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Rationale for Neoadjuvant Chemotherapy for Advanced Gastric Cancer

  • Takekazu Yamao

Abstract

The recent clinical outcome of treatment for early-stage gastric cancer is excellent in Japan; the 5 year survival rate is more than 90% in patients with stage I disease and 70% in patients with stage II disease. The prognosis of patients with advanced disease (e.g., stage III or IV) remains poor even after complete surgical resection. With such advanced disease, the survival benefit from conventional strategies such as extended surgery with or without postoperative chemotherapy is likely to be limited in consideration of the disappointing results obtained with postoperative adjuvant chemotherapy. A meta-analysis performed by Hermans et al., which analyzed 14 prospective randomized adjuvant trials including 2096 patients, has failed to reveal a consistent beneficiai effect [1].The analysis was later repeated and published in a letter to the editor in response to suggestions that additional trials should be included [2]. The final odds ratio decreased from 0.88 to 0.67, indicating a possible survival benefit from adjuvant chemotherapy. Although encouraging, it is clear that more definitive trials are necessary to test the efficacy of postoperative adjuvant chemotherapy for high-risk patients.

Keywords

Gastric Cancer Advanced Gastric Cancer Preoperative Chemotherapy Unresectable Disease Peritoneal Recurrence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Hermans J, Bonenkamp JJ, Boon MC, Bunt AM, Ohyama S, Sasako M, Van de Velde CJ (1993) Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 11:1441–1447PubMedGoogle Scholar
  2. 2.
    Hermans J, Bonenkamp JJ (1994) Meta-analysis of adjuvant therapy in gastric cancer: in reply. J Clin Oncol 12: 879–880Google Scholar
  3. 3.
    Fisher B, Gunduz N, Saffer EA (1983) Influence of the interval between primary tumor removal and chemotherapy on kinetics and growth of metastases. Cancer Res 43:1488–1492PubMedGoogle Scholar
  4. 4.
    Gunduz N, Fisher B, Saffer EA (1979) Effect of surgical removal on the growth and kinetics of residual tumor. Cancer Res 39:3861–3865PubMedGoogle Scholar
  5. 5.
    O’Reilly MS, Holmgren L, Shing Y, Chen C, Rosenthal RA, Cao Y, Moses M, Lane WS, Sage EH, Folkman J (1994) Angiostatin: a circulating endothelial cell inhibitor that suppresses angiogenesis and tumor growth. Cold Spring Harbor Symp Quant Biol 59:471–482CrossRefGoogle Scholar
  6. 6.
    O’Reilly MS, Holmgren L, Chen C, Folkman J (1996) Angiostatin induces and sustains dormancy of human primary tumors in mice. Nat Med 2:689–692CrossRefGoogle Scholar
  7. 7.
    Goldie JH, Coldman AJ (1979) A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 63:1727–1733PubMedGoogle Scholar
  8. 8.
    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
  9. 9.
    Ajani JA, Mayer RJ, Ota DM, Steele GD, Evans D, Roh M, Sugarbaker DJ, Dumas P, Gray C, Vena DA, et al (1993) Preoperative and postoperative combination chemotherapy for potentially resectable gastric carcinoma. J Natl Cancer Inst 85:1839–1844PubMedCrossRefGoogle Scholar
  10. 10.
    Leichman L, Silberman H, Leichman CG, Spears CP, Ray M, Muggia FM, Kiyabu M, Radin R, Laine L, Stain S, et al (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
  11. 11.
    Kelsen D, Brennan M, Quan V, Saltz L, Huang Y, Klimstra D, Lauers G, Botet J, Lightdale C, Gerdes H, Schwartz G, Karpeh M (1996) Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracilcisplatin plus intravenous fluorouracil. J Clin Oncol 14:1818–1828PubMedGoogle Scholar
  12. 12.
    Preusser P, Wilke H, Achterrath W, Fink U, Lenaz L, Heinicke A, Meyer J, Meyer HJ, Buente H (1989) Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer. J Clin Oncol 7:1310–1317PubMedGoogle Scholar
  13. 13.
    Crookes P, Silberman H, Groshen S, Casagrande Y, Baranda J, Stain S, Laine L, Tan M, Leichman L, Leichman CG (1997) Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 79:1767–1775PubMedCrossRefGoogle Scholar
  14. 14.
    Wilke H, Preusser P, Fink U, Gunzer U, Meyer HJ, Meyer J, Siewert JR, Achterrath W, Lenaz L, Knipp H, et al (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
  15. 15.
    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
  16. 16.
    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-a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer 30A:1269–1275CrossRefGoogle Scholar
  17. 17.
    Fink U, Schuhmacher C, Stein HJ, Busch R, Feussner H, Dittler HJ, Helmberger A, Bottcher K, Siewert JR (1995) Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection. Br J Surg 82:1248–1252PubMedCrossRefGoogle Scholar
  18. 18.
    Yonemura Y, Sawa T, Kinoshita K, Matsuki N, Fushida S, Tanaka S, Ohoyama S, Takashima T, Kimura H, Kamata T, et al (1993) Neoadjuvant chemotherapy for high-grade advanced gastric cancer. World J Surg 17:256–261PubMedCrossRefGoogle Scholar
  19. 19.
    Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M, Ohashi Y, Yanagisawa A (1997) Combined intensive chemotherapy and radical surgery for incurable gastric cancer. Ann Surg Oncol 4:203–208PubMedCrossRefGoogle Scholar
  20. 20.
    Wils J (1996) The treatment of advanced gastric cancer. Semin Oncol 23:397–406PubMedGoogle Scholar
  21. 21.
    Seike K, Ohtsu A, Toshida S, Kinoshita T, Ono M, Koizumi W, Miyata Y, Shirao K, Shimada Y, Kurihara M (1998) Efficacy of surgery after successful chemotherapy for advanced gastric cancer. Int J Clin Oncol 3:159–164CrossRefGoogle Scholar
  22. 22.
    Hagiwara A, Takahashi T, Kojima O, Sawai K, Yamaguchi T, Yamane T, Taniguchi H, Kitamura K, Noguchi A, Seiki K, et al (1992) Prophylaxis with carbon-adsorbed mitomycin against peritoneal recurrence of gastric cancer. Lancet 14:629–631CrossRefGoogle Scholar
  23. 23.
    Schiessel R, Funovics J, Schick B, Bohmig HJ, Depisch D, Hofbauer F, Jakesz R (1989) Adjuvant intraperitoneal cisplatin therapy in patients with operated gastric carcinoma: results of a randomized trial. Acta Med Austriaca 16:68–69PubMedGoogle Scholar
  24. 24.
    Sautner T, Hofbauer F, Depisch D, Schiessel R, Jakesz R (1994) Adjuvant intraperitoneal cisplatin chemotherapy does not improve long-term survival after surgery for advanced gastric cancer. J Clin Oncol 12:970–974PubMedGoogle Scholar

Copyright information

© Springer Japan 1999

Authors and Affiliations

  • Takekazu Yamao
    • 1
  1. 1.Department of MedicineCancer Institute HospitalTokyoJapan

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