Survival Benefit of Non-curative Gastrectomy for Gastric Cancer Patients with Synchronous Distant Metastasis

Li, Chen; Yan, Min; Chen, Jun; Xiang, Min; Zhu, Zheng; Yin, Hao; Lin, Yusong

doi:10.1007/s11605-009-1095-0

Cited by 32 publications

(32 citation statements)

References 21 publications

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“…However, the prognosis in patients with peritoneal dissemination has been reported to be poor regardless of the tumor burden, even in patients with only positive peritoneal lavage cytology [15,16]. More recently, in some new clinical trials for patients with advanced gastric cancer with macroscopic peritoneal metastasis and/or positive peritoneal cytology without any other distant metastasis, there were some patients with dramatically prolonged survival following the administration of S-1 or other treatments such as intraperitoneal administration of taxanes or intraoperative peritoneal hyperthermic chemotherapy after surgical resection of the primary tumor [32,34,40,41]. These new clinical trials may be able to offer treatment options to patients with peritoneal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

et al. 2010

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dissemination still have a poor prognosis [1]; most of these patients die within 6 months of diagnosis, while the 5-year survival rate is nil [2,3].The recent introduction of an oral drug, S-1, has increased the overall response rates (ORRs) to 44% and 49% and median survival time (MST) to 8 months in phase II studies [4,5].Several reports have demonstrated that S-1 was effective for undifferentiated histological types, such as poorly differentiated adenocarcinoma and signet-ring cell carcinoma, which are relevant to peritoneal dissemination [6]. S-1 has been reported to be effective in prolonging the survival of gastric cancer patients with peritoneal dissemination [4][5][6][7].Moreover, S-1 in combination with other anticancer drugs such as cisplatin (CDDP), taxanes, and irinotecan (CPT-11) increased ORRs and prolonged MST [8][9][10][11].Paclitaxel is a cytotoxic antineoplastic agent that causes excessive polymerization of tubulin and microtubule dysfunction, resulting in tumor cell death [12]. Kobayashi et al. [13] have demonstrated that paclitaxel is a promising drug for the treatment of malignant ascites in patients with gastric cancer: the concentration of paclitaxel in ascites was maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration.Recent phase II studies of systemic chemotherapy with S-1 plus taxanes have demonstrated strong anticancer effects and a good MST in the treatment of advanced gastric cancer [9,10,14]. However, the effi cacy of systemic chemotherapy for peritoneal dissemination from gastric cancer has been unclear, because peritoneal metastases have not been defi ned as measurable lesions in conventional phase II studies. Therefore, few reports describing the effi cacy of chemotherapy for these lesions are available.In this pilot study, we planned therapeutic strategies to observe the effect of chemotherapy on peritoneal metastasis by second-look laparoscopy for patients Abstract Background. This pilot study was carried out to evaluate the effi cacy of chemotherapy for patients with peritoneal dissemination from gastric cancer or positive lavage cytology diagnosed by staging laparoscopy. Methods. Sixteen patients were enrolled. Paclitaxel was administered at 120 mg/m 2 on day 1 and S-1 was administered orally at 80 mg/m 2 for 14 consecutive days, followed by a 1-week rest, as one course. After fi ve courses of this therapy, the primary gastric tumors were evaluated and second-look laparoscopy was performed for patients showing partial response or stable disease with clinical benefi t. Results. Partial response or stable disease with clinical benefi t was confi rmed in seven and fi ve patients, respectively, and these patients underwent second-look laparoscopy. No viable cancer cells were detected on cytopathological investigation during second-look laparoscopy in 9 patients who underwent surgical treatment. The intent-to-treat response rate for gastric tumor was 44% and the rate of disappearance of peritoneal metastasis was 38% ...

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Section: Discussionmentioning

confidence: 99%

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

et al. 2010

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“…Median overall survival durations of 8.5-13.8 months have been reported following resectional surgery alone as the principal treatment modality for patients with incurable gastric cancer, 18,25,[53][54][55][56][57] compared with a median overall survival of 13.8 months for patients HER2-positive tumours who received trastuzumab in the TOGA trial. 49 The comparable survival demonstrated for these treatment modalities suggests that an individualized, patient-centred multidisciplinary approach should be advocated, offering either operative or nonoperative treatment after careful risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Does surgery have a role in managing incurable gastric cancer?

et al. 2015

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Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities. Until such data are available, surgery should not be offered as a standard first-line treatment, but can be considered in selected cases after thorough multidisciplinary discussions involving the patient. Patient selection for both gastrectomy and nonresectional surgery must include consideration of various factors that predict quality of life after surgery. This Perspectives summarizes the available evidence and discusses the utility of palliative surgery in relation to other therapeutic modalities in the management of incurable gastric cancer.

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“…The surgical approach is associated with some survival advantages compared with other palliative treatments. In the study by Li et al [97] on a group of 253 synchronous GC metastases, 5-year survival was 6.5% for patients with resection vs 0% without surgery. Multivariate analysis proved that patients with liver metastases, peritoneal dissemination, and those without resection deteriorated.…”

Section: Metastatic Gcmentioning

confidence: 96%

Multimodal treatment of gastric cancer in the west: Where are we going?

Marrelli

Połom

Manzoni

et al. 2015

WJG

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The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (Ⅲ and Ⅳ), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.

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Survival Benefit of Non-curative Gastrectomy for Gastric Cancer Patients with Synchronous Distant Metastasis

Cited by 32 publications

References 21 publications

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

Does surgery have a role in managing incurable gastric cancer?

Multimodal treatment of gastric cancer in the west: Where are we going?

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