A PSEUDOMYXOMA PERITONEI CASE DEMONSTRATING COMPLETE RESPONSE WITH MULTIDISCIPLINARY TREATMENT INCLUDING MODIFIED FOLFOX6 REGIMEN

121 Background: Although the prognosis of early gastric cancer is favorable, the treatment for advanced cases still have difficulty in achieving satisfactory results. Thus, more effective multimodality treatment should be established. Chemoradiotherapy has become a standard treatment for gastric cancer especially as an adjuvant therapy while radiotherapy has been expected as one of the modalities against highly advanced gastric cancer. Methods: Patients with advanced gastric cancer who were treated with chemotherapy of S-1 and cisplatin plus radiation were analyzed retrospectively. Concurrent radiation therapy (5 days/week) at 2 Gy/day was started with chemotherapy and repeated daily on days 1–5, 8–12, 15–19 and 22–26. Irradiation was planned using a computed tomography (CT) simulator for two rectangular portals with a pair of 45-degree wedge filters and was targeted at the primary tumor and surrounding lesions, including lymph nodes. Results: A total 109 patients were treated with chemoradiotherapy between 2002 and 2013 at our institute. The median age was 64 years. Histological type included 45 differentiated and undifferentiated 64 subtypes. The TNM stage before the treatment was diagnosed as IIIA: 11; IIIB: 10; IIIC: 14; IV: 74. Of the 98 evaluable patients, 69 patients had partial responses while no patients had a complete response, resulting in an overall response rate of 70%. Progressive disease (PD) occurred in 2 patients (4%). The most frequent adverse events more than grade 3 were hematologic toxicities, including leukocytopenia (47%), neutropenia (25%), and thrombocytopenia (24%). Non-hematologic toxicities such as general fatigue, renal-related events, and gastrointestinal toxicities were manageable with no treatment-related death. The median survival time was 537 days. Conclusions: While there were disadvantages of radiotherapy including the difficulty of confirming the area of irradiation due to peristaltic movement, risk of perforation and ulceration, recent technological advancement of radiation therapy has enabled pinpoint accuracy in treatment of primary gastric lesions and regional lymph nodes. There has been much anticipation that chemoradiotherapy will be a part of multidisciplinary treatment for advanced cancer.

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Phase II study of paclitaxel and capecitabine (PX) combination as neoadjuvant chemotherapy for unresectable locally advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15164 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15164-e15164

Author(s):

Yoon Ho Ko ◽

Sook Hee Hong ◽

Sang Young Roh ◽

Kyo Young Song ◽

Eun Sun Jung ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Phase Ii ◽

Metabolic Response ◽

Phase Ii Study ◽

Multidisciplinary Treatment ◽

Locally Advanced ◽

Complete Response ◽

R0 Resection ◽

Regional Lymph Nodes ◽

Locally Advanced Gastric Cancer

e15164 Background: Unresectable locally advanced adenocarcinoma (AGC) of the stomach is associated with poor prognosis due to the lack of effective treatment. Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally AGC in the current multidisciplinary treatment model. Paclitaxel and capecitabine (PX) has been used in palliative setting with good response rates but its role in a neoadjuvant setting is not well established. This phase II study was performed to evaluate the efficacy and safety of neoadjuvant PX chemotherapy in patients with unresectable locally AGC. Methods: Patients with AGC, clinically unresectable because of local invasion and/ or conglomerated regional lymph nodes (station 7, 8, and 9) metastasis on based on laparoscopic staging, were enrolled. PX consisted of paclitaxel 175 mg/m2 i.v. on day 1, and capecitabine 835 mg/m2 twice daily p.o. on days 1–14 every 21 days. After three cycles of NAC, patients with clinically resectable AGC underwent surgical resection. Results: This trial was stopped for poor accrual after 18 patients were enrolled; 50% patients had tumors located in the proximal third of the stomach. Seventeen patients finished three cycles of chemotherapy. The overall response rate was 41.2% (7/17 cases), of which 71.4% (10/14 cases) metabolic response. Fourteen (77.8%) of the 18 patients enrolled underwent surgery, and 12 (85.7%) had an R0 resection. Pathological complete response was observed in one (7.1%) of patients. Toxicity was mild to moderate and there were no treatment-related deaths and no major surgical complications. With a median follow-up of 28.6 months (range 6.4-38.4 months), the 2-year survival rate for all patients was 71.1%. Subgroup analysis found R0 resection (35.7 months vs. 20.6 months, P= 0.005) and patients with pathologic N downstaging (P < 0.001) to have improved overall survival. Conclusions: Neoadjuvant chemotherapy with PX shows promising results in unresectable locally AGC patients without increased morbidity and mortality. Neoadjuvant PX may permit a larger chance of curative resection in unresectable locally AGC patients.

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Pathologic Complete Response of an Anastomotic Recurrence after Systemic Chemotherapy with Modified FOLFOX6: A Case Report

Nippon Daicho Komonbyo Gakkai Zasshi ◽

10.3862/jcoloproctology.69.101 ◽

2016 ◽

Vol 69 (2) ◽

pp. 101-107

Author(s):

Kazuki Ueda ◽

Junichiro Kawamura ◽

Fumiaki Sugiura ◽

Koji Daito ◽

Tadao Tokoro ◽

...

Keyword(s):

Case Report ◽

Systemic Chemotherapy ◽

Pathologic Complete Response ◽

Complete Response ◽

Anastomotic Recurrence ◽

Modified Folfox6

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Efficacy of modified FOLFOX6 chemotherapy for patients with unresectable pseudomyxoma peritonei

International Journal of Clinical Oncology ◽

10.1007/s10147-019-01592-x ◽

2019 ◽

Vol 25 (4) ◽

pp. 774-781 ◽

Cited By ~ 2

Author(s):

Sakura Hiraide ◽

Keigo Komine ◽

Yuko Sato ◽

Kota Ouchi ◽

Hiroo Imai ◽

...

Keyword(s):

Pseudomyxoma Peritonei ◽

Systemic Chemotherapy ◽

Case Series ◽

Progression Free Survival ◽

University Hospital ◽

Low Grade ◽

Chemotherapeutic Regimen ◽

First Case ◽

Modified Folfox6 ◽

Grade 3

Abstract Background Pseudomyxoma peritonei (PMP) is a rare malignancy, and there is insufficient evidence about systemic chemotherapy for this disease. Methods We retrospectively evaluated the efficacy and safety of a chemotherapeutic regimen with 5-fluorouracil and oxaliplatin (modified FOLFOX6, mFOLFOX6) for patients with unresectable pseudomyxoma peritonei. Patients who received the therapy between April 2000 and February 2019 at the Department of Medical Oncology, Tohoku University Hospital, were enrolled in this study. Results Eight patients were treated with mFOLFOX6. The sites of primary tumor were appendix in six patients, ovary in a patient, and urachus in a patient. Six patients received surgery. Seven patients had histologically high-grade PMP, and one patient had low-grade PMP. The median follow-up duration was 27.2 months. All the patients had non-measurable regions as the targets of tumor response. Non-complete response or non-progressive disease was observed in seven patients, with a disease control rate of 87.5%. The median progression-free survival and overall survival were 13.0 months and 27.9 months, respectively. An obvious reduction in the symptoms was observed in two patients. Five patients experienced decline in the serum tumor markers, CEA or CA19-9. The grade 3/4 toxicity that was observed was grade 4 neutropenia in one patient and grade 3 neutropenia in two patients. Conclusions mFOLFOX6 might be an effective and tolerable treatment option for patients with unresectable PMP. To our knowledge, this is the first case series of mFOLFOX6 in patients with unresectable PMP and the first case series of systemic chemotherapy for Asian patients with unresectable PMP.

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