Abstract
Purpose
This retrospective study evaluated the effects of neoadjuvant chemotherapy in advanced gastric cancer.
Methods
Between 2002 and 2005, we treated 14 patients with advanced gastric cancer (involvement of more than five nodes or tumor invasion into pancreas) and 25 patients with Stage III gastric cancer. The group of 14 patients with advanced gastric cancer received combination chemotherapy with S-1 and cis-diamminedichloroplatinum (CDDP) as a neoadjuvant chemotherapy (NAC). This regimen was repeated every 5 weeks for a total of 2–5 cycles. The 25 patients with Stage III gastric cancer was carried surgery alone (SA). All patients underwent extensive surgery, including gastrectomy, and D2 lymphadenectomy. The rate of response and overall survival in the two groups were compared.
Results
All patients of NAC group completed the planned regimens of chemotherapy and surgery. Patients of the NAC group had a response rate of 78.6% (95% confidence interval 57.1–100.0%). The most common adverse effect was leukocytopenia (42.9%). However, only four patients (28.6%) had upper Grade 2 leukocytopenia, and all recovered promptly. Postoperative complications were not significant differentiated between NAC and SA group of patients (7.2 vs. 4.0%). Patients in the NAC group had a significantly better survival than those in the SA group (P = 0.03). The median survival has not been reached after 26.9 months of median follow-up for patients in the NAC group. 1-, 2-, and 3-year survival rates were 92.3, 92.3, and 61.5%, respectively. NAC was identified as an independent prognostic factor in all patients (P = 0.018).
Conclusion
Neoadjuvant chemotherapy with TS-1 + CDDP improves the survival in patients with advanced gastric cancer.
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References
Ajani JA, Faust J, Ikeda K, Yao JC, Anbe H, Carr KL, Houghton M, Urrea P (2005) Phase I pharmacokinetic study of S-1 plus cisplatin in patients with advanced gastric carcinoma. J Clin Oncol 1:6957–6965
Barone C, Cassano A, Pozzo C, D’Ugo D, Schinzari G, Persiani R, Basso M, Brunetti IM, Longo R, Picciocchi A (2004) Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology 67:48–53
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H; Dutch Gastric Cancer Group (1999) Extended lymph-node dissection for gastric cancer. N Engl J Med 25:908–914
Degiuli M, Sasako M, Ponti A, Calvo F (2004) Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer 4:1727–1732
Edwards P, Blackshaw GR, Lewis WG, Barry JD, Allison MC, Jones DR (2004) Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma. Br J Cancer 17:1888–1892
Japanese Classification of Gastric Carcinoma. Japanese Research Society for Gastric Cancer (First English Edition), Kanehara & Co. Ltd., Tokyo (JCGC) 1995
Kelsen D, Karpeh M, Schwartz G, Gerdes H, Lightdale C, Botet J, Lauers G, Klimstra D, Huang Y, Saltz L, Quan V, Brennan M (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 14:1818–1828
Kochi M, Fujii M, Kaiga T, Takahashi T, Morishita Y, Kobayashi M, Kasakura Y, Takayama T (2004) FLEP chemotherapy for alpha-fetoprotein-producing gastric cancer. Oncology 66:445–449
Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A (2005) Gastric cancer surgery study group of Japan clinical oncology group Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92:1103–1109
Koizumi W, Tanabe S, Saigenji K, Ohtsu A, Boku N, Nagashima F, Shirao K, Matsumura Y, Gotoh M (2003) Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer 15:2207–2212
Nakajima T, Nashimoto A, Kitamura M, Kito T, Iwanaga T, Okabayashi K, Goto M (1999) Adjuvant mitomycin and fluorouracil followed by oral uracil plus tegafur in serosa-negative gastric cancer: a randomised trial. Gastric cancer surgical study group. Lancet 24:273–277
Newman E, Marcus SG, Potmesil M, Sewak S, Yee H, Sorich J, Hayek M, Muggia F, Hochster H (2002) Neoadjuvant chemotherapy with CPT-11 and cisplatin downstages locally advanced gastric cancer. J Gastrointest Surg 6:212–223
Rougier P, Mahjoubi M, Lasser P, Ducreux M, Oliveira J, Ychou M, Pignon JP, Elias D, Bellefqih S, Bognel C, et al (1994) Neoadjuvant chemotherapy in locally advanced gastric carcinoma—phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer 30:1269–1275
Sakata Y, Ohtsu A, Horikoshi N, Sugimachi K, Mitachi Y, Taguchi T (1998) Late phase II study of novel oral fluoropyrimidine anticancer drug S-1 (1 M tegafur-0.4 M gimestat-1 M otastat potassium) in advanced gastric cancer patients. Eur J Cancer 34:1715–1720
Yano M, Shiozaki H, Inoue M, Tamura S, Doki Y, Yasuda T, Fujiwara Y, Tsujinaka T, Monden M (2002) Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer. World J Surg 26:1155–1159
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Kochi, M., Fujii, M., Kanamori, N. et al. Neoadjuvant chemotherapy with S-1 and CDDP in advanced gastric cancer. J Cancer Res Clin Oncol 132, 781–785 (2006). https://doi.org/10.1007/s00432-006-0126-4
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DOI: https://doi.org/10.1007/s00432-006-0126-4