Ameliyata Uygun Mide Kanseri Hastalarında Perioperatif Floropirimidin, Docetaxel ve Oksaliplatin Rejiminin Adjuvan Floropirimidin ve Oksaliplatin Rejimi ile Karşılaştırılması
Year 2024,
Volume: 8 Issue: 3, 248 - 256, 31.12.2024
Aslı Yıldırım
,
Zeynep Ergenç
,
Nihal Bozdağ Kaplan
,
Hasan Ergenç
Abstract
Amaç: Bu çalışma, perioperatif 5-Florourasil (5-FU), oksaliplatin ve docetaxel (FLOT) kemoterapi rejimleri postoperatif adjuvan oral kapesitabin ve oksaliplatin/5-FU ve oksaliplatin (CAPEOX/FOLFOX) kemoterapi rejimleriyle karşılaştırılması amacıyla planlanmıştır.
Gereç ve Yöntem: Bu tek merkezli, retrospektif çalışmaya en az T2 veya daha fazla invaziv mide kanseri olan ve pozitif lenf nodu(ları) olan veya olmayan 59 hasta (17 kadın ve 42 erkek) dahil edildi. Tüm hastalara D2 lenf nodu diseksiyonu ile birlikte total veya subtotal ((sub) total) mide rezeksiyonu uygulandı. Araştırma bulgularını istatistiksel olarak analiz etmek için Sosyal Bilimler İstatistik Paketi (IBM SPSS) 26.0 programı kullanıldı.
Bulgular: 30 hastadan oluşan perioperatif FLOT tedavi grubu, adjuvan CAPEOX/FOLFOX tedavi grubuna (29 hasta) göre tanı sırasında önemli ölçüde daha ileri klinik nodal (cN) evre (p<.005), daha fazla komorbidite (p=.025) ve daha kötü Doğu Kooperatif Onkoloji Grubu (ECOG) performansı (p=.007) gösterdi. Medyan genel anket (mOS) ve medyan ilerleme serbest anket (mPFS)'nin adjuvan tedavi grubunun lehine istatistiksel olarak anlamlı (sırasıyla 21'e karşı 14 ay, p=.018 ve 17'ye karşı 8,5 ay p=.009) daha yüksek olduğu bulundu.
Sonuç: Gerçek yaşam verilerine göre, kanseri mümkün olan en kısa sürede ortadan kaldırmak için ilk tedavi seçeneği olarak cerrahiyi seçen daha genç ve daha erken evre hastaların daha uzun mOS ve mPFS'lerinin olduğu görülmüştür.
References
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- 11) Cunningham D, Allum W H, Stenning S P et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. The New England Journal of Medicine. 2006; 355(1):11– 20. Doi:10.1056/NEJMoa055531.
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- 19) Al-Batran S E , Homann N, Pauligk C et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro- oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 ;393:1948-1957. Doi:10.1016/S0140-6736(18)32557-1.
- 20) Trumper M, Ross P J, Cunningham D et al. Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophagogastric cancer: a pooled analysis of three clinical trials. Eur J Canc. 2006; 42:827e34. Doi: 10.1016/j.ejca.
- 21) Jatoi A, Foster N R, Egner J R et al. Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol. 2010; 36:601e6. Doi: 10.3892/ijo_00000535.
Comparision of Perioperative Fluoropyrimidine, Docetaxel And Oxaliplatin Regimen with Adjuvant Fluoropyrimidine and Oxaliplatine Regimen In Operable Gastric Cancer Patients
Year 2024,
Volume: 8 Issue: 3, 248 - 256, 31.12.2024
Aslı Yıldırım
,
Zeynep Ergenç
,
Nihal Bozdağ Kaplan
,
Hasan Ergenç
Abstract
Aim: As no study has compared perioperative 5-Fluorouracil (5-FU), oxaliplatin, and docetaxel (FLOT) chemotherapy regimens with postoperative adjuvant oral capecitabine and oxaliplatin/5-FU and oxaliplatin (CAPEOX/FOLFOX) chemotherapy regimens, the goal of this study was to compare them in terms of median and overall survival of operable gastric cancers.
Methods: This single-center, retrospective study recruited 59 subjects (17 females and 42 males) with at least T2 or more invasive gastric cancers with or without positive lymph node(s). All the patients underwent total or subtotal ((sub) total) gastric resection with D2 lymph node dissection. The Statistical Package for the Social Sciences (IBM SPSS) 26.0 program was used to statistically analyze the research findings.
Results: The peri-operative FLOT treatment group with 30 patients displayed significantly more advanced clinical nodal (cN) stage (p<0.005), more comorbidities (p=0.025), and worse Eastern Cooperative Oncology Group (ECOG) performance (p=0.007) during diagnosis than the adjuvant CAPEOX/FOLFOX treatment group (29 patients). The median overall survival (mOS) and median progression free survival (mPFS) were found to be statistically significant (21 vs. 14 months, p=0.018 and 17 versus 8.5 months p=0.009, respectively) higher in favor of the adjuvant treatment group.
Conclusion: According to real-life data, younger and earlier stage patients who chose surgery as the first treatment option to eliminate cancer as soon as possible had longer mOS and mPFS.
Ethical Statement
The Ethical approve of this study was obtained from Malatya Training and Research Hospital (Number no: E-23536505-604.02).
Supporting Institution
No.
References
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- 2) Slagter A E, Jansen E P M , Laarhoven H W M et al. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo- adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo- adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. BMC Cancer. 2018; 18:877. Doi: 10.1186/s12885-018-4770-2.
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- 4) Schwarz R E , Smith D D. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007; 14:317-328. Doi: 10.1245/s10434-006- 9218-2.
- 5) Karpeh M S, Leon L, Klimstra D M et al. Lymph node staging in gastric cancer: Is location more important than Number? An analysis of 1,038 patients. Ann Surg. 2000; 232:362-571. Doi: 10.1097/00000658-200009000-00008.
- 6) Yu W, Choi G S, Chung H Y et al. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006; 93:559-563. Doi: 10.1002/bjs.5353.
- 7) Cunningham D, Allum W H, Stenning S P et al. Perioperative chemotherapy versus surgery alone for Resectable Gastroesophageal Cancer. N Engl J Med. 2006; 355:11–20. Doi: 10.1056/NEJMoa055531.
- 8) Noh S H , Park S R, Yang H K et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014; 15:1389-1396. Doi: 10.1016/S1470- 2045(14)70473-5.
- 9) Bang Y J , Kim Y W, Yang H K et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012; 379:315-321. Doi:10.1016/S0140-6736(11)61873-4.
- 10) Sun Z, Zhu R J, Yang G F et al. Neoadjuvant Chemotherapy with FOLFOX4 Regimen to Treat Advanced Gastric Cancer Improves Survival without Increasing Adverse Events: A Retrospective Cohort Study from a Chinese Center. Scientific World Journal. 2014; 418694. Doi:10.1155/2014/418694.
- 11) Cunningham D, Allum W H, Stenning S P et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. The New England Journal of Medicine. 2006; 355(1):11– 20. Doi:10.1056/NEJMoa055531.
- 12) Slagter E A., Tudela B, Amelsfoort R M et al. Older versus younger adults with gastric cancer receiving perioperative treatment: Results from the CRITICS trial. EJC European Journal of Cancer. 2020; 130:146-154. Doi: 10.1016/j.ejca.2020.02.008.
- 13) Al-Batran SE, Hofheinz RD, Pauligk C et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of multicentre, open-label, randomised phase 2/3 trial. Lancet Oncol. 2016; 17:1697-1708. Doi:10.1016/S1470-2045(16)30531-9.
- 14) Cathomas G, Langer R. Tumor regression grading of gastrointestinal carcinomas after neoadjuvant treatment. Frontiers in Oncology Review Article. Front Oncol. 2013; 3:262. Doi: 10.3389/fonc.2013.00262.
- 15) Yildirim E, Bektas S, Aydin S G et al. Factors Predicting Response to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer. Jaournal of Istanbul Faculty of Medicine 2022; 85;1: 41-50.
- 16) Bartley A N, Washington M K, Colasacco C et al. HER2 testing and clinical decision making in gastroesophageal adenocarcinoma: guideline from the College of American Pathologists, American Society of Clinical Pathology, and American Society of Clinical Oncology. J Clin Oncol. 2017; 35:446-464. Doi:10.1200/JCO.2016.69.4836.
- 17) Smalley S R , Benedetti J K, Haller D G et al. Updated Analysis of SWOG-Directed Intergroup Study 0116: A Phase III Trial of Adjuvant Radiochemotherapy Versus Observation After Curative Gastric Cancer Resection. J Clin Oncol. 2012;30:2327-2333. Doi:10.1200/JCO.2011.36.7136.
- 18) Lee J , Lim D H, Kim S et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012; 30:268-273. Doi: 10.1200/JCO.2011.39.1953.
- 19) Al-Batran S E , Homann N, Pauligk C et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro- oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019 ;393:1948-1957. Doi:10.1016/S0140-6736(18)32557-1.
- 20) Trumper M, Ross P J, Cunningham D et al. Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophagogastric cancer: a pooled analysis of three clinical trials. Eur J Canc. 2006; 42:827e34. Doi: 10.1016/j.ejca.
- 21) Jatoi A, Foster N R, Egner J R et al. Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol. 2010; 36:601e6. Doi: 10.3892/ijo_00000535.