Abstract
The results of adjuvant chemotherapy trials in gastric cancer are less favorable in European and Anglo-American countries than in Japan. The majority of findings in Western countries leads to the conclusion that the routine application of adjuvant chemotherapy for gastric cancer cannot be recommended. The therapeutic benefit reported in Japanese studies is possibly due to the fact that chemotherapy is started intraoperatively or during the immediate postoperative period in Japan as opposed to the procedure in the majority of Western countries. The effectiveness of adjuvant chemotherapy may be improved by intraperitoneal drug administration because peritoneal seedings and lymph node metastases are the major cause of treatment failure after curative gastric cancer surgery. Since the efficacy of adjuvant chemotherapy is influenced by the responsiveness of cancer cells to cytotoxic agents, preoperative chemotherapy could improve the selection of patients for subsequent postoperative adjuvant treatment trials in the future.
Résumé
Les résultats du traitement du cancer gastrique par la chimiothérapie complémentaire sont moins favorables en Europe et dans les pays anglo-saxons qu'au Japon. La majorité des constatations dans les pays occidentaux aboutit à la conclusion que l'emploi de routine de la chimiothérapie complémentaire pour traiter le cancer gastrique n'est pas à recommander. Le bénéfice thérapeutique relaté par les études japonaises est probablement dû au fait que la chimothérapie est entreprise au cours de l'opération ou immédiatement après l'intervention, ce qui n'est pas le cas dans le monde occidental. L'efficacité de la chimiothérapie complémentaire peut être améliorée par l'administration intra-pêritonéale de l'agent anti-mitotique en raison de l'essaimage péritonéal des cellules néoplasiques et des métastases ganglionnaires qui représentent les causes majeures de l'échec de la chirurgie curative du cancer gastrique. Du fait que l'efficacité de la chimiothérapie complémentaire dépend de la réaction des cellules cancéreuses aux agents cyto-toxiques, la chimiothérapie pré-opératoire pourrait améliorer dans le futur la sélection des malades susceptibles d'être soumis à des essais consécutifs de traitement chimiothérapeutique.
Resumen
Los resultados de los ensayos clínicos con quimioterapia adyuvante en cáncer gástrico son menos favorables en los países Europeos y Angloamericanos que en el Japón. La mayoría de los hallazgos en las naciones occidentales llevaron à la conclusion de que la aplicación rutinaria de quimioterapia adyuvante en el cancer gástrico no puede ser recomendada en la actualidad. El efecto terapéutico beneficioso reportado en los estudios japoneses posiblemente se debe a que la quimioterapia es iniciada intraoperatoriamente o en el periodo postoperatorio inmediato, en contraposición con lo que ocurre en la mayoría de los países de Occidente. La efectividad de la quimioterapia adyuvante puede ser incrementada mediante la administratión intraperitoneal de la droga, ya que las siembras peritoneales y las metástasis ganglionares constituyen la causa principal de falla del tratamiento después de la realización de cirugía curativa en cáncer de estómago. Puesto que la eficacia de la quimioterapia adyuvante está determinada por el grado de respuesta de las células cancerosas a los agentes citotóxicos, la quimioterapia preoperatoria podría mejorar los criterios de selección de pacientes para subsiguientes ensayos clínicos de terapia adyuvante en el futuro.
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Schlag, P. Adjuvant chemotherapy in gastric cancer. World J. Surg. 11, 473–477 (1987). https://doi.org/10.1007/BF01655812
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DOI: https://doi.org/10.1007/BF01655812