Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate

Menges, med.dent. Joachim; Schmidt, C.; Lindemann, W.; Ridwelski, K.; Pueschel, Werner; Jüngling, B.; Feifel, G.; Schilling, Martin K.; Stallmach, Andreas; Zeitz, Martin

doi:10.1007/s00432-003-0467-1

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…Understandably, these studies enrolled only small numbers of patients, but demonstrated a significant benefit for those patients in that about 40% of them were R0 resected after 2 or 3 cycles of systemic chemotherapy [11,12,13,14,15,16]. The Italian group could confirm these results in a larger trial enrolling 82 patients, who were considered not curatively resectable according to laparotomy in 63% and to CT scans in the remaining third.…”

Section: Neoadjuvant Therapy In Patients Not Curatively Resectable Dusupporting

confidence: 66%

Neoadjuvant Therapy of Gastric Cancer: A Decisive Step Forward

Menges

Hoehler

2014

Gastrointest Tumors

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Background: Although its incidence has been steadily decreasing in Western countries, gastric cancer remains a leading cause of cancer deaths worldwide. The detection rate of early-stage cancers is improving; nevertheless, the majority of cases is still diagnosed at later stages with a poor prognosis. Furthermore, the results that can be achieved with surgery have reached a plateau of effectiveness. Summary: Neoadjuvant chemotherapy was successfully introduced first in patients with non-curatively resectable disease. In the last decade, neoadjuvant chemotherapy has also been established in potentially curatively resectable cases and has become the state-of-the-art treatment. Esophagogastric junction (EGJ) tumors are not optimally treated with chemotherapy alone, and combined radiochemotherapy (RCT) seems to yield superior outcomes. Key Message: The use of neoadjuvant therapy has been successfully established in patients with curatively resectable disease. Neoadjuvant chemotherapy is now a cornerstone in the treatment of gastric cancer and cancer of the EGJ, although further work is needed in order to define the optimal combination regimen. Practical Implications: Neoadjuvant chemotherapy is currently the gold standard for the treatment of gastric cancer and cancer of the EGJ. Several independent studies have shown the benefits of using combination regimens that included cisplatin and 5-fluorouracil, though recently the use of the EOX (epirubicin, oxaliplatin and capecitabine) regimen has been widely accepted in this setting. Tumors of the EGJ benefit from neoadjuvant treatment with combined RCT. It should be noted that the optimal neoadjuvant regimen in EGJ tumors has not yet been defined, and the survival advantage of neoadjuvant RCT over neoadjuvant chemotherapy remains to be established in this patient population.

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Section: Neoadjuvant Therapy In Patients Not Curatively Resectable Dusupporting

confidence: 66%

Neoadjuvant Therapy of Gastric Cancer: A Decisive Step Forward

Menges

Hoehler

2014

Gastrointest Tumors

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“…In 6 studies including a total of 264 deWnitely irresectable patients, most of them deWned by laparotomy, R-0-resections were achieved in 14-45% (Wilke et al 1989;Plukker et al 1991;Lerner et al 1992;Cascinu et al 1998;Gallardo-Rincon et al 2000;Cascinu et al 2004). In a study of our group on patients staged either by laparotomy or by endoscopic ultrasound, computed tomography and, in case of conXicting results, surgical laparoscopy, we achieved a 52% R-0-resection rate among 25 patients of stage IIIB and IV M0 (Menges et al 2003) (Table 1).…”

Section: Introductionmentioning

confidence: 74%

“…R-0-resection rates were consistently higher (41-76%) in phase-II-studies including potentially resectable patients (survey in Menges et al 2003).…”

Section: Introductionmentioning

confidence: 92%

Current strategies in systemic treatment of gastric cancer and cancer of the gastroesophageal junction

Menges¹,

Hoehler

2008

J Cancer Res Clin Oncol

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Gastric cancer is a major health issue and a leading cause of death worldwide. The results of standard therapy remain unsatisfactory mainly because of diagnosis at the late stage of disease. Innovative strategies such as neoadjuvant chemotherapy in locally advanced cancer have improved the outcome even in operable cases. Whether an adjuvant radiochemotherapy is of benefit after curative resection including systematic lymphadenectomy remains yet unclear. Some progress has been made in the palliative setting by introducing new substances. This review examines recent advances in the systemic treatment of gastric and gastroesophageal junction cancer.

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“…In 5 studies including a total of 182 definitely irresectable patients, most of them defined by laparotomy, R-0 resections were achieved in 14-44% [4][5][6][7][8]. In a study of our group on patients staged either by laparotomy or by endoscopic ultrasound, computed tomography and, in case of conflicting results, surgical laparoscopy, we achieved a 53% R-0 resection rate among 25 patients of stage III B and IV M0 [9] (table 1). R-0 resection rates were consistently higher (41-76%) in studies including potentially resectable patients (survey in [9]).…”

Section: Efficacy Of the Treatment In Terms Of Achieving R-0 Resectionmentioning

confidence: 98%

“…In a study of our group on patients staged either by laparotomy or by endoscopic ultrasound, computed tomography and, in case of conflicting results, surgical laparoscopy, we achieved a 53% R-0 resection rate among 25 patients of stage III B and IV M0 [9] (table 1). R-0 resection rates were consistently higher (41-76%) in studies including potentially resectable patients (survey in [9]). So far, a benefit of neoadjuvant therapy in potentially resectable patients with gastric cancer has not been demonstrated -recently the first data of a large randomised multicentre trial (the MAGIC-study) were presented: 503 patients with resectable upper gastrointestinal cancer (in 74% gastric cancer), were randomised to receive surgery alone or perioperative chemotherapy (3 pre-and 3 postoperative cycles of ECF: epirubicin (50 mg/m 2 every 3 weeks), cisplatin (60 mg/m 2 every 3 weeks) and infusional 5-fluorouracil (5-FU, 200 mg/m 2 continuously daily).…”

Section: Efficacy Of the Treatment In Terms Of Achieving R-0 Resectionmentioning

confidence: 99%

Innovative Drugs and Strategies in the Treatment of Upper Gastrointestinal Tract Carcinomas

Menges

Hoehler²

2004

Oncol Res Treat

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The results of the standard therapy of upper gastrointestinal tract cancer remain unsatisfactory, mainly because still the majority of cases are diagnosed at a late stage of disease, which implicates a poor prognosis. Innovative strategies focus on neoadjuvant chemotherapy in locally advanced gastric cancer and chemo- or radiochemotherapy in advanced oesophageal cancer. Results of phase II studies published so far have been promising. There is rising evidence that adjuvant radiochemotherapy in gastric cancer may be of benefit for curatively resected patients, whereas the results of trials including a systematic lymphadenectomy have to be awaited. New substances like the taxanes or irinotecan in the palliative setting did not prove to be superior to platinum-based standard chemotherapy protocols so far.

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Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate

Cited by 17 publications

References 21 publications

Neoadjuvant Therapy of Gastric Cancer: A Decisive Step Forward

Neoadjuvant Therapy of Gastric Cancer: A Decisive Step Forward

Current strategies in systemic treatment of gastric cancer and cancer of the gastroesophageal junction

Innovative Drugs and Strategies in the Treatment of Upper Gastrointestinal Tract Carcinomas

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