Conversion surgery for recurrent hepatic angiosarcoma after systemic chemotherapy with paclitaxel

2022 ◽  
Author(s):  
Yuta Ushida ◽  
Takafumi Sato ◽  
Tomotaka Kato ◽  
Yasuyuki Shigematsu ◽  
Hiromichi Ito ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Conversion Surgery ◽  
Hepatic Angiosarcoma

412 Outcomes of Intraperitoneal and Systemic Chemotherapy for Patients with Peritoneal Metastases from Gastric Cancer: Is Conversion Surgery Possible?

2016 ◽  
Vol 150 (4) ◽  
pp. S1178
Author(s):  
Dexter Y. Chan ◽  
Nicholas L. Syn ◽  
Rachel Yap ◽  
Janelle N. Phua ◽  
Amy Yuh Ling Tay ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Peritoneal Metastases ◽  
Conversion Surgery

scholarly journals Conversion Surgery for Metastatic Pancreatic Mucinous Carcinoma Responsive to Systemic Chemotherapy with Modified FOLFIRINOX: A Case Report

2019 ◽  
Vol 86 (5) ◽  
pp. 284-290 ◽  
Author(s):  
Tadashi Yokoyama ◽  
Hiroshi Makino ◽  
Atsushi Hirakata ◽  
Junji Ueda ◽  
Hideyuki Takata ◽  
...  
Keyword(s):  
Case Report ◽  
Systemic Chemotherapy ◽  
Mucinous Carcinoma ◽  
Conversion Surgery

Outcomes of a phase II study of intraperitoneal paclitaxel plus systemic capecitabine and oxaliplatin (XELOX) for gastric cancer with peritoneal metastases.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 165-165
Author(s):  
Daryl Chia ◽  
Raghav Sundar ◽  
Guo Wei Kim ◽  
Jiajun Ang ◽  
Jeffrey Lum ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Performance Status ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Peritoneal Metastases ◽  
Conversion Surgery ◽  
Current Standard ◽  
Peritoneal Disease ◽  
Phase 2 Trial

165 Background: The addition of intraperitoneal (IP) paclitaxel (PTX) to systemic chemotherapy comprising taxane/fluoropyrimidine doublet has shown promising results for patients with gastric cancer (GC) and peritoneal metastases (PM). However, this has not been studied in combination with platinum/fluoropyrimidine doublet which is the current standard-of-care for metastatic GC. We conducted a prospective phase 2 trial of IP PTX with capecitabine and oxaliplatin (XELOX) in patients with GCPM. Methods: The trial enrolled 44 patients with GCPM who received treatment comprising IP PTX (40mg/m2 on day 1,8), PO capecitabine (1000mg/m2 twice daily from day 1-14) and IV oxaliplatin (100mg/m2 on day 1) in 21-day cycles. Patients with synchronous GCPM were eligible for conversion surgery comprising radical gastrectomy if they had good response after chemotherapy, negative cytology on 2 consecutive peritoneal fluid assessments, no extraperitoneal metastasis and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were also compared with a retrospective cohort of 39 patients with GCPM who received identical systemic chemotherapy (SC) comprising platinum/fluoropyrimidine agents alone. Results: The median OS for the IP and SC groups was 14.6 and 10.6 months (HR 0.44; 95% CI, 0.26-0.74; P=0.002). The 1-year OS was 67.8% in the IP group and 32.3% in the SC group (Logrank p<0.001). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI, 0.25-0.66; P<0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p=0.021) and had better baseline performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p=0.007) compared to the IP cohort. In the IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95%CI 13.1 – 35.3) months and 1-year OS of 84.6%. Wound-related complications requiring the port to be explanted or re-sited occurred in 9% (4/44) of patients. Conclusions: IP PTX with XELOX is a promising treatment option for GCPM patients. For patients with good response, conversion surgery was feasible with favourable outcomes. Clinical trial information: NCT01739894. [Table: see text]

Conversion Surgery Post-Intraperitoneal Paclitaxel and Systemic Chemotherapy for Gastric Cancer Carcinomatosis Peritonei. Are We Ready?

2016 ◽  
Vol 21 (3) ◽  
pp. 425-433 ◽  
Author(s):  
Dexter Yak Seng Chan ◽  
Nicholas Li-Xun Syn ◽  
Rachel Yap ◽  
Janelle Niam Sin Phua ◽  
Thomas I. Peng Soh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Conversion Surgery

Conversion surgery for unresectable gastric cancer following complete response of distant metastasis by systemic chemotherapy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 152-152
Author(s):  
Daisuke Kobayashi ◽  
Mitsuro Kanda ◽  
Chie Tanaka ◽  
Naoki Iwata ◽  
Masamichi Hayashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Time ◽  
Distant Metastasis ◽  
Systemic Chemotherapy ◽  
Lung Metastases ◽  
Prognostic Significance ◽  
Complete Response ◽  
R0 Resection ◽  
Conversion Surgery ◽  
Unresectable Gastric Cancer

152 Background: In case of gastric cancer (GC), conversion surgery (CS) can be defined as resection of the primary cancer by gastrectomy which had not been originally planned but was indicated after confirming complete response (CR) in the distant metastasis (DM) by chemotherapy. In the present study, we looked at prognostic significance of CS, which is intended to cure originally unresectable GC. Methods: From 2004 to Feb in 2016, 24 GC patients who were treated by chemotherapy and achieved CR in DM underwent CS among 909 patients with gastrectomy in our department. 10 out of 24 patients who had peritoneal metastases (P) as a single non-curative factor underwent intraperitoneal chemotherapy (IP) in addition to systemic chemotherapy. CR was confirmed by CT and/or laparoscopic examination. Results: 15 patients had P, 13 had distant lymph node metastases (LYM), 2 had liver metastases, and 2 had lung metastases. Chemotherapeutic regimens consisted of systemic chemotherapy plus IP of taxane in 10 patients, S-1/CDDP in 7, capecitabine/CDDP/trastsuzumab in 3, and others in 4. Median duration of chemotherapy before surgery was 7.3 months (2.3-17.5). Total gastrectomy was performed in 18 patients and distal gastrectomy in 6, achieving R0 resection in 21 patients and R1 in 3. 10 patients with P who underwent IP relapsed within 12 months postoperatively except for 2 and had significantly shorter overall survival time than those with other DM except for P (median: 20 vs. 42 months, P = 0.004). Among 14 patients who had DM other than P as target lesions, 9 are disease-free with postoperative median follow up time of 35 months (6.8-82), and 5 patients had recurrence (LYM in 4 and P in 1) with postoperative median survival time of 25 months (4.8-45). DM of the patients without recurrence had achieved CR within shorter period (median: 3.6 vs. 6.7 months) and had higher pathological response rate of the primary lesion (89% vs. 40%) compared to patients with recurrence. Conclusions: Outcome of GC patients who underwent CS after achieving CR in DM was promising, especially in those without P. Further issues such as appropriate chemotherapeutic period, and prognostic factors to decide on the indication for CS need to be solved.

scholarly journals Conversion Surgery with HIPEC for Peritoneal Oligometastatic Gastric Cancer

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1715 ◽  
Author(s):  
Mielko ◽  
Rawicz-Pruszyński ◽  
Skórzewska ◽  
Ciseł ◽  
Pikuła ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Median Survival ◽  
Systemic Chemotherapy ◽  
Stage Iv ◽  
R0 Resection ◽  
Conversion Surgery ◽  
Comprehensive Complication Index ◽  
Japanese Classification ◽  
Severe Grade

Peritoneal metastases (PM) of gastric cancer (GC) are characterized by a particularly poor prognosis, with median survival time of 6 months, and virtually no 5-year survival reported. Conversion therapy for GC is defined as a surgical treatment aiming at an R0 resection after systemic chemotherapy for tumours that were originally unresectable (or marginally resectable) for technical and/or oncological reasons. The aim of the present study was to evaluate early and late outcomes in GC patients with PM who underwent the cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant (conversion) chemotherapy. Thirty patients with stage IV GC underwent CRS plus HIPEC. Severe grade III/IV (Clavien-Dindo classification) complications occurred in 13 (43%) patients. The Comprehensive Complication Index (CCI) ranged from 8.7 to 100 (median, 42.4). In the multivariate survival analysis, ypT2 and P3 (according to the Japanese classification of the PM severity) were favourable and adverse prognostic factors p = 0.031 and o = 0.035, respectively. Estimated 1- and 3-year survival was 73.9% and 36.6%, respectively. The median survival was 19.3 months. Conclusion: Conversion surgery, including extended gastrectomy and multi-organ resections followed by HIPEC performed after systemic chemotherapy therapy for GC with PM is justified in downstaged patients with ypT2 and limited (less than P3) PM.

scholarly journals Conversion Surgery for Patients with Advanced Gastric Cancer with Peritoneal Carcinomatosis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ting-Ying Lee ◽  
Guo-Shiou Liao ◽  
Hsiu-Lung Fan ◽  
Chung-Bao Hsieh ◽  
Teng-Wei Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Advanced Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Malignant Ascites ◽  
Peritoneal Cytology ◽  
Conversion Surgery ◽  
Peritoneal Cancer

Background. Patients with advanced gastric cancer (AGC) with peritoneal carcinomatosis (PC) usually have poor outcomes and high mortality risk, even with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This study analyzed the prognostic factors of AGC with PC and evaluated laparoscopic HIPEC (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) as a conversion surgery for AGC patients with PC with a poor initial prognosis. Patient and Methods. We retrospectively evaluated 127 patients with AGC and PC from January 1, 2012, to March 1, 2020. After the exclusion of 32 ineligible patients, the conversion group comprised 34 patients who underwent LHIPEC + NIPS as a conversion surgery followed by CRS plus HIPEC. The CRS + HIPEC group included 15 patients who underwent CRS with HIPEC alone. Additionally, the C/T group comprised 23 patients who received systemic chemotherapy, and the palliative group comprised 23 patients who received only conservative therapy or palliative gastrectomy. Results. The conversion group demonstrated a significantly better mean overall survival compared to the CRS + HIPEC, C/T, and palliative groups ( p < 0.001 ). Patients in the conversion group who underwent LHIPEC + NIPS had significantly decreased peritoneal cancer index (PCI) scores ( p < 0.001 ) and ascites ( p = 0.003 ). Malignant ascites amount also significantly decreased after treatment in the LHIPEC + NIPS group ( p < 0.001 ). Conclusions. LHIPEC + NIPS can significantly improve the overall survival, the PCI score, and malignant ascites amount in peritoneal cytology-positive gastric cancer with PC, and an initially high PCI score. Therefore, it may be a feasible conversion strategy for AGC patients with PC.

scholarly journals Neoadjuvant Intraperitoneal and Systemic Chemotherapy Versus Neoadjuvant Systemic Chemotherapy With Docetaxel, Oxaliplatin, and S-1 for Gastric Cancer With Peritoneal Metastasis: A Propensity Score Matched Analysis

2021 ◽  
Vol 20 ◽  
pp. 153303382110363
Author(s):  
Xin Zhang ◽  
Hejing Huang ◽  
Dejun Yang ◽  
Peng Wang ◽  
Xin Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Propensity Score ◽  
Peritoneal Metastasis ◽  
Systemic Chemotherapy ◽  
Cox Regression ◽  
R0 Resection ◽  
Conversion Surgery ◽  
Resection Rate ◽  
Response To Chemotherapy

Background: The optimal treatment for gastric cancer with peritoneal metastasis (GCPM) remains debatable. This study aimed to compare the efficacy and safety of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) versus neoadjuvant systemic chemotherapy (NSC) for GCPM. Methods: Patients of GCPM received neoadjuvant chemotherapy with docetaxel, oxaliplatin and S-1 between January 2011 and June 2019 were retrospectively evaluated. Propensity score matched (PSM) analysis was carried out to reduce the selection bias. Multivariate Cox regression model was applied to screen the prognostic factors. Results: After PSM processing, 71 patients in each group were matched among the 186 GCPM patients included. NIPS yielded a better ascites and cytology response to chemotherapy, higher conversion resection rate and R0 resection rate than NSC. The overall survival (OS) rate in NIPS group was better than that in NSC group. Multivariate analysis revealed that the P stage, ascites response, conversion surgery rate and R0 resection rate were independent prognostic factors. Subgroup analysis indicated that NIPS showed a survival benefit over NSC only in patients with cT3-4a, P1-2, whose cytology turned negative, and who received conversion surgery; while not in patients with cT4b, P0 or P3, whose cytology did not turn negative, or who did not receive conversion surgery. Conclusions: NIPS is a safe and feasible treatment for GCPM, which showed more benefit than NSC.

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