Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America

Knight, Gregory; Earle, Craig C.; Cosby, Roxanne; Coburn, Natalie; Youssef, Youssef; Malthaner, Richard; Wong, Rebecca

doi:10.1007/s10120-012-0148-3

Cited by 49 publications

(35 citation statements)

References 60 publications

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“…Current practice guidelines for North America support the use of either chemotherapy alone or chemoradiation and recommend treatment choice on a case-by-case basis [13]. In the postoperative patient, combined chemoradiation may increase complexity, cost and toxicity when compared to either modality alone.…”

Section: Introductionmentioning

confidence: 99%

Chemoradiation Therapy versus Chemotherapy Alone for Gastric Cancer after R0 Surgical Resection: A Meta-Analysis of Randomized Trials

et al. 2014

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Objective: Current national guidelines include category 1 recommendations for perioperative chemotherapy or adjuvant chemoradiation with surgical resection for patients with stage IB-IIIB gastric cancer. We conducted a meta-analysis of randomized trials in which chemotherapy was prospectively tested against chemoradiation with surgical resection. Methods: We electronically searched PubMed and EMBASE for randomized, controlled clinical trials involving patients with gastric adenocarcinoma, status post-R0 resection. The interventions compared were adjuvant chemotherapy versus chemoradiation, with any chemotherapy regimen. The primary outcomes of interest were disease-free survival and overall survival. The Mantel-Haenszel random-effects model was used to calculate effect sizes. Results: Six trials that included 1,171 patients were evaluated; 599 were randomized to adjuvant chemoradiation and 572 to chemotherapy alone. Chemoradiation was associated with a significant increase in disease-free survival (odds ratio 1.48, 95% confidence interval 1.08-2.03) when compared to chemotherapy alone. However, there was no significant difference in overall survival (odds ratio 1.27, 95% confidence interval 0.95-1.71). Five trials found no statistically significant differences in toxicities between the two groups. Conclusion: In patients with gastric cancer status post-R0 resection, adjuvant chemoradiation was associated with higher disease-free survival when compared to chemotherapy alone. It remains appropriate to design trials testing new systemic agents with radiotherapy.

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Section: Introductionmentioning

confidence: 99%

Chemoradiation Therapy versus Chemotherapy Alone for Gastric Cancer after R0 Surgical Resection: A Meta-Analysis of Randomized Trials

et al. 2014

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“…The mainstay of gastric cancer treatment is surgery and there is limited evidence showing if adjuvant chemotherapy might be successful in advanced cases (10,11). Therefore an adequate extent of surgery remains most crucial in these patients.…”

Section: Discussionmentioning

confidence: 99%

Morbidity, Mortality and Survival after Stomach Resection with or without Splenectomy – The Single Centre Observations

Stojčev¹,

Bobowicz²,

Jarząb³

et al. 2013

Polish Journal of Surgery

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Over the last decade, gastric cancer treatment has changed from extensive multiorgan resections towards less invasive approaches with limited resections and a more selective lymphadenectomy. Despite all available trials, the conclusions on the extent of necessary resections still remain debatable. the aim of the study was to assess the short term outcomes (morbidity and mortality) of a total gastrectomy depending on the simultaneous splenectomy status. material and methods. We performed a retrospective analysis of the records of all patients treated with a curative intent using a total gastrectomy for gastric cancer between 1997 and 2003. 49 patients fulfilled the inclusion criteria. Patients were divided into two groups: S(+) gastrectomy with splenectomy group (29 patients) and S(-) total gastrectomy with spleen preservation (20 patients). Results. Survival analysis at one year showed that there was no difference in survival between the two groups (p=0.84). There were six recurrences, one in the group S(+) and five in group S(-) (p>0.05). Dissemination was observed in three patients in group S(-) (p>0.05). Other complications including infectious complications, exenteration, subileus, cardiovascular insufficiency, multiorgan failure were more frequent in the S(+) group (31% v 15%) although the difference was not significant (p=0.17). Conclusions. Splenectomy during gastrectomy for cancer has no statistically significant impact on short-term morbidity and mortality. Even though it does not show benefit in terms of 5-year overall survival rates it might be performed when needed in more advanced cases in properly selected patients (e.g. upper gastric T3/4 gastric cancer). Key words: neoplasm; stomach; splenectomy; complications; lymph node excision Gastric cancer was the fourth most common cancer in males in 2009 in Poland with an incidence rate of 12.3 per 100 000 people and a high mortality rate with poor 5-year overall survival (1). Although we could observe a reduction in mortality over the last decade from 16.5/100 000 people to 12.1/100 000 people it seems that it was rather thanks to the decreased incidence (16/100 000 in year 1999) rather than to changes in surgical practice. As we followed the most recent publications of international trials for gastric cancer we could observe changes in practice being adopted all over the world with a changing approach from

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“…Razón por la cual las guías de práctica clínica de "The National Comprehensive Cancer Network, European Society for Medical Oncology and Canada" recomiendan quimioterapia perioperatoria o quimioradioterapia post operatoria para los pacientes con tumores resecables. [26][27][28] Respecto a estudios con quimioradioterapia, actualmente Kang et al, completo acumulación de información de un estudio en 2011 con 458 pacientes comparando capecitabina, cisplatino con o sin radioterapia. Además un segundo estudio del mismo grupo busca recolectar información de 1000 pacientes comparando S-1/oxaliplatino con o sin radioterapia, se espera que termine recolección de datos en 2016.…”

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Cáncer gástrico, actualidades y perspec-tivas del futuro

Muñoz¹,

Lopez

2016

RC_UCR-HSJD

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El cáncer gástrico es una de las causas de muerte más importantes a nivel mundial, pese al descenso de la incidencia y mortalidad sigue siendo un pro-blema de salud pública importante. A nivel inter-nacional existen guías y constante investigación respecto al tema. En este artículo el lector encon-trara los resultados de la revisión de los últimos 5 años respecto a diagnóstico, tamizaje, prevención, abordaje terapéutico y terapia neoadyudante en los sitios a nivel mundial que se encargan de ex-pandir la frontera respecto a las prácticas clínicas, investigación clínica y preclínica. Con la idea de proveer al lector con perspectivas y tendencias que serán necesarias para mantenerse actualizado con el manejo de la patología.

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Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America

Cited by 49 publications

References 60 publications

Chemoradiation Therapy versus Chemotherapy Alone for Gastric Cancer after R0 Surgical Resection: A Meta-Analysis of Randomized Trials

Chemoradiation Therapy versus Chemotherapy Alone for Gastric Cancer after R0 Surgical Resection: A Meta-Analysis of Randomized Trials

Morbidity, Mortality and Survival after Stomach Resection with or without Splenectomy – The Single Centre Observations

Cáncer gástrico, actualidades y perspec-tivas del futuro

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