scholarly journals Advanced gastric cancer: new perspectives of treatment

2016 ◽  
Author(s):  
Matteo Nardi ◽  
Luca Ansaloni ◽  
Giulia Montori ◽  
Marco Ceresoli ◽  
Giacomo Crescentini ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Survival Rates ◽  
Comprehensive Treatment ◽  
Peritoneal Carcinosis ◽  
Curative Intent ◽  
One Year

The prognosis in patients with advanced gastric cancer with carcinosis remains poor with a median survival of less than one year. High rates of peritoneal recurrence of patients undergoing resection with potentially curative intent are strictly related with lymphatic spread and penetration of the serosa. To increase survival rates, during the last thirty years different strategies about screening and treatment have been tested and proposed. Early detection of occult peritoneal micrometastasis is a base step to reduce local and serosa recurrences and to offer a tailored surgical and neoadjuvant therapeutic treatment. The complete cytoreductive surgery, however, remains the cornerstone of treatment. It could be associated with different combinations of chemotherapy regimens. Adjuvant, neoadjuvant and intraperitoneal chemotherapy have been demonstrated effective in improving the survival. In the last years, a few new molecules have been introduced which enhance the effect of chemotherapy by biologically targeting its objective. Lastly the prevention of macroscopic peritoneal carcinosis in all those patients at high risk due to serosal infiltration by treating them with intraperitoneal chemotherapy has been demonstrated to be one of the future winning approaches. In patients with peritoneal carcionosis, multimodal comprehensive treatment should be mandatory, with a pivotal role of intraperitoneal chemotherapy associate to CC0 cytoreduction. Neoadjuvant chemotherapy followed by cytoreductive surgery and intraperitoneal chemotherapy gave promising results. The new molecules as monoclonal antibodies seem to improve outcomes.

Early intraperitoneal chemotherapy following cytoreductive surgery in the patients with far advanced gastric cancer

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 4265-4265
Author(s):  
J. H. Cheong ◽  
W. J. Hyung ◽  
J. Kim ◽  
J. Chen ◽  
S. H. Choi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery

Phase I study of neoadjuvant chemotherapy with xeloda and oxaliplatin (G-XELOX) for locally advanced gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 149-149
Author(s):  
Hironaga Satake ◽  
Masato Kondo ◽  
Takeshi Kotake ◽  
Yoshihiro Okita ◽  
Takatsugu Ogata ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Maximum Tolerated Dose ◽  
Curative Intent ◽  
Locally Advanced Gastric Cancer ◽  
Level 1 ◽  
One Year ◽  
Type 3

149 Background: Prognosis for locally advanced gastric cancer, such as clinical T4 disease, bulky nodal involvement, type 4 and large type 3 gastric cancer, remains unsatisfactory, even with D2 gastrectomy followed by adjuvant chemotherapy. Neoadjuvant chemotherapy is a promising approach, and combination chemotherapy with Xeloda and oxaliplatin (G-XELOX) is recognized as a potentially promising regimen for gastric cancer. However, the use of neoadjuvant chemotherapy consisting of G-XELOX for locally advanced gastric cancer has not been reported. The aim of this study was to evaluate the incidence of dose limiting toxicities (DLTs) during the neoadjuvant chemotherapy and to determine the maximum tolerated dose (MTD) and recommended dose of preoperative chemotherapy combined with oxaliplatin with a fixed Xeloda dose for locally advanced gastric cancer. Methods: Patients received two cycles of neoadjuvant chemotherapy with oxaliplatin on day 1, as well as Xeloda (2000 mg/m2/day, b.i.d.) for 14 days, repeatedly every 3 weeks. They then underwent gastrectomy with curative D2/3 lymph-node dissection followed by adjuvant S-1 (80 mg/m2/day, b.i.d.) for one year. A decrease of oxaliplatin dose was planned (starting at level 1, 130 mg/m2). Results: Six patients (5 male, 1 female) with a median age of 72 (range 68-79) were enrolled. MTD was not reached at level 1. Oxaliplatin 130 mg/m2 in combination with Xeloda 2000 mg/m2/day, b.i.d. could be administered with acceptable toxicity. No treatment-related death was observed. Most frequent drug-related AEs during the neoadjuvant chemotherapy period were G1 anemia, G1/2 thrombocytopenia and G1 peripheral neuropathy. One patient refused surgical resection, therefore five received resection with curative intent. Of the five patients, all achieved a pathological downstaging after neoadjuvant G-XELOX therapy. The incidence of operative morbidity was tolerable. Conclusions: Neoadjuvant chemotherapy with G-XELOX regimen was feasible by patients with locally advanced gastric cancer. Clinical trial information: UMIN000015950.

scholarly journals Which patient is going to benefit from surgical cytoreduction with intraperitoneal chemotherapy (for manifest peritoneal metastases)?

2017 ◽  
Vol 30 (4) ◽  
pp. 207-210
Author(s):  
Sebastian Blaj ◽  
Pompiliu Piso
Keyword(s):  
Gastric Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Multimodal Therapy ◽  
Survival Rates ◽  
Peritoneal Metastases ◽  
Oncological Surgery ◽  
Positive Expression ◽  
Multimodal Therapy Concept ◽  
Her 2

Abstract The gastric cancer with peritoneal metastases still represents a serious problem in the oncological surgery, whereas the peritoneal metastases arising from colorectal cancer can be successfully treated using a multimodal therapy concept consisting of systemic chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. The best survival rates in patients suffering from peritoneal metastases of gastric cancer have been reported by the ToGa trial, in patients with HER-2 positive expression who received standard chemotherapy and trastuzumab. Cytoreductive surgery and HIPEC are increasingly wining a place in the multimodal therapy of gastric cancer with peritoneal metastases, the criteria for such an aggressive therapy are strict and the operability needs to be previously assessed by laparoscopic exploration. Interesting new data are awaited from the German GASTRIPEC study and from the French GASTRICHIP study.

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