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 Prognostic Significance of Conversion Surgery Following First- or Second-line Chemotherapy for Unresectable Gastric Cancer

2018 ◽  
Vol 38 (11) ◽  
pp. 6473-6478 ◽  
Author(s):  
MINORU FUKUCHI ◽  
ERITO MOCHIKI ◽  
TORU ISHIGURO ◽  
YOUICHI KUMAGAI ◽  
KEIICHIRO ISHIBASHI ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Significance ◽  
Conversion Surgery ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Unresectable Gastric Cancer ◽  
Line Chemotherapy

scholarly journals Efficacy of Conversion Surgery Following Apatinib Plus Paclitaxel/S1 for Advanced Gastric Cancer With Unresectable Factors: A Multicenter, Single-Arm, Phase II Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhiyuan Xu ◽  
Can Hu ◽  
Jianfa Yu ◽  
Yian Du ◽  
Ping Hu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Objective Response ◽  
Bleeding Event ◽  
Primary Objective ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Conversion Surgery ◽  
Response To Chemotherapy ◽  
Unresectable Gastric Cancer ◽  
Grade 3

Objective: Conversion therapy (surgical resection after chemotherapy) is a promising option for unresectable gastric cancer (GC) patients. Addition of anti-angiogenesis drug improves response to chemotherapy. Hence, this study explored the feasibility and efficacy of preoperative paclitaxel (PTX)/S1 chemotherapy combined with apatinib for unresectable GC.Methods: Thirty-one eligible patients with a single unresectable factor were enrolled in this multi-center, single-arm trial. Apatinib (500 mg qd) was administered continuously, while PTX (130 mg/m2) on day 1 and S1 (80 mg/m2) on day 1–14 were given every 3 weeks. The treatment was given for three cycles preoperatively, but the last cycle did not include apatinib. The primary objective measurements included R0 resection rate, objective response rate (ORR) and morbidity of preoperative treatment.Results: Among the 31 patients, 30 patients were evaluable for tumor response, the ORR to preoperative treatment was 73.3%. Eighteen of 30 patients underwent surgery, and R0 resection was achieved in 17 patients. The patients who underwent the conversion surgery had a superior OS compared with those who did not (3 years OS: 52.9 vs 8.3%, p = 0.001). The surgery was operated after apatinib had stopped for a median duration of 4 weeks. Neither anastomotic leakage nor wound healing complications was observed. No increased bleeding event was observed compared with historical data. During preoperative treatment, grade 3 or 4 toxicities were experienced by 58.1% of the patients.Conclusion: Chemotherapy in combination with apatinib demonstrated higher rates of conversion and R0 resection and a superior survival benefit in initial unresectable GC. It is safe and reasonable to suspend apatinib for 4 weeks before the gastrectomy.

scholarly journals The Results of Conversion Therapy for Initially Unresectable Gastric Cancer: a Respective Analysis of 191 Patients

2021 ◽  
Author(s):  
Shaopeng Zhang ◽  
Song Wu ◽  
Yuan Kong ◽  
Wei Li
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Surgical Treatment ◽  
Systemic Chemotherapy ◽  
R0 Resection ◽  
Conversion Therapy ◽  
Response To Chemotherapy ◽  
Unresectable Gastric Cancer ◽  
N Stage ◽  
Intraperitoneal Hyperthermic Perfusion

Abstract 【Objective】 To analyze the clinical efficacy of systemic chemotherapy combined with intraperitoneal hyperthermic perfusion in the treatment of locally invasive stage III gastric cancer and stage IV gastric cancer. 【Methods】 The clinical data of 191 patients with gastric cancer who received systemic chemotherapy combined with intraperitoneal hyperthermic perfusion from June 2010 to December 2018 were retrospectively analyzed. 【Results】 The unresectable factors in 191 patients with gastric cancer included peritoneum metastasis (106), local invasion (67), liver metastasis (25), lung metastasis (3), bone metastasis (4), adnexal metastasis (3) and adrenal metastasis (4). After conversion therapy, 191 patients were divided into finished conversion group and non-finished group. There were significant differences in T stage, M stage and tumor differentiation between the two groups. During the course of chemotherapy, 11 patients had grade 3 or 4 chemotherapy adverse reactions. The median survival was 36 months in the finished conversion group and 14 months in the non-finished group. The median survival of the 69 R0 resected patients was 38 months, which was higher than that of chemotherapy alone (14 months), best supportive care (13 months) and patients who completed chemotherapy without R0 resection (19 months). Univariate Cox survival analysis found that N stage, R0 resection, response to chemotherapy and unresectable factors were prognostic factors. Multivariate Cox survival analysis showed that N-stage, response to chemotherapy and unresectable factors were independent prognostic factors. 【 Conclusion 】 For unresectable gastric cancer patients, surgical treatment after chemotherapy can prolong survival. Radical surgical treatment after conversion therapy and chemotherapy response are important factors related to patient survival. Chemotherapy alone can prolong survival in primary unresectable gastric cancer, but with limited effect.

Predictive factors for long-term survival after conversion surgery for unresectable gastric cancer: A retrospective analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 205-205
Author(s):  
Tamotsu Sagawa ◽  
Kyoko Hamaguchi ◽  
Akira Sakurada ◽  
Fumito Tamura ◽  
Tsuyoshi Hayashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Residual Tumor ◽  
R0 Resection ◽  
Conversion Surgery ◽  
Tumor Depth ◽  
Term Survival ◽  
Long Term Survival ◽  
Line Therapy ◽  
Unresectable Gastric Cancer

205 Background: Chemotherapy occasionally converts an initially unresectable gastric cancer to a resectable cancer. However, the association between clinical factors and long-term prognosis after conversion surgery for unresectable gastric cancer has not been investigated. Methods: We retrospective reviewed 36 gastric cancer patients who underwent conversion surgery at our institute between 2005 and 2015. Clinicopathologic characteristics and patient outcomes were analyzed, with particular focus on the potential to predict long-term survival. Results: The number of incurable factors was one in 31 patients and two in 5, including metastases to non-regional lymph node in 22, peritoneum in 10, liver in 6, and lung in 3. The regimen of chemotherapy was Docetaxel/CDDP/S-1 in 23 patients, Docetaxel/CDDP/S-1+Trastuzmab in 7, S-1/CDDP in 2, Docetaxel/S-1 in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. Complete resection with no residual tumor (R0) was achieved in 25 of 36 patients, microscopic residual tumor status (R1) in 10, and macroscopic residual tumor (R2) in 1. The 3-year overall survival (OS) rate among the 36 patients who underwent conversion surgery was 60.3 % (median survival time, 1200 days). The 3-year OS rate among patients who underwent R0 resection was 70.8 % (median survival time, 1503 days). Patients who underwent R0 resection had significantly longer OS times than those who underwent R1 and R2 resection ( p=0.0124). We selected 16 variables in addition to residual tumor for Kaplan–Meier analysis. According to the log rank test, the following four variables were significantly associated with a better OS: clinical response to 1st line therapy (CR or PR vs. SD or PD)( p=0.0283), pathological response grade (1b-3 vs. 0-1a) ( p=0.0304), pathological tumor depth (CR or T1~T3 vs. T4) ( p=0.0261), and pathological nodal stage (N0〜2 vs. N3) ( p=0.0086). Conclusions: Our data indicates that clinical response to 1st line therapy in preoperative characteristics, R0 resection, pathological response grade, pathological tumor depth, pathological nodal stage in postoperative characteristics are predictive factors that can be expected to long-term survival.

A phase II study of S-1, oxaliplatin, and nab-paclitaxel, and itraconazole aimed at conversion surgery for advanced and recurrent gastric cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4026-4026
Author(s):  
Yoshihiko Nakamoto ◽  
Hiroshi Tsubamoto ◽  
Miyuki Sawazaki ◽  
Ayako Kakuno ◽  
Takashi Sonoda
Keyword(s):  
Gastric Cancer ◽  
Lung Metastases ◽  
Gastroesophageal Junction ◽  
Stage Iv ◽  
Sensory Neuropathy ◽  
R0 Resection ◽  
Chemotherapy Response ◽  
Conversion Surgery ◽  
Recurrent Gastric Cancer ◽  
Grade 3

4026 Background: Preclinical and clinical studies demonstrated that itraconazole, a common anti-fungal agent, has anticancer activity. The purpose of this study was to evaluate the efficacy of the chemotherapy with itraconazole on unresectable, metastatic, and recurrent gastric cancer. Methods: All patients were referred to our clinic with a clinical diagnosis of unresectable gastric cancer. The regimen consisted of 160 mg/m2 nab-paclitaxel IV on day 1, 100 mg/m2 oxaliplatin IV on day 1, 60 mg/m2 S-1 orally on days 1-7, and 400mg itraconazole orally on days -1 to 3, repeated every 3 weeks. Conversion surgery was allowed. The primary endpoint was overall survival (OS). Results: Between 2015 and 2018. 23 patients were enrolled. Their median age was 68 years (range 40-80 years); stomach/gastroesophageal junction: 21/2; Stage IIIA/IIIB/IV: 2/1/20. Among 10 patients who had liver metastases, 2 had simultaneous lung metastases. Nine patients had peritoneal dissemination. Five patients with stage IV had recurrent disease after primary surgery followed by adjuvant S-1. The other 18 patients had no history of surgery or chemotherapy. Response rate was 70% (CR/PR: 2/14). Among 12 patients (67%) who had conversion surgery, R0 resection was conducted in 8 and no residual tumor was observed in 2. Among enrolled 23 patients, median OS was 22 months (95%CI: > 12 months) and 1-year OS rate was 81.8% (95%CI: 46.7%―95.5%). Grade 3/4 neutropenia in 5 (22%), no grade 3/4 thorombocytopenia, grade 2 peripheral sensory neuropathy in 6 (26%). Conclusions: The addition of itraconazole to chemotherapy showed promising efficacy with high conversion surgery rate and with acceptable toxicities. Clinical trial information: UMIN000021340.

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.

Conversion chemotherapy combined with surgical treatment of unresectable advanced gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 189-189 ◽  
Author(s):  
Yian Du ◽  
Pengfei Yu
Keyword(s):  
Gastric Cancer ◽  
Survival Time ◽  
Advanced Gastric Cancer ◽  
Surgical Resection ◽  
Distant Metastasis ◽  
Distant Metastases ◽  
R0 Resection ◽  
Extended Lymph Node Dissection ◽  
Significant Difference ◽  
Local Advanced

189 Background: Local advanced gastric cancer which could not receive R0 resection, or gastric cancer with single distant metastasis usually received palliative chemotherapy or entered into various clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From 2007.8 to 2012.8, 78 cases of local advanced gastric cancer which can not be treated with R0 resection(T4N2~3M0) or gastric cancer with single distant metastases(M1) were prospectively analysed. Patients were treated with 2~4 cycles of combined chemotherapy with paclitaxel (150mg/m2,d1), cisplatin(25mg/m2, d1~3) and 5-fluorouracil (750 mg/m2, d1~3) ( repeated every 3 weeks), and were then treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with extended lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, liver resection and tumor radio frequency, followed by another 2~4 cycles of postoperative PCF chemotherapy.The treatment completion rate, patients’ tolerance and overall survival time were analyzed. Results: 56 patients (71.8%) accomplished chemotherapy and surgical resection as planned. 47 cases had R0 resection(60.3%). Grade 3/4 toxic effects included bone marrow suppression(24.4%) and gastrointestinal reaction(37.2%), the overall response rate (CR+PR) was 73.1%(CR 2 cases, PR 55 cases). Survival analysis: the median survival time was 23.4 months. 1-year and 3-year survival rate was 68.1% and 33.5%. The OS of patients with surgical resection was much longer than that of the non-surgery group.(36.1 VS 10.0 months, P<0.01). The OS of local advanced group was 38.6 months, and was significantly longer than 20.7 months of the distant metastasis group (P<0.01), however, it had no significant difference compared to 31.3 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single distant metastasis.

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.

scholarly journals Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koichi Hayano ◽  
Hiroki Watanabe ◽  
Takahiro Ryuzaki ◽  
Naoto Sawada ◽  
Gaku Ohira ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
R0 Resection ◽  
Conversion Surgery ◽  
First Line ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Gastric Cancer Patients ◽  
First Line Treatment

Abstract Background Since the ToGA trial, trastuzumab-based chemotherapy is the standard treatment for HER2 positive stage IV gastric cancer. However, it is not yet clear whether surgical resection after trastuzumab-based chemotherapy (conversion surgery) can improve survival of HER2 positive stage IV gastric cancer. The purpose of this study is to evaluate the prognostic benefit of conversion surgery in HER2 positive stage IV gastric cancer patients. Case presentation We retrospectively investigated the medical records of the patients with HER2 positive (IHC3(+) or IHC2(+)/FISH(+)) stage IV gastric cancer treated with trastuzumab-based chemotherapy as the first line treatment. Overall survival (OS) was compared between patients with conversion surgery and without. Eleven HER2 positive stage IV gastric cancer patients treated with trastuzumab-based chemotherapy as the first line treatment were evaluated. Response rate was 63.6%, and 6 of 11 patients could receive conversion surgery. R0 resection was achieved in four patients. In Kaplan–Meier analysis, patients who received conversion surgery showed significantly better OS than those without surgery (3-year survival rate, 66.7% vs. 20%, P = 0.03). The median OS of patients who achieved R0 resection is 51.8 months. Conclusions Conversion surgery might have a survival benefit for HER2 positive stage IV gastric cancer patients. If curative surgery is technically possible, conversion surgery could be a treatment option for HER2 positive stage IV gastric cancer.

Treatment of canine lymphoma with COPLA/LVP

2000 ◽  
Vol 36 (5) ◽  
pp. 395-403 ◽  
Author(s):  
KL Boyce ◽  
BE Kitchell
Keyword(s):  
Partial Response ◽  
Survival Time ◽  
National Cancer Institute ◽  
Median Survival Time ◽  
Prognostic Significance ◽  
Complete Response ◽  
Canine Lymphoma ◽  
Remission Duration ◽  
First Remission ◽  
Toxicity Criteria

Seventy-five dogs with cytopathologically or histopathologically confirmed lymphoma received L-asparaginase, vincristine, cyclophosphamide, prednisone, and doxorubicin (COPLA) induction followed by chlorambucil, vincristine, and prednisone (LVP) maintenance between January 1994 and June 1997. Toxicity was evaluated using the National Cancer Institute (NCI) toxicity criteria. Age, weight, sex, and response were evaluated for prognostic significance against first remission duration. A complete response (CR) was obtained in 61 (80%) dogs, a partial response (PR) was obtained in nine (12%) dogs, and no response (NR) was obtained in five (8%) dogs. The median first remission duration was 25 weeks, with 17% and 5% of the dogs in remission at one and two years, respectively. Observed toxicity was low, with 84% of dogs given an NCI score of 1 or 2. Median survival time for dogs achieving CR was 36 weeks versus four weeks for those achieving PR or NR.

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