Revista de Oncología

, Volume 6, Issue 9, pp 525–531 | Cite as

Tratamiento adyuvante del cáncer gástrico resecable: experiencia en un servicio de Oncología

  • María Sereno Moyano
  • Javier de Castro Carpeño
  • Jaime Feliu Batles
  • Cristóbal Belda Iniesta
  • Lara Miralles Olmedo
  • Manuel González Barón
Originales
  • 45 Downloads

Resumen

Introducción. El tratamiento curativo del cáncer gástrico es la cirugía. La tasa de recidivas con esta terapia es del 40%–70%. Hasta ahora, la administración de quimioterapia adyuvante ha sido ineficaz en demostrar un descenso en la tasa de recidivas. A la vista de los resultados del estudio INT-0116, pacientes intervenidos de cáncer gástrico estadios desde I-B (T1N1 o T2a/b N0) a IV (T4N1,2,3 M0/T1,2,3 N3M0) recibieron tratamiento combinado quimiorradioterápico según el esquema de McDonalds en nuestro servicio.

Material y métodos. Se incluyeron 39 pacientes a lo largo de los 36 meses que duró el estudio.

Resultados. La principal toxicidad fue la gastrointestinal de grado 1–2 en 17 de 39 pacientes (44%). La neutropenia fue la toxicidad hematológica más frecuente, siendo grado 1–2 en 7 de 39 pacientes (26,5%) Resulta llamativo que 17 de 39 (44%) de los pacientes presentaron astenia durante el tratamiento y tras su finalización. Tras una mediana de seguimiento de 20,2 meses no se alcanzó la mediana de supervivencia global (SG) ni la mediana de supervivencia libre de enfermedad (SLE). Se detectaron recaídas en 14 de los 39 pacientes (35,8%) permaneciendo el resto de los enfermos (25 de 39, 64,2%) libres de enfermedad.

Conclusiones. A la vista de la elevada tasa de recaídas incluso con el tratamiento adyuvante, son necesarios más estudios que mejoren la tasa de supervivencia libre de enfermedad. De la misma forma es prioritaria la administración de esquemas mejor tolerados que favorezcan un mayor cumplimiento terapeútico.

Palabras clave

adenocarcinoma gástrico tratamiento adyuvante 5-fluoracilo radioterapia 

Adjuvant treatment of resectable gastric cancer: experience in an Oncology Service

Abstract

Introduction. The curative management of gastric adenocarcinoma depends on complete resection of the primary tumour. The relapse rates from the recurrent cancer are between 40% and 70%. Until recently, attempts at preventing recurrence, usually using adjuvant chemotherapy, have been ineffective. Based on INT-0116 results, gastric cancer patients from stage IB (T1N1 or T2a/b N0) to stage IV (T4 N1,2,3 M0/T1,2,3 N3M0) received combined chemotherapy and radiotherapy treatment following gastric resection.

Material and methods. Patients (n=39) were included over 36 months.

Results. The main toxicity was digestive grade 1 or 2 in 17/39 (44%) cases. More frequent haematological toxicity was grade 1–2 neutropenia, in 7/39 patients (26.5%). Asthenia was a relevant toxicity in 17/39 (44%) of our patients. With a median follow-up of 20.2 months, we have not reached the median overall survival nor the median disease-free survival. There was recurrence in 14/39 (35.8%) cases and the remainder are disease-free (64.2%).

Conclusions. More studies are necessary to evaluate better the disease-free survival following gastric cancer resection. Also, less toxic treatments need to be developed so as to increase treatment compliance.

Key words

gastric carcinoma adjuvant treatment 5-fluoracil and radiotherapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografía

  1. 1.
    Jemal A, Thomas A, Murria, et al. Cancer statistics, 2002. CA Cancer J Clin 2002;52:23–47.CrossRefPubMedGoogle Scholar
  2. 2.
    Vaughan TL, Davis S, Kristal A, et al. Obesity, alcohol, and tobacco as risk factors for cancer of the esophagus and gastric cardia: Adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 1995;4:85–92.PubMedGoogle Scholar
  3. 3.
    Chow WH, Blot WJ, Vaughan TL, et al. Body mass index and risk of adenocarcinomas of esofagous and gastric cardia. J Natl Cancer Inst 1998;90:150–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Lagergren J, Bergstrom R, Nyren O, et al. Association between body mass and adenocarcinoma of the esofagus and gastric cardia. Ann Intern Med 1999;130:883–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Dupon JB, Lee JR, Burton GR, et al. Adenocarcinoma of the stomach: review of 1487 cases. Cancer 1978;41:941–7.CrossRefGoogle Scholar
  6. 6.
    Brennan MF, Karpeh MS. Surgery of Gastric Cancer: The American View. Semin Oncol 1996;23:352–9.PubMedGoogle Scholar
  7. 7.
    Maruyama K, Sasako M, Kinoshita T, et al. Surgical treatment for gastric cancer: The Japanese approach. Semin Oncol 1996; 23:360–8.PubMedGoogle Scholar
  8. 8.
    Hermans J, Bonenkapp JJ, Boon MC, et al. Adjuvant therapy after curative resection for gastric cancer: meta-analysis for randomized trial. J Clin Oncol 1993;11:1441–7.PubMedGoogle Scholar
  9. 9.
    Earle CC, Maroun JA. Adjuvant chemotherapy after curative resection for gastric cancer: revisiting a meta-analysis of randomized trials. Proc Am Soc Clin Oncol 1998;17:263a.Google Scholar
  10. 10.
    Kun Hu, Chen X, Guang Z, et al. Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials. World Gastroenterol 2002;8:1023–8.CrossRefGoogle Scholar
  11. 11.
    Moertel CG, Childs DS, O’Fallon JR, et al. Combined 5-fluoracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 1984;2:1249–54.PubMedGoogle Scholar
  12. 12.
    Takahashi M, Abe M. Intra-operative radiotherapy for carcinoma of the stomach. Eur J Surg Oncol 1986;12:247–50.PubMedGoogle Scholar
  13. 13.
    McDonald J, Smalley S, Benedetti J, et al. Chemotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–30.CrossRefGoogle Scholar
  14. 14.
    Bonenkamp JJ, Songum I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–8.CrossRefPubMedGoogle Scholar
  15. 15.
    UICC. Tumor de estómago. En: International Union Against cancer. TNM Clasificación de los tumores malignos 2002 6a ed. Barcelona: Pulso, 2002; p. 69–71.Google Scholar
  16. 16.
    Dent D, Werner I, Novis B, et al. Prospective randomized trial of combined oncological therapy for gastric carcinoma. Cancer 1979;44:395–401.CrossRefGoogle Scholar
  17. 17.
    Roder JD, Bottcher K, Siewert JR, et al. Prognostic factors in gastric cancer. Results in the German Gastric Carcinoma Study. Cancer 1993;72:2089–97.CrossRefPubMedGoogle Scholar
  18. 18.
    Maruyama K, Sasako M, Kinoshita T, et al. Optimun resection with lymph-node disection for gastric cancer. En: Wanebo HJ, editor. Surgery for gastrointestinal cancer: A multidisciplinary Approach. Philadelphia: Lippincott-Raven Publishers, 1997; p. 319–25.Google Scholar
  19. 19.
    Cuscheri A, Weeden S, Fielding J, et al. Patient survival after D1 and surgical trial. Br J Cancer 1999;79:1522–30.CrossRefGoogle Scholar
  20. 20.
    Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Smith JW, Shiu MH, Kelsey L, et al. Morbility of radical lymphadenectomy in curative resection of gastric carcinoma. Arch Surg 1991;126:1469–73.CrossRefPubMedGoogle Scholar
  22. 22.
    Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Find results of the randomized Ducht gastric cancer group trial. J Clin Oncol 2004;22:2069–77. Epub 2004 Apr13.CrossRefPubMedGoogle Scholar
  23. 23.
    Parkin DM, Pisani P, Ferlay J, et al. Global Cancer Statistics. CA Cancer J Clin 1999;49:33–64.CrossRefPubMedGoogle Scholar

Copyright information

© FESEO 2004

Authors and Affiliations

  • María Sereno Moyano
    • 1
  • Javier de Castro Carpeño
    • 1
  • Jaime Feliu Batles
    • 1
  • Cristóbal Belda Iniesta
    • 1
  • Lara Miralles Olmedo
    • 1
    • 2
  • Manuel González Barón
    • 1
  1. 1.Servicio de Oncología MédicaHospital La PazMadridEspaña
  2. 2.Servicio de Oncología RadioterápicaHospital La PazMadridEspaña

Personalised recommendations