Skip to main content
SpringerLink
Log in

Neoadjuvant Treatment for Resectable Locally Advanced Gastric Cancer

  • Chapter
Surgery in the Multimodal Management of Gastric Cancer

Abstract

This chapter briefly reviews recent developments in pre-operative therapies for gastric carcinoma, stressing their safety and efficacy. The data and studies discussed in the following were obtained from PubMed, using the search terms “pre-operative chemotherapy,” “pre-operative radiotherapy,” “pre-operative chemoradiotherapy,” “neoadjuvant treatment,” and “gastric cancer.” Only papers published in English from January 1970 through January 2010 were taken into consideration. Studies conducted over the last 20 years have progressed from the first “pioneering” chemotherapies for patients with non-resectable disease (“induction” therapy) to the most recent phase III trials on “neoadjuvant” therapies for resectable gastric neoplasms. There have also been several clinical trials examining pre-operative chemotherapy in the management of gastric cancer. While further evidence on the definitive role of neoadjuvant therapy is still needed, the most recent results of treatment using a multimodal approach to gastric adenocarcinoma are encouraging. In fact, most pre-operative multimodal regimens increase the likelihood that postponed tumor resection can still fulfill all the requirements of a true R0 resection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  PubMed  Google Scholar 

  2. Kubota H, Kotoh T, Masunaga R, et al (2000) Impact of screening survey of gastric cancer on clinicopathological features and survival: retrospective study at a single institution. Surgery 128:41–47

    Article  PubMed  CAS  Google Scholar 

  3. Hundahl SA, Phillips JL, Menck HR (2000) The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer 88:921–932

    Article  PubMed  CAS  Google Scholar 

  4. Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730

    Article  PubMed  CAS  Google Scholar 

  5. Sakuramoto S, Sasako M, Yamaguchi T et al (2007) ACTSGC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  PubMed  CAS  Google Scholar 

  6. Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

    Article  PubMed  CAS  Google Scholar 

  7. D’Ugo D, Rausei S, Biondi A et al (2009) Preoperative treatment and surgery in gastric cancer: friends or foes? Lancet Oncol 10:191–195

    Article  PubMed  Google Scholar 

  8. August DA, Gannon C (2010) Guest editorial: Neoadjuvant therapy, predictors of response, and patient outcomes. J Surg Oncol 102:107–108

    Article  PubMed  Google Scholar 

  9. Wilke H, Preusser P, Fink U et al (1989) Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin and cisplatin. J Clin Oncol 7:1318–1326

    PubMed  CAS  Google Scholar 

  10. Plukker JT, Mulder NH, Sleijfer DTH et al (1991) Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: phase II study with methotrexate and 5-fl uorouracil. Br J Surg 78:955–958

    Article  PubMed  CAS  Google Scholar 

  11. Rougier P, Mahjoubi M, Lasser P 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 30:1269–1275

    Article  Google Scholar 

  12. Kelsen D, Karpeh M, Schwartz G et al (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

    PubMed  CAS  Google Scholar 

  13. Melcher AA, Mort D, Maughan TS (1996) Epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF) as neoadjuvant chemotherapy in gastro-oesophageal cancer. Br J Cancer 74:1651–1654

    Article  PubMed  CAS  Google Scholar 

  14. Gallardo-Rincon D, Onate-Ocana LF, Calderillo-Ruiz G (2000) Neoadjuvant chemotherapy with P-ELF (cisplatin, etoposide, leucovorin, 5-fluorouracil) followed by radical resection in patients with initially unresectable gastric adenocarcinoma: a phase II study. Ann Surg Oncol 7:45–50

    Article  PubMed  CAS  Google Scholar 

  15. Cascinu S, Scartozzi M, Labianca R, et al (2004) Italian Group for the Study of Digestive Tract Cancer (GISCAD). High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer (GISCAD). Br J Cancer 90:1521–1525

    Article  PubMed  CAS  Google Scholar 

  16. Ajani JA, Ota DM, Jessup JM et al (1991) Resectable gastric carcinoma: an evaluation of preoperative and postoperative chemotherapy. Cancer 68:1501–1506

    Article  PubMed  CAS  Google Scholar 

  17. Leichman L, Silberman H, Leichman CG 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 10:1933–1942

    PubMed  CAS  Google Scholar 

  18. Kang YK, Choi DW, Kim CW et al (1992) The effect of neoadjuvant chemotherapy on the surgical outcome of locally advanced gastric adenocarcinoma: interim report of a randomized controlled trial. Proc Am Soc Clin Oncol 11:173

    Google Scholar 

  19. Ajani JA, Mayer RJ, Ota DM et al (1993) Preoperative and postoperative chemotherapy for patients with potentially resectable gastric carcinoma. J Natl Cancer Inst 85: 1839–1844

    Article  PubMed  CAS  Google Scholar 

  20. Rougier P, Lasser P, Ducreux M et al (1994) Preoperative chemotherapy of locally advanced gastric cancer. Ann Oncol 5:59–68

    PubMed  Google Scholar 

  21. Kelsen D, Karpeh M, Schwartz G et al (1996) Neoadjuvant therapy of highrisk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluorouracil-cisplatin plus intravenous fl uorouracil. J Clin Oncol 14:1818–1828

    PubMed  CAS  Google Scholar 

  22. Crookes P, Leichman CG, Leichman L et al (1997) Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 79:1767–1775

    Article  PubMed  CAS  Google Scholar 

  23. Songun I, Keizer HJ, Hermans J et al (1999) Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTX trial. Eur J Cancer 35:558–562

    Article  PubMed  CAS  Google Scholar 

  24. Schuhmacher CP, Fink U, Becker K et al (2001) Neoadjuvant therapy for patients with locally advanced gastric carcinoma with etoposide, doxorubicin, and cisplatinum: closing results after 5 years of follow-up. Cancer 91:918–927

    Article  PubMed  CAS  Google Scholar 

  25. D’Ugo D, Persiani R, Rausei S et al (2006) Response to neoadjuvant chemotherapy and effects of tumor regression in gastric cancer. Eur J Surg Oncol 32:1105–1109

    Article  PubMed  Google Scholar 

  26. Boige V, Pignon J, Saint-Aubert B et al (2007) Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol ASCO Annual Meeting Proceedings 2007:4510

    Google Scholar 

  27. Schuhmacher C, Schlag P, Lordick F et al (2009) Neoadjuvant chemotherapy versus surgery alone for locally advanced adenocarcinoma of the stomach and cardia: Randomized EORTC phase III trial #40954. J Clin Oncol ASCO Annual Meeting Proceedings 2009:4510

    Google Scholar 

  28. Kinoshita T, Sasako M, Sano T et al (2009) Phase II trial of S-1 for neoadjuvant chemotherapy against scirrhous gastric cancer (JCOG 0002). Gastric Cancer 12:37–42

    Article  PubMed  CAS  Google Scholar 

  29. Biffi R, Fazio N, Luca F et al (2010) Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locallyadvanced gastric cancer. World J Gastroenterol 16:868–874

    PubMed  CAS  Google Scholar 

  30. Hartgrink HH, van de Velde CJ, Putter H et al (2004) Cooperating Investigators of The Dutch Gastric Cancer Group. Neoadjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30:643–649

    Article  PubMed  CAS  Google Scholar 

  31. Zhang ZX, Gu XZ, Yin WB et al (1998) Randomized clinical trial of the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of the gastric cardia (AGC)-report on 370 patients. Int J Radiat Oncol Biol Phys 42:929–934

    Article  PubMed  CAS  Google Scholar 

  32. Shchepotin IB, Evans SR, Chorny V et al (1994) Intensive preoperative radiotherapy with local hyperthermia for the treatment of gastric carcinoma. Surg Oncol 3:37–44

    Article  PubMed  CAS  Google Scholar 

  33. Skoropad V, Berdov B, Zagrebin V (2002) Concentrated preoperative radiotherapy for resectable gastric cancer: 20-years follow-up of a randomized trial. J Surg Oncol 80:72–78

    Article  PubMed  Google Scholar 

  34. Fiorica F, Cartei F, Enea M et al (2007) The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data. Cancer Treat Rev 33:729–740

    Article  PubMed  Google Scholar 

  35. Safran H, King TP, Choy H et al (1997) Paclitaxel and concurrent radiation for locally advanced pancreatic and gastric cancer: a phase I study. J Clin Oncol 15:901–907

    PubMed  CAS  Google Scholar 

  36. Lowy AM, Feig BW, Janjan N et al (2001) A pilot study of preoperative chemoradiotherapy for resectable gastric cancer. Ann Surg Oncol 8:519–524

    Article  PubMed  CAS  Google Scholar 

  37. Ajani JA, Mansfield PF, Janjan N et al (2004) Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric cancer. J Clin Oncol 22:2774–2780

    Article  PubMed  CAS  Google Scholar 

  38. Ajani JA, Mansfield PF, Crane CH et al (2005) Paclitaxelbased chemoradiotherapy in localized gastric carcinoma: Degree of pathologic response and not clinical parameters dictated patient outcome. J Clin Oncol 23:1237–1244

    Article  PubMed  CAS  Google Scholar 

  39. Allal AS, Zwahlen D, Brundler MA et al Neoadjuvant radiochemotherapy for locally advanced gastric cancer: Longterm results of a phase I trial. Int J Radiat Oncol Biol Phys 63:1286–1289

    Google Scholar 

  40. Ajani JA, Winter K, Okawara GS et al (2006) Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904) Quality of combined modality therapy and pathologic response. J Clin Oncol 24: 3953–3958

    Article  PubMed  CAS  Google Scholar 

  41. Lowy AM, Mansfield PF, Leach SD et al (1999) Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg 229:303–308

    Article  PubMed  CAS  Google Scholar 

  42. Persiani R, Rausei S, Biondi A et al (2009) Perioperative chemotherapy for gastric cancer: how should we measure the efficacy? Ann Surg Oncol 16:1077–1079

    Article  PubMed  Google Scholar 

  43. Becker K, Mueller JD, Schuhmacher C et al (2003) Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 98:1521–1530

    Article  PubMed  Google Scholar 

  44. Ott K, Lordick F, Herrmann K et al (2008) The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies. Gastric Cancer 11:1–9

    Article  PubMed  Google Scholar 

  45. Vallböhmer D, Hölscher AH, Schneider PM et al (2010) 18F]-fluorodeoxyglucose-positron emission tomography for the assessment of histopathologic response and prognosis after completion of neoadjuvant chemotherapy in gastric cancer. J Surg Oncol 102:135–140

    Article  PubMed  Google Scholar 

  46. Mezhir JJ, Tang LH, Coit DG (2010) Neoadjuvant therapy of locally advanced gastric cancer. J Surg Oncol 101:305–314

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Surgery, General Surgery Unit, Catholic University of Rome, “A. Gemelli” Hospital, Rome, Italy

    Domenico D’Ugo

Authors
  1. Domenico D’Ugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Biondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ferdinando Cananzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dept. of Surgery Upper G.I. Surgery Division, University of Verona, Verona, Italy

    Giovanni de Manzoni

  2. Dept. of Human Pathology and Oncology Section of General Surgery and Surgical Oncology Translational Research Laboratory, University of Siena, Siena, Italy

    Franco Roviello

  3. Surgical Clinic, Dept. of Medical and Surgical Sciences “Ospedali Riuniti” University Hospital, Polytechnic University of Marche, Ancona, Italy

    Walter Siquini

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

D’Ugo, D., Biondi, A., Cananzi, F. (2012). Neoadjuvant Treatment for Resectable Locally Advanced Gastric Cancer. In: de Manzoni, G., Roviello, F., Siquini, W. (eds) Surgery in the Multimodal Management of Gastric Cancer. Springer, Milano. https://doi.org/10.1007/978-88-470-2318-5_21

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2318-5_21

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2317-8

  • Online ISBN: 978-88-470-2318-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation