Multimodality Therapy of Local-Regional Gastric Carcinoma

  • Jaffer A. Ajani


Gastric carcinoma is more frequent in the Orient, South America, eastern Europe, and countries of the former Soviet Union than it is in North America and western Europe. Its incidence has been declining throughout the world for the past 50 years. Screening for gastric carcinoma is performed only in Japan and then on a limited basis. Therefore, in rest of the world patients are frequently diagnosed with advanced gastric carcinoma at the outset. It had been estimated that, more than 22600 new cases of gastric cancer would be diagursed in 1998 in the United States, and 13700 deaths were expected [1]. In Western patients the curative resection rate (R0 type surgery) can be achieved in fewer than 50% of patients [2,3]. Clearly, this low R0 resection rate in the West is due to suboptimal clinical staging and the higher stage at diagnosis. In Western countries the incidence of proximal gastric carcinoma has risen during the past 15 years, and proximal gastric carcinomas carry a worse prognosis than do distal carcinomas [4,5].


Gastric Cancer Gastric Carcinoma Preoperative Chemotherapy Gastric Adenocarcinoma Preoperative Therapy 
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  1. 1.
    Landis SH, Murray T, Bolden S, Wingo PA (1998) Cancer statistics, 1998. CA Cancer J Clin 48:6–29PubMedCrossRefGoogle Scholar
  2. 2.
    Adashek K, Sanger J, Longmire WP (1979) Cancer of the stomach: review of consecutive ten-year intervals. Ann Surg 198:6–10CrossRefGoogle Scholar
  3. 3.
    Wanebo HJ, Kennedy BJ, Chmiel J, Steele G Jr, Winchester D, Osteen R (1993) Cancer of the stomach: a patient care study by the American College of Surgeons. Ann Surg 218:583–592PubMedCrossRefGoogle Scholar
  4. 4.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289PubMedCrossRefGoogle Scholar
  5. 5.
    Philip PA, Ajani JA (1996) Gastric carcinoma. In: Pazdur R (ed) Medical oncology: a comprehensive review 2nd edn. PRR, Huntington, NY, pp 235–246Google Scholar
  6. 6.
    Douglass HO, Nava HR (1985) Gastric adenocarcinoma: management of the primary disease. Semin Oncol 12:32–45PubMedGoogle Scholar
  7. 7.
    Buchholtz TW, Welch CE, Malt RA (1978) Clinical correlates of resectability and survival in gastric carcinoma. Ann Surg 188:711–715PubMedCrossRefGoogle Scholar
  8. 8.
    Mayer RJ (1988) Current issues in the treatment of patients with gastric cancer. In: Levin B (ed) Gastrointestinal cancer: current approaches to diagnosis and treatment. Austin, University of Texas Press, pp 365–379Google Scholar
  9. 9.
    Krook JE, O’Connell MJ, Wieand HS, Beart RW Jr, Leigh JE, Kugler JW, Foley JF, Pfeifle DM, Twito DI (1991) Prospective randomized evaluation of intensive course 5-fluorouracil plus doxorubicin as surgical adjuvant chemotherapy for resected gastric cancer. Cancer 67:2454–2458PubMedCrossRefGoogle Scholar
  10. 10.
    Higgins GA, Amadeo JH, Smith DE, Humphrey EW, Keehn RJ (1983) Efficacy of prolonged intermittent therapy with combined 5-FU and methyl-CCNU following resection for gastric carcinoma: a Veterans Administration Surgical Oncology Group report. Cancer 52:1105–1112PubMedCrossRefGoogle Scholar
  11. 11.
    Engstrom PF, Lavin PT, Douglass HO Jr, Brunner KW (1985) Postoperative adjuvant 5-fluorouracil plus methyl-CCNU therapy for gastric cancer patients: Eastern Cooperative Oncology Group study (EST 3275). Cancer 55:1868–1873PubMedCrossRefGoogle Scholar
  12. 12.
    Gastrointestinal Tumor Study Group (1982) Controlled trial of adjuvant chemotherapy following curative resection for gastric cancer. Cancer 49:1116–1122CrossRefGoogle Scholar
  13. 13.
    Ajani JA, Ota DM, Jessup JM, Ames FC, McBride C, Boddie A, Levin B, Jackson DE, Roh M, Hohn D (1991) Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer 68:1501–1506PubMedCrossRefGoogle Scholar
  14. 14.
    Ajani JA, Mayer RJ, Ota DM, Steele GD, Evans D, Roh M, Sugarbaker DJ, Dumas P, Gray C, Vena DA, Stablein DM (1993) Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Natl Cancer Inst 85:1839–1844PubMedCrossRefGoogle Scholar
  15. 15.
    Wilke H, Preusser P, Fink U, Gunzer U, Meyer HJ, Meyer J, Siewert JR, Achterrath W, Lenaz L, Knipp H, Schmoll HJ (1989) Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol 7:1318–1326PubMedGoogle Scholar
  16. 16.
    Plukker JT, Mulder NH, Sleijfer DT, Grond J, Verschueren RC (1991) Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: phase II study with methotrexate and 5-fluorouracil. Br J Surg 78:955–958PubMedCrossRefGoogle Scholar
  17. 17.
    Leichman L, Silberman H, Leichman CG, Spears CP, Ray M, Muggia FM, Kiyabu M, Radin R, Laine L, Stain S, Fuerst M, Groshen S, Donovan A (1992) Preoperative systemic chemotherapy followed by adjuvant postoperative intraperitoneal therapy for gastric cancer: a University of Southern California pilot program. J Clin Oncol 10:1933–1942PubMedGoogle Scholar
  18. 18.
    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 carcinoma: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 14:1818–1828PubMedGoogle Scholar
  19. 19.
    Ajani JA, Mansfield PF, Dumas P, Pazdur R, Evans D, Curley S, Pisters P, Lynch P, Ota D (1996) All chemotherapy preoperatively with cisplatin, 5-FU, and Intron in patients with potentially resectable gastric carcinoma. Proc ASCOGoogle Scholar
  20. 20.
    Lowy AM, Mansfield PF, Leach SD, Pazdur R, Dumas P, Ajani JA (in press) Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann SurgGoogle Scholar
  21. 21.
    Gunderson LL, Burch PA, Donohue JH (1995) The role of irradiation as a component of combined modality treatment for gastric carcinoma. J Infus Chemother 5:117–124PubMedGoogle Scholar
  22. 22.
    Papachristou DN, Fortner JG (1981) Local recurrence of gastric adenocarcinoma after gastrectomy. J Surg Oncol 18:47–53PubMedCrossRefGoogle Scholar
  23. 23.
    Landry J, Tepper JE, Wood WC, Moulton EO, Koerner F, Sullinger J (1990) Analysis of survival and local control following surgery for gastric cancer. Int J Radiat Oncol Biol Phys 19:1357–1362PubMedCrossRefGoogle Scholar
  24. 24.
    Gunderson LL, Sosin H (1982) Adenocarcinoma of the stomach: areas of failure in a reoperation series (second or symptomatic looks): clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 8:1–11PubMedCrossRefGoogle Scholar
  25. 25.
    Horn RC (1995) Carcinoma of the stomach: autopsy findings in untreated cases. Gastroenterology 29:515–525Google Scholar
  26. 26.
    McNeer G, Vanderberg H, Donn FY, Bowden LA (1957) A critical evaluation of subtotal gastrectomy for the cure of cancer of the stomach. Ann Surg 134:2–7CrossRefGoogle Scholar
  27. 27.
    Wisbeck WM, Becher EM, Russell AH (1986) Adenocarcinoma of the stomach: autopsy observations with therapeutic implications for the radiation oncologists. Radiother Oncol 7:13–18PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 1999

Authors and Affiliations

  • Jaffer A. Ajani
    • 1
  1. 1.Department of Gastrointestinal Oncology and Digestive DiseasesThe University of Texas M. D. Anderson Cancer CenterHoustonUSA

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