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NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS

Year 1999, Volume: 12 Issue: 1, 20 - 24, 03.12.2016

Abstract

Objective: The feasibility of neoadjuvant
chemotherapy for clinically unresectable gastric and gastroesophageal (GE) junction cancers.
Methods: Eleven patients with gastric and GE junction cancers underwent preoperative combined modality chemo and radiotherapy and a subsequent attempt for surgical resection.
Results: Combined modality periadjuvant therapies downsized 9 of 11 T3-4 gastric and gastroesophageal junction cancers and produced 4 pathologically proven complete remissions. Treatment appeared to convert lymph nodes to a cancer free status for 7 of 11 patients. After treatment, exploratory surgery found that 3 patients had only minute foci of occult metastatic disease. The quality of the responses was underestimated by both endoscopic ultrasound and CT scans. Responses were sometimes only achieved after 2-3 months of therapy.
Conclusion: Combined modality therapy
demonstrates the feasibility of a flexible multistep approach to neoadjuvant therapy incorporating new drugs such as methotrexate and hydroxyurea in addition to fluorouracil and cisplatin. Long delays in surgery (gastrectomy) appear to be safe in the context of combined modality therapy. Median survival exceeds 2 years. The experience suggests new early end points for evaluation of neoadjuvant treatments: quality of life, quality of lymph node sterilization and extent of required gastrectomy in comparison to standard surgery.
Key Words: Neoadjuvant, Gastric cancer, Gastroesophageal cancer, Combined modality treatment

References

  • Kelsen DP. Adjuvant and neoadjuvant therapy of gastric cancer. Semin-Oncol 1996; 23: 379-389.
  • Gunderson I.L, Sosin ft. Adenocarcinoma of the
  • stomach: Areas of failure in a reoperation
  • seriesisecond or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiation Oncol Biol Phys 1981; 8:1-1 I.
  • Ajani JA, Ota DPI, Jessup JP1, et al. Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy. Cancer 1991; 68:1501-1506.
  • Hermans J, Bonenkamp JJ, Boon PIC, et ah. Adjuvant therapy after curative resection for gastric cancer: Meta analysis of randomized trials. J Clin Oncol 1993; I 1:1441 -1447.
  • Regine WF, Mohiuddln M. Impact of adjuvant therapy on locally advanced adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys 1992; 24:921-927.
  • Kiyabu PI, Leichman L, Chandrasoma P. Effects of preoperative chemotherapy on gastric adenocarcinoma. Cancer 1992; 70:2239-2245.
  • Ajani JA, Player RJ, Ota DPI, et al. Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Hat Cancer Inst 1993; 85:1839-1844.
  • Wilke H, Preusser P, Fink U, et al. Preoperative chemotherapy in locally advanced and non- resectable gastric cancer: A phase II study with etoposide, doxorubicin, cisplatin. J Clin Oncol 1989; 7:1318-1326.
  • Ajani JA, Roth JA, Ryan P1B, et al. Intensive preoperative chemotherapy with colony stimulating factor for resectable adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 1993; 11:22-28.
  • Rougier P, Plahjoubi PI, Lasser P, et al. Heoadjuvant chemotherapy in locally advanced gastric
  • Marmara Medical Journal Volume 12 No: 1 January 1999
  • carcinoma- a phase II trial with combined continuous intravenous 5fiuorouracii and bolus cisplatinum. Eur J of Cancer ¡994; 30:1269-1275.
  • Tsukiyama 1, Akine Y, Kajiura Y, et al. Radiation therapy for advanced gastric cancer. Int J Radi at Oncol Biol Phys 1988; 15:123-127.
  • Gunderson LL, Burch FA, Donahue Jtl. The role of irradiation as a component of combined modality treatment for gastric cancer. J Infus Chemother 1995; 5:1 17-124.
  • Elinsky BD. The role of radiation therapy in gastric cancer. Semin Oncol 1996; 23:390-396.
  • Bruckner fl. Effective treatment for adenocarcinoma of the stomach when surgery is contraindicated. Am J Gastroenterol 1988; 83:699- 700.
  • Smith JW, Brennan MF, Botet JF, et al. Preoperative endoscopic ultrasound can predict the risk of
  • recurrence after operation for gastric carcinoma. J Clin Oncol 1993; 1 1:2380-2385.
  • Lemoine NR, Jain S, Silvestre F, et al. Amplifications and over expression of the EGF receptor on C-erb B- 2 proto-oncogenes in human stomach cancer. Br J Cancer 1991; 64:79-83.
  • Johnston PG, Lenz fIJ, Leichman CO, et al. Thymidilate synthase protein and gene expression correlate and are associated with response to 5- fluorouracil in human colorectal and gastric tumors. Cancer Res 1995; 55:1407-14 12.
  • Robey-Cafferty SS, Ajani J A, OtaDM, et al. Histologic observations and P-glycoprotein expression in gastric and esophageal adenocarcinomas treated with preoperative chemotherapy. Arch Pathol Lab Med 1991; 115:807-812.
Year 1999, Volume: 12 Issue: 1, 20 - 24, 03.12.2016

Abstract

References

  • Kelsen DP. Adjuvant and neoadjuvant therapy of gastric cancer. Semin-Oncol 1996; 23: 379-389.
  • Gunderson I.L, Sosin ft. Adenocarcinoma of the
  • stomach: Areas of failure in a reoperation
  • seriesisecond or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiation Oncol Biol Phys 1981; 8:1-1 I.
  • Ajani JA, Ota DPI, Jessup JP1, et al. Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy. Cancer 1991; 68:1501-1506.
  • Hermans J, Bonenkamp JJ, Boon PIC, et ah. Adjuvant therapy after curative resection for gastric cancer: Meta analysis of randomized trials. J Clin Oncol 1993; I 1:1441 -1447.
  • Regine WF, Mohiuddln M. Impact of adjuvant therapy on locally advanced adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys 1992; 24:921-927.
  • Kiyabu PI, Leichman L, Chandrasoma P. Effects of preoperative chemotherapy on gastric adenocarcinoma. Cancer 1992; 70:2239-2245.
  • Ajani JA, Player RJ, Ota DPI, et al. Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Hat Cancer Inst 1993; 85:1839-1844.
  • Wilke H, Preusser P, Fink U, et al. Preoperative chemotherapy in locally advanced and non- resectable gastric cancer: A phase II study with etoposide, doxorubicin, cisplatin. J Clin Oncol 1989; 7:1318-1326.
  • Ajani JA, Roth JA, Ryan P1B, et al. Intensive preoperative chemotherapy with colony stimulating factor for resectable adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 1993; 11:22-28.
  • Rougier P, Plahjoubi PI, Lasser P, et al. Heoadjuvant chemotherapy in locally advanced gastric
  • Marmara Medical Journal Volume 12 No: 1 January 1999
  • carcinoma- a phase II trial with combined continuous intravenous 5fiuorouracii and bolus cisplatinum. Eur J of Cancer ¡994; 30:1269-1275.
  • Tsukiyama 1, Akine Y, Kajiura Y, et al. Radiation therapy for advanced gastric cancer. Int J Radi at Oncol Biol Phys 1988; 15:123-127.
  • Gunderson LL, Burch FA, Donahue Jtl. The role of irradiation as a component of combined modality treatment for gastric cancer. J Infus Chemother 1995; 5:1 17-124.
  • Elinsky BD. The role of radiation therapy in gastric cancer. Semin Oncol 1996; 23:390-396.
  • Bruckner fl. Effective treatment for adenocarcinoma of the stomach when surgery is contraindicated. Am J Gastroenterol 1988; 83:699- 700.
  • Smith JW, Brennan MF, Botet JF, et al. Preoperative endoscopic ultrasound can predict the risk of
  • recurrence after operation for gastric carcinoma. J Clin Oncol 1993; 1 1:2380-2385.
  • Lemoine NR, Jain S, Silvestre F, et al. Amplifications and over expression of the EGF receptor on C-erb B- 2 proto-oncogenes in human stomach cancer. Br J Cancer 1991; 64:79-83.
  • Johnston PG, Lenz fIJ, Leichman CO, et al. Thymidilate synthase protein and gene expression correlate and are associated with response to 5- fluorouracil in human colorectal and gastric tumors. Cancer Res 1995; 55:1407-14 12.
  • Robey-Cafferty SS, Ajani J A, OtaDM, et al. Histologic observations and P-glycoprotein expression in gastric and esophageal adenocarcinomas treated with preoperative chemotherapy. Arch Pathol Lab Med 1991; 115:807-812.
There are 23 citations in total.

Details

Journal Section Original Research
Authors

Serdar Turhal This is me

Howard Bruckner This is me

Publication Date December 3, 2016
Published in Issue Year 1999 Volume: 12 Issue: 1

Cite

APA Turhal, S., & Bruckner, H. (2016). NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS. Marmara Medical Journal, 12(1), 20-24.
AMA Turhal S, Bruckner H. NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS. Marmara Med J. June 2016;12(1):20-24.
Chicago Turhal, Serdar, and Howard Bruckner. “NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS”. Marmara Medical Journal 12, no. 1 (June 2016): 20-24.
EndNote Turhal S, Bruckner H (June 1, 2016) NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS. Marmara Medical Journal 12 1 20–24.
IEEE S. Turhal and H. Bruckner, “NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS”, Marmara Med J, vol. 12, no. 1, pp. 20–24, 2016.
ISNAD Turhal, Serdar - Bruckner, Howard. “NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS”. Marmara Medical Journal 12/1 (June 2016), 20-24.
JAMA Turhal S, Bruckner H. NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS. Marmara Med J. 2016;12:20–24.
MLA Turhal, Serdar and Howard Bruckner. “NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS”. Marmara Medical Journal, vol. 12, no. 1, 2016, pp. 20-24.
Vancouver Turhal S, Bruckner H. NEW NEOADJUVANT TREATMENT STRATEGIES FOR GASTRIC AND GASTROESOPHAGEAL JUNCTION CANCERS. Marmara Med J. 2016;12(1):20-4.