Adjuvant Chemotherapy for Gastric Cancer with S-1, an Oral Fluoropyrimidine

Sakuramoto, Shinichi; Sasako, Mitsuru; Yamaguchi, Toshiharu; Kinoshita, Taira; Fujii, Masashi; Nashimoto, Atsushi; Furukawa, Hiroshi; Nakajima, Toshifusa; Ohashi, Yasuo; Imamura, Hiroshi; Higashino, Masayuki; Yamamura, Yoshitaka; Kurita, Akira; Arai, Kuniyoshi

doi:10.1056/nejmoa072252

Cited by 2,246 publications

(1,836 citation statements)

References 24 publications

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“…[5][6][7] Thus, over time, these important contributions have translated into treatment recommendations and guidelines to improve the quality of care and survival outcomes of gastric cancer in the United States.…”

mentioning

confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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confidence: 99%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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“…Japanese surgeons have been involved with showing the benefits of S‐1 adjuvant chemotherapy for patients with locally advanced gastric cancer who have undergone D2 lymph node dissection 33. This was followed by the demonstration of cisplatin being beneficial on top of S‐1 as first‐line treatment for advanced and unresectable gastric cancer 34.…”

Section: Gastric Surgerymentioning

confidence: 99%

Gastroenterological surgery in Japan: The past, the present and the future

Colvin

Mizushima

Eguchi

et al. 2017

Annals of Gastroent Surgery

138

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In the last two centuries, there has been remarkable progress in the field of gastroenterological surgery, including the curative resection of cancers, replacement of failed organs through transplantation, increased safety of undergoing major surgeries and decreased operative morbidity through developments in minimal access surgery. Japan has very much been at the forefront of these advances, as is evident from the present review, from advancing the surgical management of gastric cancer to the pioneering work in live‐donor transplantation. This review also highlights many instances where surgical management of the same pathologies has evolved differently between Japan and the West. It is encouraging that many procedures established in Japan are eventually taken up by the West, often after rigorous assessment affirming the quality and applicability of such techniques. In Japan, many of the crucial issues in gastroenterological surgery are increasingly addressed through large multi‐institutional prospective control trials, ensuring that Japanese surgeons continue to contribute to the advances in gastroenterological surgery.

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“…Whether to stop gastrectomy at the confirmation of CY1 or to continue has been a matter of debate, particularly for linitis plastica type cancer 30. 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.…”

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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Adjuvant Chemotherapy for Gastric Cancer with S-1, an Oral Fluoropyrimidine

Abstract: S-1 is an effective adjuvant treatment for East Asian patients who have undergone a D2 dissection for locally advanced gastric cancer. (ClinicalTrials.gov number, NCT00152217 [ClinicalTrials.gov].).

Cited by 2,246 publications

References 24 publications

Variations in gastric cancer care

Variations in gastric cancer care

Gastroenterological surgery in Japan: The past, the present and the future

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

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