Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy

Abstract

Patients with locoregional gastric carcinoma often die because of the low rates of curative resection and frequent appearance of distant metastases (mainly peritoneal and hepatic). To evaluate the feasibility of preoperative and postoperative chemotherapy, 25 consecutive previously untreated patients with potentially resectable locoregional gastric carcinoma received two preoperative and three postoperative courses of etoposide, 5‐fluorouracil, and cisplatin (EFP). Ninety‐eight courses (median, five courses; range, two to five courses) were administered. Six patients had major responses to EFP. Eighteen patients (72%) had curative resections, and three specimens (12%) contained only microscopic carcinoma. At a median follow‐up of 25 months, the median survival of 25 patients was 15 months (range, 4 to 32+ months). Peritoneal carcinomatosis was the most common indication of failure. One patient died of postoperative complications, but there were no deaths due to chemotherapy. EFP‐induced toxic reactions were moderate. Preoperative and postoperative chemotherapy for locoregional gastric carcinoma is feasible, and additional studies to develop regimens that could result in 5% to 10% complete pathologic responses may be warranted.

Factors predicting peritoneal recurrence in advanced gastric cancer: implication for adjuvant intraperitoneal chemotherapy

“…Therefore, prevention of peritoneal carcinomatosis is key to long-term survival. Adjuvant systemic chemotherapy has been recommended as the standard of care for resectable gastric cancer [4,5]; however, peritoneal recurrence is still the most common treatment failure after adjuvant systemic chemotherapy [4][5][6]19]. In this study, peritoneal recurrence also occurred most frequently despite the fact that a number of patients with stages II and III (AJCC/ UICC 6th edition) received adjuvant systemic chemotherapy, except when the patients had poor general condition.…”

Multimodale Therapie bei Tumoren des oberen Gastrointestinaltrakts

“…Basierend auf diesen überzeugenden Ergebnissen wurde in einer Reihe von Studien daraufhin die neoadjuvante Chemotherapie auch bei Patienten mit potentiell resektablem Magencarcinom evaluiert. Alle publizierten Untersuchungen bei diesem Patientengut (ausschlieûlich unkontrollierte Phase-II-Studien) zeigten übereinstim-mend, daû eine präoperativen Chemotherapie nicht zu einer Erhöhung der postoperativen Letalität oder Morbidität führt [1,2,32]. Die mit der präoperativen Polychemotherapie verbundene Knochenmarksuppression konnte in der Regel durch Dosisreduktion und den Einsatz von knochenmarkstimulierenden Faktoren beherrscht werden.…”

Gastric cancer: prevention and treatment of peritoneal metastases

“…Preusser et al [53] demonstrated that an aggressive systemic chemotherapy regimen can have a 50% response rate in advanced gastric cancer, however this less effective in patients with peritoneal metastases. Ajani et al [54] used neoadjuvant chemotherapy and reported the failure of the regimen was most common in patients with peritoneal metastases. Systemic chemotherapy alone for primary gastric cancer with peritoneal metastases is a disappointing plan of management.…”

“…Therefore, peritoneal implants should be treated via a combined intraperitoneal and intravenous approach. Intravenous chemotherapy has minimal effects on peritoneal metastases and intraperitoneal chemotherapy alone has a less than 30% effect on ascites [34][35][36]53,54] . The bidirectional chemotherapy (intraperitoneal and intravenous) have a response rate of 57% with 100% resolution of ascites.…”