Preliminary trial of adjuvant surgery for advanced gastric cancer

Suzuki,T.; Tanabe,K.; Taomoto,J.; Yamamoto,H.; Tokumoto,N.; Yoshida,K.; Ohdan,H.

doi:10.3892/ol_00000130

Preliminary trial of adjuvant surgery for advanced gastric cancer

Authors:
- T. Suzuki
- K. Tanabe
- J. Taomoto
- H. Yamamoto
- N. Tokumoto
- K. Yoshida
- H. Ohdan
View Affiliations

Affiliations: Department of Surgery, Division of Frontier Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
Published online on: July 1, 2010 https://doi.org/10.3892/ol_00000130
Pages: 743-747

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

In patients with stage IV gastric cancer, systemic chemotherapy is the key treatment. Combination chemotherapy (cis-diamminedichloride platinum plus S-1 and docetaxel plus S-1) results in long-term survival in clinical practice. In selected cases, additional (adjuvant) surgery may result in further long-term survival. This study aimed to evaluate the efficacy of adjuvant surgery following the response to chemotherapy for advanced gastric cancer. Based on response to chemotherapy, the indications for adjuvant surgery (surgery after the response to chemotherapy) are that resection is expected to be curative rather than palliative, provided that no other distant metastases occur. The study included 20 advanced gastric cancer patients who had undergone gastrectomies after the response to the combination chemotherapy of docetaxel and S-1, between September 2003 and December 2008 at Hiroshima University Hospital. At a median follow-up of 980 days, the median overall survival was 855 days. A 2- and 3-year survival was observed in 80 and 54.9% of patients, respectively, following macroscopic curative surgery. In the palliative group, the median overall survival was 510 days, but a 3-year survival was not observed. In the partial response group, the median overall survival was 865 days and a 3-year survival was observed in 37% of patients. One-year survival was not observed in the stable disease group. The patient survival in the partial response group was statistically more prolonged than in the stable disease group. The median overall survival in patients with liver metastasis was 865 days, while that in patients with peritoneal dissemination was 510 days. In conclusion, adjuvant surgery may be effective in gastric cancer patients diagnosed as stage IV by means of liver or distant lymph node metastasis, except in cases of peritoneal dissemination.

View Figures

View References

1	Kamangar F, Dores GM and Anderson WF: Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 24:2137–2150. 2006. View Article : Google Scholar
2	Inoue M and Tsugane S: Epidemiology of gastric cancer in Japan. Postgrad Med J. 81:419–424. 2005. View Article : Google Scholar
3	Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA and Rausch M: Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer. 72:37–41. 1993. View Article : Google Scholar : PubMed/NCBI
4	Glimelius B, Ekstrom K, Hoffman K, et al: Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 8:163–168. 1997. View Article : Google Scholar : PubMed/NCBI
5	MacDonald JS, Schein PS, Woolley PV, et al: 5-fluorouracil, doxorubicin, and mitomycin (fam) combination chemotherapy for advanced gastric cancer. Ann Intern Med. 93:533–536. 1980. View Article : Google Scholar : PubMed/NCBI
6	Findlay M, Cunningham D, Norman A, et al: A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF). Ann Oncol. 5:609–616. 1994.PubMed/NCBI
7	Ohtsu A, Shimada Y, Shirao K, et al: Randomized phase III trial of fluorouracil alone vs. fluorouracil plus cisplatin vs uracil and tegafur plus mitomycin in patients with unresectable, advanced gastric cancer: the Japan Clinical Oncology Group Study (JCOG9205). J Clin Oncol. 21:54–59. 2003. View Article : Google Scholar : PubMed/NCBI
8	Koizumi W, Narahara H, Hara T, et al: S-1 plus cisplatin vs. S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): A phase III trial. Lancet Oncol. 9:215–221. 2008. View Article : Google Scholar : PubMed/NCBI
9	Boku N, Yamamoto S, Fukuda H, et al: Fluorouracil vs. combination of irinotecan plus cisplatin vs S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol. 10:1063–1069. 2009. View Article : Google Scholar : PubMed/NCBI
10	Einzig AI, Neuberg D, Remick SC, et al: Phase II trial of docetaxel (taxotere) in patients with adenocarcinoma of the upper gastrointestinal tract previously untreated with cytotoxic chemotherapy: the Eastern Cooperative Oncology Group (ECOG) results of protocol e1293. Med Oncol. 13:87–93. 1996. View Article : Google Scholar
11	Thuss-Patience PC, Kretzschmar A and Reichardt P: Docetaxel in the treatment of gastric cancer. Future Oncol. 2:603–620. 2006. View Article : Google Scholar
12	Fushida S, Fujimura T, Oyama K, Yagi Y, Kinoshita J and Ohta T: Feasibility and efficacy of preoperative chemotherapy with docetaxel, cisplatin and S-1 in gastric cancer patients with para-aortic lymph node metastases. Anticancer Drugs. 20:752–756. 2009. View Article : Google Scholar : PubMed/NCBI
13	Zang DY, Yang DH, Kim MJ, et al: Dose-finding study of docetaxel, oxaliplatin, and S-1 for patients with advanced gastric cancer. Cancer Chemother Pharmacol. 64:877–883. 2009. View Article : Google Scholar : PubMed/NCBI
14	Yoshida K, Hirabayashi N, Takiyama W, et al: Phase I study of combination therapy with S-1 and docetaxel (TXT) for advanced or recurrent gastric cancer. Anticancer Res. 24:1843–1851. 2004.PubMed/NCBI
15	Yoshida K, Ninomiya M, Takakura N, et al: Phase II study of docetaxel and S-1 combination therapy for advanced or recurrent gastric cancer. Clin Cancer Res. 12:3402–3407. 2006. View Article : Google Scholar : PubMed/NCBI
16	Suzuki T, Yoshida K, Tanabe K, et al: Three advanced gastric cancer patients successfully treated by combination therapy of docetaxel and TS-1. Gan To Kagaku Ryoho. 32:509–513. 2005.PubMed/NCBI
17	Tsutani Y, Ohara M, Suzuki T, et al: Docetaxel and S-1 as a first-line treatment in patients with advanced or recurrent gastric cancer. Anticancer Res. 29:2775–2779. 2009.PubMed/NCBI
18	Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 45:228–247. 2009. View Article : Google Scholar
19	Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma - 2nd english edition. Gastric Cancer. 1:10–24. 1998. View Article : Google Scholar : PubMed/NCBI
20	Trotti A, Colevas AD, Setser A, et al: CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 13:176–181. 2003. View Article : Google Scholar
21	Tanabe K, Yoshida K, Hamai Y, et al: Clinical study of TS-1 for inoperative and recurrent gastric cancer and evaluation of long survival cases. Gan To Kagaku Ryoho. 32:1145–1148. 2005.PubMed/NCBI
22	Van Den Neste E, de Valeriola D, Kerger J, et al: A phase I and pharmacokinetic study of docetaxel administered in combination with continuous intravenous infusion of 5-fluorouracil in patients with advanced solid tumors. Clin Cancer Res. 6:64–71. 2000.PubMed/NCBI
23	Takahashi I, Emi Y, Kakeji Y, Uchida J, Fukushima M and Maehara Y: Increased antitumor activity in combined treatment TS-1 and docetaxel. A preclinical study using gastric cancer xenografts. Oncology. 68:130–137. 2005. View Article : Google Scholar : PubMed/NCBI
24	Wada Y, Yoshida K, Suzuki T, et al: Synergistic effects of docetaxel and S-1 by modulating the expression of metabolic enzymes of 5-fluorouracil in human gastric cancer cell lines. Int J Cancer. 119:783–791. 2006. View Article : Google Scholar : PubMed/NCBI
25	Koizumi W, Tanabe S, Saigenji K, et al: Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer. 89:2207–2212. 2003. View Article : Google Scholar : PubMed/NCBI
26	Nakajima T, Ota K, Ishihara S, et al: Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol. 4:203–208. 1997. View Article : Google Scholar : PubMed/NCBI
27	Chua YJ and Cunningham D: The UK NCRI MAGIC trial of perioperative chemotherapy in resectable gastric cancer: implications for clinical practice. Ann Surg Oncol. 14:2687–2690. 2007. View Article : Google Scholar : PubMed/NCBI
28	Alexander HR, Grem JL, Pass HI, et al: Neoadjuvant chemotherapy for locally advanced gastric adenocarcinoma. Oncology (Williston Park). 7:37–53. 1993.PubMed/NCBI