Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives
AbstractThe standard treatment for locally advanced gastric cancer differs across the world. In western countries, perioperative chemotherapy or postoperative adjuvant chemoradiotherapy are the preferred treatment options, whereas in Asia, D2 gastrectomy followed by postoperative adjuvant chemotherapy is standard. In Japan, adjuvant chemotherapy with S-1 is the standard treatment for pStage II gastric cancer, whereas adjuvant chemotherapy with a doublet regimen is preferred for pStage III gastric cancer. The efficacy of preoperative neoadjuvant chemotherapy using S-1 plus cisplatin, has been investigated in selected patients with expected poor survival outcomes. To expand the indications for neoadjuvant chemotherapy, a clinical trial investigating the efficacy of preoperative S-1 plus oxaliplatin in patients with cStage III (cT3-4N1-3) gastric cancer (JCOG1509) is ongoing in Japan. The addition of immune checkpoint inhibitors to cytotoxic chemotherapy also seems promising and is being investigated in international randomized clinical trials. Although we have to await the final results of these studies, preoperative neoadjuvant chemotherapy is a promising treatment strategy and likely to become standard treatment for locally advanced gastric cancer in Japan.
Conclusion: Conversion surgery, including extended gastrectomy and multi-organ resections followed by HIPEC performed after systemic chemotherapy therapy for GC with PM is justified in downstaged patients with ypT2 and limited (less than P3) PM.
Laparoscopy-assisted distal gastrectomy offered better short-term, post-surgical outcomes for patients with locally advanced gastric cancer who were undergoing neoadjuvant chemotherapy.
In patients with locally advanced gastric cancer, laparoscopy-assisted distal gastrectomy (LADG) after neoadjuvant chemotherapy appears to offer more short-term benefits than does open gastrectomy, according to Chinese researchers.Reuters Health Information
In this study, an open-label, single cente r, phase 2 randomized clinical trial with a noninferiority design, the authors assessed outcomes at 3 years. All patients received neoadjuvant therapy of oxaliplatin and capecitabine before their operation. Li and colleagues reported significantly lower postoperative complication rates, less postope rative pain, and better adherence to and completion of adjuvant therapy among trial participants.
To demonstrate that post-therapy pathological tumor volume (ypTV) should be considered as an independent prognostic factor in advanced gastric cancer (GC) patients who underwent neoadjuvant chemotherapy (NAC) ...
This article reviews the history of surgical EGJ cancer treatment and current surgical strategies from a Western perspective. PMID: 31245158 [PubMed]
Conclusions: Most endoscopic responders showed JCGC histological responses. Evaluation of neoadjuvant chemotherapeutic efficacy by endoscopy in gastric cancer may be useful before gastrectomy. As this was a retrospective study, further investigations are required. The protocol was approved by the ethics review committee at Osaka Medical College (No. 2422) and was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000033088).Digestion
CONCLUSION: The modified ypTNM staging system improves the accuracy of OS prediction for patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy. PMID: 31197829 [PubMed - as supplied by publisher]
Publication date: Available online 3 June 2019Source: European Journal of Surgical OncologyAuthor(s): Karol Rawicz-Pruszyński, Jerzy Mielko, Bogumiła Ciseł, Magdalena Skórzewska, Agnieszka Pikuła, Katarzyna Gęca, Tomasz Skoczylas, Tomasz Kubiatowski, Andrzej Kurylcio, Wojciech Piotr PolkowskiAbstractBackgroundSurgical quality assurance is a key element of gastric cancer treatment. The Maruyama Computer Program (MCP) allows to predict lymph node involvement in stations no. 1–16. The aim of the current study was to evaluate the accuracy of the MCP predictions in GC patients treated with neoadjuvant chemothe...
Neoadjuvant chemotherapy for advanced gastric cancer is expected to improve prognoses. However, as there is no method to evaluate neoadjuvant chemotherapeutic efficacy before gastrectomy, some patients at high risk for a poor prognosis undergo gastrectomy. The aim of the present study was to investigate whether endoscopy could assess the efficacy of neoadjuvant chemotherapy.