Abstract
Fifty-five patients with high-grade advanced gastric cancer in whom the presence of stage IV was confirmed by preoperative diagnostic imaging were treated with PMUE therapy by a combined use of cisplatin (CDDP) 75 mg/m2, mitomycin C (MMC) 10 mg/body, etoposide 150 mg/body, and UFT (a combination of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil in a molar ratio of 1∶4) 400 mg/day. CDDP and MMC was administered intravenously on the first day, followed by etoposide 50 mg/day on the 3rd, 4th, and 5th days. All the patients had measurable lesions that were evaluated by computed tomography scanning before and after the treatments. These patients were allocated randomly to two groups. Of these cases, 29 belonged to the neoadjuvant chemotherapy (NAC) group to whom PMUE therapy was given preoperatively; the remaining 26 patients underwent operation first and received PMUE thereafter (control group). Background factors did not differ significantly between the two groups. The response rate was higher in the NAC group than in the control group (62% in the former versus 35% in the latter). The resectability rates were 79% and 88% in the NAC and control groups, respectively. However, the rate of potentially curable cases was higher in the NAC group than in the control group (38% in the former versus 15% in the latter). Among the nonresection cases, the prognosis was highly unfavorable in both groups. In the resection cases, however, the survival rate was significantly better in the NAC group than in the control group. These results may indicate that in patients with high-grade, advanced gastric cancer initial chemotherapy (neoadjuvant chemotherapy) and then surgery should be considered.
Résumé
Cinquante-cinq cas de cancer gastrique avancé, à potentiel très malin (stade IV à l'imagerie préopératoire), ont été traités par une chimiothérapie PMUE comprenant une combinaison de CDDP, 75 mg/m2, MMC, 10 mg/Kg poids corporel, d'etopocide, 150 mg/Kg poids corporel et d'UFT, 400 mg/jour. Le CDDP et le MMC ont été donnés par voie intraveineuse à Jl, suivis d'etoposide, 50 mg/jour aux jours 3, 4 et 5. Tous les patients avaient des lésions qui ont pu être évaluées par la tomodensitométrie avant et après le traitement. Ces patients ont été randomisés en deux groupes: 29 ont eu une chimiothérapie néoadjuvante (CNA) par le PMUE en préopératoire, alors que les 26 autres ont d'abord été opérés, et ensuite ont reçu une chimiothérapie PMUE (groupe contrôle). Les caractéristiques des deux groupes ne différaient pas de façon significative. Le taux de réponse était plus haut dans le groupe CNA par rapport au groupe contrôle (62% contre 35%). Le taux de résecabilité était respectivement, de 79 et 88% dans les deux groupes. Le taux de cas potentiellement curables, cependant, était plus élevé dans le groupe CNA par rapport au groupe contrôle (38% contre 15%). Dans les cas de cancer gastrique non réséqués, le pronostic était extrêmement mauvais, quel que soit le groupe. Dans les cancers réséqués, la survie était significativement plus élevée dans le groupe CNA comparé au groupe contrôle. Ces résultats indiquent que chez les patients ayant un cancer gastrique avancé à potentiel très malin, une chimiothérapie néoadjuvante (d'emblée), suivie de chirurgie, peut être le meilleur choix thérapeutique.
Resumen
Cincuenta y cinco casos de cáncer gástrico avanzado, en los cuales se había confirmado el Estado IV mediante imágenes diagnósticas preoperatorias, recibieron quimioterapia PMVE con el uso combinado de cisplatino (CDDP) 75 mg/m2, MMC 10 mg/cuerpo, Ectoposide 150 mg/cuerpo y VHF 400 mg/día. El CDDP y el MMC fueron administrados por vía intravenosa en el primer día, seguidos de Ectoposide 50 mg/día en los días 3, 4 y 5. Todos los pacientes exhibían lesiones medibles, las cuales fueron valoradas por escanografía computadorizada antes y después del tratamiento. Los pacientes fueron ubicados al azar en dos grupos; 29 quedaron en el grupo de la quimioterapia neoadyuvante (QNA) en el cual la quimioterapia PMVE fue practicada preoperatoriamente, y los 26 pacientes restantes fueron sometidos primero a operación y luego a quimioterapia PMVE, constituyendose en el grupo de control. Los antecedentes médicos no eran significativamente diferentes en los dos grupos. La respuesta fue mayor en el grupo de QNA en comparación con el grupo control (62% vs 35%). La tasa de resecabilidad fue de 79% y 88% en el grupo QNA y en el grupo de control, respectivamente. Sin embargo, la rata de casos potencialmente curables fue más alta en el grupo de QNA, en comparación con el grupo control (38% vs 15%). En los casos no resecados, sin embargo, la tasa de sobrevida fue significativamente superior en el grupo de QNA en comparación con el grupo control. Tales resulados pueden significar que en pacientes con cáncer gástrico de alto grado y en estado avanzado se debe considerar primero la quimioterapia como paso inicial (quimioterapia neodyuvante), y luego la cirugía.
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Yonemura, Y., Sawa, T., Kinoshita, K. et al. Neoadjuvant chemotherapy for high-grade advanced gastric cancer. World J. Surg. 17, 256–261 (1993). https://doi.org/10.1007/BF01658939
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DOI: https://doi.org/10.1007/BF01658939