scholarly journals Preoperative Versus Postoperative Chemo-Radiotherapy For Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Ning Li ◽  
Xiaoyong Xiang ◽  
Dongbin Zhao ◽  
Xin Wang ◽  
Yuan Tang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Postoperative Treatment ◽  
Long Term Outcome ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer

Abstract Background: peri-operative chemo-radiotherapy played important role in locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare long-term oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT). Methods: From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups.Results: The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p=0.244), 78.7% vs. 65.7% (p=0.017), 74.9% vs. 65.3% (p=0.042) and 74.4% vs. 61.2% (p=0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis. Conclusion: Preoperative CRT showed advantages of long-term outcome compared with postoperative CRT. Trial registration: ClinicalTrial.gov NCT01291407, NCT03427684 and NCT04062058, date of registration: Feb 8, 2011

scholarly journals Three-year outcomes of the randomized phase III SEIPLUS trial of extensive intraoperative peritoneal lavage for locally advanced gastric cancer

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Jing Guo ◽  
Aman Xu ◽  
Xiaowei Sun ◽  
Xuhui Zhao ◽  
Yabin Xia ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Peritoneal Lavage ◽  
Randomized Study ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Phase Iii ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer

AbstractWhether extensive intraoperative peritoneal lavage (EIPL) after gastrectomy is beneficial to patients with locally advanced gastric cancer (AGC) is not clear. This phase 3, multicenter, parallel-group, prospective randomized study (NCT02745509) recruits patients between April 2016 and November 2017. Eligible patients who had been histologically proven AGC with T3/4NxM0 stage are randomly assigned (1:1) to either surgery alone or surgery plus EIPL. The results of the two groups are analyzed in the intent-to-treat population. A total of 662 patients with AGC (329 patients in the surgery alone group, and 333 in the surgery plus EIPL group) are included in the study. The primary endpoint is 3-year overall survival (OS). The secondary endpoints include 3-year disease free survival (DFS), 3-year peritoneal recurrence-free survival (reported in this manuscript) and 30-day postoperative complication and mortality (previously reported). The trial meets pre-specified endpoints. Estimated 3-year OS rates are 68.5% in the surgery alone group and 70.6% in the surgery plus EIPL group (log-rank p = 0.77). 3-year DFS rates are 61.2% in the surgery alone group and 66.0% in the surgery plus EIPL group (log-rank p = 0.24). The pattern of disease recurrence is similar in the two groups. In conclusion, EIPL does not improve the 3-year survival rate in AGC patients.

A prospective, randomized, controlled, multicenter study of apatinib combined with S-1 plus docetaxel as adjuvant therapy for locally advanced gastric cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16019-e16019
Author(s):  
Zhili Shan ◽  
Feng Guo ◽  
Hong Chen ◽  
Dapeng Li ◽  
Zhongqi Mao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Randomized Controlled ◽  
Locally Advanced Gastric Cancer ◽  
Group A ◽  
Group B ◽  
Disease Free

e16019 Background: Postoperative adjuvant chemotherapy is commonly given after the curative resection of gastric cancer (GC) in both Eastern and Western countries. Several studies have investigated the feasibility and safety of S-1 plus docetaxel or S-1 plus cisplatin. However, the best choice of adjuvant treatment for patients with gastric cancer is still debated. Apatinib, an oral small molecular of VEGFR-2 TKI, has been confirmed to improve OS and PFS with acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy. In this study, we aimed to evaluate the efficacy and safety of apatinib combined with S-1/docetaxel for locally advanced gastric cancer (T3-4aN+M0). Methods: This is a prospective, randomized, controlled, multicenter clinical study. Patients with locally advanced gastric cancer, pathological stage T3-4aN+M0 who underwent D2 lymphadenectomy without prior anti-cancer therapy were included. All these patients were assigned to group A or B. Patients in group A received 6 cycles (21 days a cycle) of adjuvant therapy using S-1 (80-120mg/d, d1-14), and docetaxel (40mg/m2, d1). Group B received the same regimen with the addition of apatinib (250mg, qd.). The primary endpoint was disease-free survival (DFS). The final analysis cutoff date was 30 November, 2020. Results: A total of 45 patients were enrolled from January 2019 to November, 2010 and assigned to group A (21) or group B (24). The DFS was not reached in both of the groups. The 1-year disease-free survival rate was 60% in group A and 90% in the group B, while the difference was not significant. The main AEs in group A were anemia (55%), nausea (50%) and neutropenia (40%); The most common AEs in group B were anemia (45%) neutropenia (40%) and diarrhea (25%). There were no treatment-related deaths. The longest administered time of apatinib with no progression was 457 days. And the median time to receive apatinib was 329 days. Conclusions: Combination of apatinib with S-1/docexal chemotherapy shows clinical benefits in locally advanced gastric cancer (T3-4aN+M0), with tolerable toxicity. The study is still ongoing to reach our final endpoint, DFS. Clinical trial information: ChiCTR2000038900.

scholarly journals Long-term results of combined treatment of patients with locally advanced gastric cancer with the inclusion of neoadjuvant chemoradiotherapy.

2021 ◽  
Vol 67 (2) ◽  
pp. 254-259
Author(s):  
Дмитрий Кудрявцев ◽  
Vitaliy Skoropad ◽  
Sergey Gamayunov ◽  
Igor` Gulidov ◽  
Sergey Ivanov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Independent Effect ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer

ntroduction.  Gastric cancer remains one of the most common malignant neoplasms. In the world, including Russia, high incidence rates and low efficacy rates of long-term treatment outcomes remain. The use of neoadjuvant therapy is now increasingly seen as a standard therapy approach for locally advanced gastric cancer and cardioesophageal junction. Materials and methods. This work presents the results of treatment using a new method – combined treatment of locally advanced stomach cancer (neoadjuvant chemoradiotherapy in the regime of accelerated hyperfraction with daily dose splitting up to SOD 46 Gy against the background of modified polychemotherapy according to the Xelox scheme). The structure of the development of locoregional relapses and metastases, the indicators of overall and relapse-free survival, depending on various clinical and morphological factors, were described. In total, the results were analyzed in 43 patients diagnosed with gastric cancer. Results and discussion. At the time of this analysis, 22 patients died, 21 patients continued to be observed or were lost from the observation. Life expectancy ranged from 6.1 to 122 months. According to the multivariate analysis, two factors were identified that have a statistically significant independent effect on overall survival: the macroscopic type of growth according to Borrmann (P≤0.009) and the degree of therapeutic pathomorphism (P≤0.015). In 3 cases, a complete therapeutic tumor pathomorphism was registered. Patients continue observation for up to 6 years. Local recurrence was not detected in any case. Regional recurrence was detected and morphologically confirmed in one patient. Peritoneal metastases, the development of which more often occurred in the case of low-grade forms of gastric cancer, were observed in 12 cases. Conclusion. All in all, the annual survival rate was 80.5 ± 6.2%, three-year 55.5 ± 7.8%, and five-year 45.0 ± 7.9%. The results show that combined treatment of locally advanced gastric cancer, using a new technique of neoadjuvant chemoradiotherapy, contributes to an increase in overall and relapse-free survival.

Influence of perineural invasion in predicting overall survival and disease-free survival in patients With locally advanced gastric cancer

2017 ◽  
Vol 213 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Paolo Aurello ◽  
Giammauro Berardi ◽  
Simone Maria Tierno ◽  
Gian Luca Rampioni Vinciguerra ◽  
Fabio Socciarelli ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Advanced Gastric Cancer ◽  
Perineural Invasion ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer ◽  
Disease Free

Downstaging depth score as a better surrogate endpoint than pCR, histological response and ypN0 for long-term outcomes in locally advanced gastric cancer patients after preoperative chemo-radiotherapy

2020 ◽  
Author(s):  
Ning Li ◽  
Xin Wang ◽  
Yuan Tang ◽  
Dongbin Zhao ◽  
Yihebali Chi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Surrogate Endpoint ◽  
Histological Response ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer ◽  
Gastric Cancer Patients

Abstract Background: The prediction effect of preoperative chemo-radiotherapy(CRT) is not high and difficult to guide individualized treatment. We explored a surrogate endpoint for long-term outcomes in locally advanced gastric cancer patients after preoperative CRT. Methods: From April 2012 to April 2019, 95 patients enrolled in 4 prospective studies with locally advanced gastric cancer who received preoperative concurrent radio-chemotherapy were included. All patients were stage T3/4, N+. Local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were evaluated. The clinicopathological factors related to the long-term prognosis were analysed by uni- and multivariant analyses. The downstaging depth score (DDS), a novel method of evaluating the CRT response, was used to predict long-term outcomes. Results: The median follow-up period for survivors was 30 months. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve predicted by the DDS was 0.728, which was better than that of pathological complete response (pCR), histological response and ypN0 (AUC= 0.634, 0.640 and 0.643, respectively). The DDS cut-off value was 4. pCR and ypN0 were associated with OS (p = 0.026, 0.049). Surgery and the DDS were correlated with DMFS, DFS and OS (p = 0.001, 0.000, and 0.000 and 0.009, 0.013, and 0.032, respectively). The multivariate analysis showed that the DDS was an independent prognostic factor of DFS (p = 0.021). Conclusion: The DDS, a simple, short-term indicator, seems to be a better surrogate endpoint than pCR, histological response and ypN0 for DFS.

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