Current treatment strategies for patients with only peritoneal cytology positive stage IV gastric cancer

11 Background: Staging laparoscopy (SL) can identify occult, subradiographic metastatic disease, either visible or cytologic, defining patients with stage IV gastric cancer who are unlikely to benefit from gastrectomy. The purpose of this study was to characterize the yield of repeat SL performed immediately prior to gastrectomy following administration of neoadjuvant therapy for locoregionally advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. Methods: Retrospective review of a prospective database identified patients with locoregionally advanced G/GEJ adenocarcinoma (T3−4Nany or TanyN+) that underwent pretreatment SL with negative peritoneal cytology followed by neoadjuvant chemotherapy or chemoradiation. After neoadjuvant therapy, patients underwent repeat SL. The yield of repeat SL to identify metastatic disease (M1) was determined and outcome data were analyzed. Results: From 1994−2010, 164 patients with locoregionally advanced G/GEJ adenocarcinoma were identified who underwent repeat SL immediately prior to gastrectomy. Occult M1 disease was identified in 12 patients (7.3%). Of these 12 patients, M1 disease was identified at laparoscopy in 9 patients (5.5%)—8 patients had visible disease and 1 patient had peritoneal cytology−only M1 disease. M1 disease not identified by SL was discovered at laparotomy in the other 3 patients (1.8%). There were no complications associated with patients who only underwent SL. Median follow-up was 30 months with a median survival of 18 months for patients with M1 disease and 47 months for patients resected with curative intent without M1 disease (p<0.001). Conclusions: Repeat staging laparoscopy following neoadjuvant therapy for locoregionally advanced G/GEJ adenocarcinoma identifies 5−6% of patients with clinically occult, subradiographic M1 disease. The majority of M1 disease is identified at repeat SL rather than at laparotomy and the majority is visible as opposed to cytology−only M1. These patients with occult M1 disease have a poor prognosis, are unlikely to benefit from gastrectomy, and repeat SL can avert the morbidity of a non−therapeutic laparotomy in this patient population.

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Gastrectomy for stage IV gastric cancer: a comparison of different treatment strategies from the SEER database

Scientific Reports ◽

10.1038/s41598-021-86352-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jacopo Desiderio ◽

Andrea Sagnotta ◽

Irene Terrenato ◽

Bruno Annibale ◽

Stefano Trastulli ◽

...

Keyword(s):

Gastric Cancer ◽

Treatment Strategies ◽

Stage Iv ◽

Multimodality Treatment ◽

Timing Of Surgery ◽

Seer Database ◽

Newly Diagnosed ◽

The West ◽

Stage Iv Gastric Cancer ◽

Stage Iv Disease

AbstractIn the West, more than one third of newly diagnosed subjects show metastatic disease in gastric cancer (mGC) with few care options available. Gastrectomy has recently become a subject of debate, with some evidence showing advantages in survival beyond the sole purpose of treatment tumor-related complications. We investigated the survival benefit of different strategies in mGC patients, focusing on the role and timing of gastrectomy. Data were extracted from the SEER database. Groups were determined according to whether patients received gastrectomy, chemotherapy, supportive care. Patients receiving a multimodality treatment were further divided according to timing of surgery, whether performed before (primary gastrectomy, PG) or after chemotherapy (secondary gastrectomy, SG). 16,596 patients were included. Median OS was significantly higher (p < 0.001) in the SG (15 months) than in the PG (13 months), gastrectomy alone (6 months), and chemotherapy (7 months) groups. In the multivariate analysis, SG showed better OS (HR = 0.22, 95%CI = 0.18–0.26, p < 0.001) than PG (HR = 0.25, 95%CI = 0.23–0.28, p < 0.001), gastrectomy (HR = 0.40, 95%CI = 0.36–0.44, p < 0.001), and chemotherapy (HR = 0.42, 95%CI = 0.4–0.44, p < 0.001). The survival benefits persisted even after the PSM analysis. This study shows survival advantages of gastrectomy as multimodality strategy after chemotherapy. In selected patients, SG can be proposed to improve the management of stage IV disease.

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Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.251.rv2 ◽

2016 ◽

Vol 25 (1) ◽

pp. 87-94 ◽

Cited By ~ 31

Author(s):

Kunihiko Izuishi ◽

Hirohito Mori

Keyword(s):

Gastric Cancer ◽

Performance Status ◽

Locally Advanced ◽

Growth Factor Receptor ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy ◽

Advanced Tumor ◽

Esophagogastric Cancer ◽

Previously Treated

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

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Conversion surgery of Stage IV gastric cancer with peritoneal dissemination after nivolumab

International Cancer Conference Journal ◽

10.1007/s13691-021-00503-0 ◽

2021 ◽

Author(s):

Yuji Toyota ◽

Kunio Okamoto ◽

Norimitsu Tanaka ◽

Hugh Shunsuke Colvin ◽

Yuta Takahashi ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Dissemination ◽

Stage Iv ◽

Conversion Surgery ◽

Stage Iv Gastric Cancer

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Gastric Cancer Treatments and Survival Trends in the United States

Current Oncology ◽

10.3390/curroncol28010017 ◽

2020 ◽

Vol 28 (1) ◽

pp. 138-151

Author(s):

Kelly A. Stahl ◽

Elizabeth J. Olecki ◽

Matthew E. Dixon ◽

June S. Peng ◽

Madeline B. Torres ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Stage Iv ◽

The United States ◽

Current Treatment ◽

Stage I ◽

Stage Ii ◽

Chi Square ◽

Specific Guideline ◽

Kaplan Meier

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

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SPan-1 Is a Useful Prognostic Marker for Patients with Stage IV Gastric Cancer Who Underwent Palliative Gastrectomy: A Retrospective Multivariate Study

World Journal of Surgery ◽

10.1007/s00268-013-2016-7 ◽

2013 ◽

Vol 37 (7) ◽

pp. 1681-1687

Author(s):

Naoshi Kubo ◽

Masaichi Ohira ◽

Katsunobu Sakurai ◽

Takahiro Toyokawa ◽

Hiroaki Tanaka ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Marker ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy ◽

Multivariate Study

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Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

World Journal of Surgery ◽

10.1007/s00268-005-0129-3 ◽

2005 ◽

Vol 30 (1) ◽

pp. 21-27 ◽

Cited By ~ 66

Author(s):

Reza F. Saidi ◽

Stephen G. ReMine ◽

Paul S. Dudrick ◽

Nader N. Hanna

Keyword(s):

Gastric Cancer ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy

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COMPLETE REMISSION AFTER COMBINATION CHEMOTHERAPY FOR STAGE IV GASTRIC CANCER WITH PERITONEAL DISSEMINATION AND LIVER METASTASES

Annals of Cancer Research and Therapy ◽

10.4993/acrt1992.11.169 ◽

2003 ◽

Vol 11 (1-2) ◽

pp. 169-181 ◽

Cited By ~ 1

Author(s):

Masaya Mukai ◽

Tomoya Hinoki ◽

Takayuki Tajima ◽

Hisao Nakasaki ◽

Shinkichi Sato ◽

...

Keyword(s):

Gastric Cancer ◽

Complete Remission ◽

Liver Metastases ◽

Combination Chemotherapy ◽

Peritoneal Dissemination ◽

Stage Iv ◽

Stage Iv Gastric Cancer

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

Surgical Case Reports ◽

10.1186/s40792-020-00984-w ◽

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.

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