Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms

Chelakkot, Prameela G.; Ravind, Rahul; Sruthi, K; Menon, Durgapoorna

doi:10.4103/ijc.ijc_375_18

Cited by 4 publications

(10 citation statements)

References 42 publications

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“…In countries leading in the diagnosis and treatment of this cancer, this translates into a significantly better prognosis than in the past. In the Far East, the 5-year survival rate reaches 70%, in Western European countries it is 25% [1,4,6]. Unfortunately, in Poland the 5-year survival rate in this group of patients increased slightly during the first decade of the 21st century, from 14.6% to 16.4% in men and from 18.2% to 19.8% in women.…”

Section: Discussionmentioning

confidence: 99%

The influence of surgery quality on the longtime results of gastric cancer combination therapy

Pierzankowski

Dmitruk²,

Rybski³

et al. 2022

Nowotwory. Journal of Oncology

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Introduction.The aim of this study was to analyze the influence of surgical center experience on the long term survival of patients with locoregionally advanced gastric adenocarcinoma undergoing primary surgery, followed by complementary chemoradiotherapy according to MacDonald regimen. Material and methods. 154 patients treated surgically, including 75 (48.7%) at the Maria Sklodowska-Curie National Research Institute of Oncology (NIO-PIB) in Warsaw, and 79 (51.3%) outside this center. Both groups were retrospectively analyzed. The compared groups were statistically homogeneous. The following parameters were analyzed: age, gender, tumor differentiation, TNM VII (2010) staging, nodal index, radicality of surgical treatment, tumor type according to the Lauren classification, clinical stage, presence of prognostic factors, overall survival time. Results. Among those patients operated on at NIO-PIB, 71 (94.7%) patients underwent radical resection, 4 (5.3%) cases were microscopically non-radical resection had. There were no macroscopically non-radical resections (0%). For patients operated on outside NIO-PIB, 60 (75.9%) R0 resections, 15 (19%) R1 resections and 4 (5.1%) R2 resections were performed. The percentage of radical resections was significantly higher at NIO-PIB (p = 0.001). In 77% of patients operated on at NIO-PIB, disease progression in terms of feature could be established. This percentage for patients operated on outside the NIO-PIB was 54% and was significantly lower (p = 0.001). The probability of 5-year survival was 41.6% in total, with 45.3% for the group of patients operated on in the NIO-PIB and 38.0% for the group of patients operated on outside the NIO-PIB, respectively (p = 0.628). Conclusions. The quality of surgical treatment was significantly higher in NIO-PIB. The difference in 5-year overall survival (OS) between the compared groups is not statistically significant. Complementary treatment with chemoradiotherapy (CRT) according to MacDonald regimen reduces the shortcomings in the quality of surgical treatment in locoregionally advanced gastric adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

The influence of surgery quality on the longtime results of gastric cancer combination therapy

Pierzankowski

Dmitruk²,

Rybski³

et al. 2022

Nowotwory. Journal of Oncology

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“…Two other important clinical trials in gastric cancer have to be mentioned given the comparison made between the chemotherapy alone versus chemoradiotherapy treatment approaches with results questioning the benefit of radiotherapy. 6 Lee et al, published the ARTIST trial in 2012 comparing adjuvant chemotherapy alone to adjuvant chemoradiotherapy (also with chemotherapy before and after in the combined treatment) and showed that the addiction of chemoradiotherapy in patients submitted to curative gastric cancer surgery with D2 lymphadenectomy did not provide benefit in locoregional control of the disease. 10 However, the subgroup analysis did find a statistically significant prolongation in DFS survival in patients with positive pathologic lymph node gastric cancer submitted to chemoradiotherapy versus chemotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

“…3 The uncertainty of which treatment strategy (perioperative chemotherapy or adjuvant chemoradiotherapy) is superior still exists for some patients, even with the results of more recent clinical trials that compared chemotherapy to chemoradiotherapy in resectable gastric cancer. 6 This study pretends to compare the outcomes of toxicity, disease-free survival (DFS) and OS of patients treated with MAGIC protocol versus MacDonald protocol in a university hospital center.…”

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confidence: 99%

MacDonald versus MAGIC treatment protocols for gastric cancer: age as a decision factor

Figueiredo¹,

Delgado²,

Pais³

et al. 2020

Int J Adv Med

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Background: A multimodality approach is the standard of care in the treatment of locally advanced non-metastatic gastric cancer. However, it lacks studies that compares the adjuvant chemoradiotherapy strategy of the landmark MacDonald clinical trial with the perioperative chemotherapy strategy of the landmark MAGIC clinical trial.Methods: Retrospective study of patients with gastric cancer stage IB-III treated at a single cancer center between 2010 and 2013 with MacDonald or MAGIC treatment protocols.Results: Sixty-two patients were identified (38 patients in the MacDonald protocol and 24 in the MAGIC protocol), with a mean age of 68 years (range: 39-84). At a median follow-up of 37 months, the DFS survival at 12 and 36 months of the patients in the MacDonald protocol was 83.5% and 61.1% versus 79.2% and 49.7% in the MAGIC protocol, respectively (p=0.319). The overall survival at 12 and 36 months of the patients in the MacDonald protocol was 89.5% and 65.8% versus 83.3% and 54.2% in the MAGIC protocol, respectively (p=0.168). At multivariate analysis, the risk of death was significantly superior in older patients undergoing the MAGIC protocol (p=0.02), but not the MacDonald protocol (p=0.627). The differences in toxicity between the two protocols were not statistically different.Conclusions: This result suggest that patient age is a factor to consider when choosing between the MacDonald or MAGIC protocols. However, the limitations inherent to a retrospective study of small sample size must be accounted for.

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“…Our study results are in congruence with other studies like FNCLCC [15][16][17] which followed the path of the MAGIC trial, testifying favorable survival outcomes for adjuvant and neoadjuvant therapies in gastric cancer. [18] Although the FAMTX trial [19] could not demonstrate better outcomes for neoadjuvant chemotherapy, a meta-analysis on chemotherapy concluded that chemotherapy was advantageous in advanced gastric cancer. [20] In India, there has been a long-existing disparity in gastric cancer research in general and specifically in the context of therapeutics compared to other Western and Asian countries, as reported by review articles.…”

Section: Discussionmentioning

confidence: 99%

“…[20] In India, there has been a long-existing disparity in gastric cancer research in general and specifically in the context of therapeutics compared to other Western and Asian countries, as reported by review articles. [18,21] Studies have reported neoadjuvant therapy to be reliable in LAGC and improving outcomes such as resectability rate and survival while reducing recurrence. [22][23][24][25] In the recent randomized controlled trial comparing two chemotherapy regimens in the neoadjuvant setting, the median OS at 2 years was 52% and 44% for both the groups.…”

Section: Discussionmentioning

confidence: 99%

Does Neoadjuvant Chemotherapy Increase the Survival in Patients with Locally Advanced Gastric Cancer Patients? – A Real‑World Evidence

Janarthinakani

Kalaiselvi

Priyadarshini

et al. 2020

Indian Journal of Medical and Paediatric Oncology

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Background: In locally advanced gastric cancer (LAGC), perioperative chemotherapy has shown to improve the survival to a larger extent compared to surgery alone. In India, the treatment followed for gastric carcinoma widely varies based on the type of health-care provider and treatment access. There is a paucity of data on the role of neoadjuvant chemotherapy on survival among LAGC patients in the Indian context. Aim: The aim of this study was to compare the disease-free survival (DFS) and overall survival (OS) between neoadjuvant and adjuvant chemotherapies among LAGC patients. Subjects and Methods: This was a retrospective cohort study involving clinical record review of LAGC patients enrolled between 2015 and 2017 from four tertiary cancer centers in South India. The date for the following events, namely diagnosis, recurrence, death, and last day of visit, was extracted in a mobile-based open-access tool. The median duration of OS and DFS between the neoadjuvant and adjuvant groups was compared using Kaplan–Meier survival curves. Results: Of the 137 patients, 70 (51%) had received neoadjuvant chemotherapy followed by surgery and 67 (49%) had adjuvant chemotherapy following the surgery. The mean (standard deviation) age of participants was 55.4 (11.4) years. Seventy-eight percent of the patients were diagnosed at Stage 3 or 4. Regional lymph nodes were involved in 83.9%. The median duration of follow-up was 15 months. The OS in the neoadjuvant and adjuvant groups was 18.6 months and 8.3 months, respectively. Nonregional lymph node involvement and adjacent organ involvement had independently increased the risk of death. Conclusion: Among LAGC patients, the neoadjuvant chemotherapy indicated a better median and DFS compared to the adjuvant group. However, these findings were statistically not significant. The current study has contributed an important finding to the existing evidences of clinical practice in an Indian setting. Further large-scale studies are required to validate the promising trend of using neoadjuvant chemotherapy in LAGC.

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Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms

Cited by 4 publications

References 42 publications

The influence of surgery quality on the longtime results of gastric cancer combination therapy

The influence of surgery quality on the longtime results of gastric cancer combination therapy

MacDonald versus MAGIC treatment protocols for gastric cancer: age as a decision factor

Does Neoadjuvant Chemotherapy Increase the Survival in Patients with Locally Advanced Gastric Cancer Patients? – A Real‑World Evidence

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