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Management Strategies for Locoregional Recurrence in Early-Stage Gastric Cancer: Retrospective Analysis and Comprehensive Literature Review

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Abstract

Objective

To present a comprehensive account and literature review addressing the anatomical distribution, natural history, and management strategies for locoregional recurrence in early-stage gastric cancer (EGC).

Patients and methods

Retrospective chart review of patients presenting with EGC recurrence at King Hussein Cancer Center (Amman, Jordan) between July 2006 and May 2009. A literature review of publications addressing recurrence following surgery for EGC was undertaken via a systematic search of PUBMED database and National Comprehensive Cancer Network (NCCN) guideline updates.

Results

Seventeen patients presented with EGC, three of whom (17.6%) were pathologically staged as T2N1 [1/33 lymph nodes (LNs)], T1N0, and T1N0 were afflicted by recurrence following R0 partial gastrectomy. Literature review yielded 18 studies specifically addressing recurrence in EGC. Several management strategies have been proposed for isolated recurrence following gastrectomy in EGC. NCCN clinical practice guideline updates do not take into consideration whether the recurrence is isolated or widespread and whether the initial stage is early or advanced.

Conclusions

While acknowledging the limitations of this study, including the small sample size and the short follow-up period, it appears clear that oncologic treatment is possible for EGC recurrence, particularly, in patients with isolated relapse. Guideline updates should differentiate between management strategies suitable for recurrence occurring in early versus advanced initial cancer stage.

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References

  1. Sim SH, Kim YJ, Oh DY, et al. The role of PET/CT in detection of gastric cancer recurrence. BMC Cancer. 2009;9:73.

    Article  PubMed  Google Scholar 

  2. Lim L, Michael M, Mann GB, Leong T. Adjuvant therapy in gastric cancer. J Clin Oncol. 2005;23(25):6220–32.

    Article  PubMed  CAS  Google Scholar 

  3. Wydmański J, Suwinski R, Poltorak S, et al. The tolerance and efficacy of preoperative chemoradiotherapy followed by gastrectomy in operable gastric cancer, a phase II study. Radiother Oncol. 2007;82(2):132–6.

    Article  PubMed  Google Scholar 

  4. Zhou E, Wen M, Li Y, Qing D. Analysis of the diagnosis and treatment of 78 gastric cancer cases in young people. Chin–German J Clin Oncol. 2006;5(6):396–8.

    Article  Google Scholar 

  5. Jansen EP, Boot H, Verheij M, van de Velde CJ. Optimal locoregional treatment in gastric cancer. J Clin Oncol. 2005;23(20):4509–17.

    Article  PubMed  Google Scholar 

  6. MacDonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725–30.

    Article  PubMed  CAS  Google Scholar 

  7. Kim JW, Hwang I, Kim MJ, Jang SJ. Clinicopathological characteristics and predictive markers of early gastric cancer with recurrence. J Korean Med Sci. 2009;24(6):1158–64.

    Article  PubMed  CAS  Google Scholar 

  8. Haglund UH, Wallner B. Current management of gastric cancer. J Gastrointest Surg. 2004;8(7):907–14.

    Article  PubMed  Google Scholar 

  9. Sugano K. Long-term outcome and surveillance policy after endoscopic therapy for early gastric cancer. Gastric Cancer. 2006;9(2):67–9.

    Article  PubMed  Google Scholar 

  10. Sasson AR. Localized gastric cancer: chemoradiation is not always needed. Gastrointest Cancer Res. 2009;3(2 Suppl):S22–5.

    PubMed  Google Scholar 

  11. Jo MJ, Lee JH, Nam BH, et al. Preoperative serum angiopoietin-2 levels correlate with lymph node status in patients with early gastric cancer. Ann Surg Oncol. 2009;16(7):2052–7.

    Article  PubMed  Google Scholar 

  12. Lee HJ, Kim YH, Kim WH, et al. Clinicopathological analysis for recurrence of early gastric cancer. Jpn J Clin Oncol. 2003;33(5):209–14.

    Article  PubMed  Google Scholar 

  13. Folli S, Dente M, Dell'Amore D, et al. Early gastric cancer: prognostic factors in 223 patients. Br J Surg. 1995;82(7):952–6.

    Article  PubMed  CAS  Google Scholar 

  14. Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer. 1993;72(11):3174–8.

    Article  PubMed  CAS  Google Scholar 

  15. Wu B, Wu D, Wang M, Wang G. Recurrence in patients following curative resection of early gastric carcinoma. J Surg Oncol. 2008;98(6):411–4.

    Article  PubMed  Google Scholar 

  16. Habu H, Takeshita K, Sunagawa M, Endo M. Prognostic factors of early gastric cancer—results of long-term follow-up and analysis of recurrent cases. Jpn J Surg. 1987;17(4):248–55.

    Article  PubMed  CAS  Google Scholar 

  17. Ichiyoshi Y, Toda T, Minamisono Y, et al. Recurrence in early gastric cancer. Surgery. 1990;107(5):489–95.

    PubMed  CAS  Google Scholar 

  18. Uña E. Gastric cancer: predictors of recurrence when lymph-node dissection is inadequate. World J Surg Oncol. 2009;7:69.

    Article  PubMed  Google Scholar 

  19. Kim MS, Yoo SY, Cho CK, et al. Stereotactic body radiotherapy for isolated para-aortic lymph node recurrence after curative resection in gastric cancer. J Korean Med Sci. 2009;24(3):488–92.

    Article  PubMed  Google Scholar 

  20. Henning GT, Schild SE, Stafford SL, et al. Results of irradiation or chemoirradiation for primary unresectable, locally recurrent, or grossly incomplete resection of gastric adenocarcinoma. Int J Radiat Oncol Biol Phys. 2000;46(1):109–18.

    Article  PubMed  CAS  Google Scholar 

  21. von Rahden BH, Stein HJ, Siewert JR. Surgical management of esophagogastric junction tumors. World J Gastroenterol. 2006;12(41):6608–13.

    Google Scholar 

  22. Siewert JR, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1, 002 consecutive patients. Ann Surg. 2000;232(3):353–61.

    Article  Google Scholar 

  23. Stein HJ, Feith M, Siewert JR. Cancer of the esophagogastric junction. Surg Oncol. 2000;9(1):35–41. Review.

    Article  PubMed  CAS  Google Scholar 

  24. Park MJ, Lee WJ, Lim HK, et al. Detecting recurrence of gastric cancer: the value of FDG PET/CT. Abdom Imaging. 2009;34(4):441–7.

    Article  PubMed  Google Scholar 

  25. Huang CM, Lin JX, Zheng CH, et al. Prognostic impact of dissected lymph node count on patients with node-negative gastric cancer. World J Gastroenterol. 2009;15(31):3926–30.

    Article  PubMed  Google Scholar 

  26. Reed VK, Krishnan S, Mansfield PF, et al. Incidence, natural history, and patterns of locoregional recurrence in gastric cancer patients treated with preoperative chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2008;71(3):741–7.

    Article  PubMed  Google Scholar 

  27. Park IH, Kim SY, Kim YW, et al. Clinical characteristics and treatment outcomes of gastric cancer patients with isolated para-aortic lymph node involvement. Cancer Chemother Pharmacol. 2010; Mar 11. [Epub ahead of print].

  28. Yu J, Zhao Q. The demographic characteristics of histological types of gastric cancer with gender, age, and tumor location. J Gastrointest Cancer. 2009;40(3–4):98–100.

    Article  PubMed  Google Scholar 

  29. Sipponen P. Gastric cancer: pathogenesis, risks, and prevention. J Gastroenterol. 2002;37 Suppl 13:39–44.

    Article  PubMed  CAS  Google Scholar 

  30. Sun J, Sun YH, Zeng ZC, et al. Consideration of the role of radiotherapy for abdominal lymph node metastases in patients with recurrent gastric cancer. Int J Radiat Oncol Biol Phys. 2009; Jul 3.

  31. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: gastric cancer. V.1.2010. NCCN, 2010. http://www.nccn.org.

  32. Park SM, Lee CH, Park CH, et al. Reoperation of recurrent gastric cancer. Cancer Res Treat. 2001;33(6):478–82. In Korean.

    Google Scholar 

  33. Song KY, Park SM, Kim SN, Park CH. The role of surgery in the treatment of recurrent gastric cancer. Am J Surg. 2008;196(1):19–22.

    Article  PubMed  Google Scholar 

  34. Nashimoto A, Sasaki J, Sano M, et al. Disease-free survival for 6 years and 4 months after dissection of recurrent abdominal paraaortic nodes (no. 16) in gastric cancer: report of a case. Surg Today. 1997;27(2):169–73.

    Article  PubMed  CAS  Google Scholar 

  35. Minami K, Tsutani Y, Suzuki T, et al. Chemotherapy for patients with non-curative advanced or recurrent gastric cancer in our hospital. Gan To Kagaku Ryoho. 2008;35(1):55–60. In Japanese.

    PubMed  Google Scholar 

  36. Teraishi F, Suzuki T, Nakamoto M, et al. Marked response to S-1 chemotherapy for para-aortic lymph node metastasis arising from gastric cancer. Gan To Kagaku Ryoho. 2007;34(11):1857–9. In Japanese.

    PubMed  Google Scholar 

  37. Murakami M, Morikawa A, Okabe R, et al. Three cases of recurrent gastric cancer responding to TS-1 therapy following combination therapy with 5-fluorouracil, mitomycin C and cisplatin. Gan To Kagaku Ryoho. 2002;29(5):767–70. In Japanese.

    PubMed  Google Scholar 

  38. de Liaño AD, Yarnoz C, Aguilar R, Artieda C, Ortiz H. Surgical treatment of recurrent gastric cancer. Gastric Cancer. 2008;11(1):10–4.

    Article  PubMed  Google Scholar 

  39. Carboni F, Lepiane P, Santoro R, et al. Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: does surgery play a role? World J Gastroenterol. 2005;11(44):7014–7.

    PubMed  Google Scholar 

  40. Wainberg ZA, Anghel A, Desai AJ, et al. Lapatinib, a dual EGFR and HER2 kinase inhibitor, selectively inhibits HER2-amplified human gastric cancer cells and is synergistic with trastuzumab in vitro and in vivo. Clin Cancer Res. 2010;16(5):1509–19.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan

    Ahmed Salem, Sameh Hashem, Layth Y. I. Mula-Hussain, Issa Mohammed, Ala’a Nour, Imad Jaradat, Jamal Khader & Abdelatief Almousa

  2. Clinical Research and Cancer Registry, King Hussein Cancer Center, Amman, Jordan

    Wael Shelpai

  3. Department of Surgical Oncology, King Hussein Cancer Center, Amman, Jordan

    Faiez Daoud & Basem Morcos

  4. Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan

    Yasser Yamin

Authors
  1. Ahmed Salem
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  2. Sameh Hashem
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Correspondence to Abdelatief Almousa.

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Salem, A., Hashem, S., Mula-Hussain, L.Y.I. et al. Management Strategies for Locoregional Recurrence in Early-Stage Gastric Cancer: Retrospective Analysis and Comprehensive Literature Review. J Gastrointest Canc 43, 77–82 (2012). https://doi.org/10.1007/s12029-010-9207-3

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  • DOI: https://doi.org/10.1007/s12029-010-9207-3

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