu³

et al. 2018

Cancer Medicine

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This study aimed to explore the correlation of circulating pro‐angiogenic miRNAs’ expressions with risk, clinicopathological features, and survival profiles in gastric cancer (GC). Three hundred and thirty‐three GC patients underwent radical resection and 117 health controls (HCs) were recruited for this study. Plasma samples were obtained from GC patients before the operation and from HCs after enrollment. Fourteen pro‐angiogenic miRNAs were asseassed by quantitative polymerase chain reaction (qPCR). Disease‐free survival (DFS) and overall survival (OS) of GC patients were calculated and the median follow‐up duration was 36.0 months. Seven out of 14 pro‐angiogenic miRNAs including let‐7f, miR‐17‐5p, miR‐18a, miR‐19b‐1, miR‐20a, miR‐210, and miR‐296 were observed to be elevated in GC patients compared with HCs. MiR‐18a, miR‐20a, and miR‐210 disclosed good predictive values of GC risk. Six pro‐angiogenic miRNAs including miR‐17‐5p, miR‐92a, miR‐210, miR‐20a, miR‐18a, and miR‐296 expressions were positively while 1 pro‐angiogenic miRNA (miR‐130a) was negatively correlated with tumor malignancy degree in GC patients. K‐M curve disclosed that 5 pro‐angiogenic miRNAs including miR‐17‐5p, miR‐18a, miR‐20a, miR‐92a, and miR‐210 correlated with worse DFS, while 4 pro‐angiogenic miRNAs including miR‐17‐5p, miR‐18a, miR‐20a, and miR‐210 associated with shorter OS. Further multivariate Cox's analysis revealed that miR‐17‐5p, miR‐18a, miR‐20a, and miR‐210 were independent predictive factors for unfavorable DFS and OS. In conclusion, circulating pro‐angiogenic miRNAs could serve as novel noninvasive biomarkers for disease risk and malignancy degree, and miR‐17‐5p, miR‐18a, miR‐20a, and miR‐210 are independent factors predicting poor prognosis in GC patients.

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Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

Abstract: Learning Objectives Summarize trends of adjuvant treatment in gastric cancer. Describe the potential role of adjuvant chemotherapy versus radiation in gastric cancer.

Cited by 38 publications

References 70 publications

Phase I study of postoperative radiotherapy concurrent with S-1 in patients with gastric cancer

Phase I study of postoperative radiotherapy concurrent with S-1 in patients with gastric cancer

Locally Advanced Gastroesophageal Junction Tumor: A Treatment Dilemma

The correlation of circulating pro‐angiogenic miRNAs’ expressions with disease risk, clinicopathological features, and survival profiles in gastric cancer

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