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Balmaceda NB, Kim SS. Evolving Strategies in the Management of Microsatellite Instability-High/Mismatch Repair Deficient Esophagogastric Adenocarcinoma. Curr Oncol Rep 2025; 27:81-94. [PMID: 39832053 DOI: 10.1007/s11912-024-01624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2024] [Indexed: 01/22/2025]
Abstract
PURPOSE OF REVIEW This review addresses the current treatment paradigm and new advancements in the management of microsatellite instability-high/mismatch repair deficient (MSI-H/dMMR) esophagogastric cancer (EGC). RECENT FINDINGS While chemotherapy and surgery remain the cornerstone of EGC treatment, MSI-H/dMMR tumors harbor high tumor mutational burden and represent a subset of patients who benefit from immune checkpoint inhibitors (ICI). ICI has been incorporated in the front line setting with and without chemotherapy for advanced disease. Recently, ICI has been studied in the perioperative setting for resectable disease. Though perioperative ICI results in improved response rates, it is not yet clear whether this translates to a survival benefit. Despite high response rates with ICI in this patient population, many do not respond to therapy, representing a major challenge in treatment. Preclinical studies have highlighted potential mechanisms of resistance which will guide drug development and clinical trials.
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Affiliation(s)
- Nicole Baranda Balmaceda
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunnie S Kim
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Zhan T, Betge J, Schulte N, Dreikhausen L, Hirth M, Li M, Weidner P, Leipertz A, Teufel A, Ebert MP. Digestive cancers: mechanisms, therapeutics and management. Signal Transduct Target Ther 2025; 10:24. [PMID: 39809756 PMCID: PMC11733248 DOI: 10.1038/s41392-024-02097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 10/20/2024] [Accepted: 11/29/2024] [Indexed: 01/16/2025] Open
Abstract
Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.
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Affiliation(s)
- Tianzuo Zhan
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Johannes Betge
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Junior Clinical Cooperation Unit Translational Gastrointestinal Oncology and Preclinical Models, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nadine Schulte
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena Dreikhausen
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Michael Hirth
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Moying Li
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philip Weidner
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Antonia Leipertz
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Teufel
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthias P Ebert
- Department of Medicine II, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- DKFZ Hector Cancer Institute at University Medical Center Mannheim, Mannheim, Germany.
- Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Molecular Medicine Partnership Unit, European Molecular Biology Laboratory, Heidelberg, Germany.
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Leong T, Smithers BM, Michael M, Haustermans K, Wong R, Gebski V, O'Connell RL, Zalcberg J, Boussioutas A, Findlay M, Willis D, Moore A, Murray WK, Lordick F, O'Callaghan C, Swallow C, Darling G, Miller D, Strickland A, Liberman M, Mineur L, Simes J. Preoperative Chemoradiotherapy for Resectable Gastric Cancer. N Engl J Med 2024; 391:1810-1821. [PMID: 39282905 DOI: 10.1056/nejmoa2405195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
BACKGROUND In Western countries, the current standard of care for resectable gastric cancer is perioperative chemotherapy. Preoperative chemoradiotherapy has been considered, but data are limited regarding this treatment as compared with perioperative chemotherapy alone. METHODS We conducted an international, phase 3 trial in which patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to receive preoperative chemoradiotherapy plus perioperative chemotherapy or perioperative chemotherapy alone (control). In both groups, patients received either epirubicin, cisplatin, and fluorouracil or fluorouracil, leucovorin, oxaliplatin, and docetaxel both before and after surgery; the preoperative-chemoradiotherapy group also received chemoradiotherapy (45 Gy in 25 fractions of radiation, plus fluorouracil infusion). The primary end point was overall survival, and secondary end points included progression-free survival, pathological complete response, toxic effects, and quality of life. RESULTS A total of 574 patients underwent randomization at 70 sites in Australasia, Canada, and Europe: 286 to the preoperative-chemoradiotherapy group and 288 to the perioperative-chemotherapy group. A higher percentage of patients in the preoperative-chemoradiotherapy group than in the perioperative-chemotherapy group had a pathological complete response (17% vs. 8%) and greater tumor downstaging after resection. At a median follow-up of 67 months, no significant between-group differences in overall survival or progression-free survival were noted. The median overall survival was 46 months with preoperative chemoradiotherapy and 49 months with perioperative chemotherapy (hazard ratio for death, 1.05; 95% confidence interval, 0.83 to 1.31), and the median progression-free survival was 31 months and 32 months, respectively. Treatment-related toxic effects were similar in the two groups. CONCLUSIONS The addition of preoperative chemoradiotherapy to perioperative chemotherapy did not improve overall survival as compared with perioperative chemotherapy alone among patients with resectable gastric and gastroesophageal junction adenocarcinoma. (Funded by the National Health and Medical Research Council and others; TOPGEAR ClinicalTrials.gov number, NCT01924819.).
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Affiliation(s)
- Trevor Leong
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - B Mark Smithers
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Michael Michael
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Karin Haustermans
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Rebecca Wong
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Val Gebski
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Rachel L O'Connell
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - John Zalcberg
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Alex Boussioutas
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Michael Findlay
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - David Willis
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Alisha Moore
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - William K Murray
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Florian Lordick
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Chris O'Callaghan
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Carol Swallow
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Gail Darling
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Danielle Miller
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Andrew Strickland
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Moishe Liberman
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - Laurent Mineur
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
| | - John Simes
- From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.)
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Wong R, Anderson B, Bashir B, Bateman J, Chalchal H, Davies J, Dehmoobed A, Geller G, Ghose A, Gill S, Gordon V, Green S, Hebbard P, Iqbal M, Ji S, Karachiwala H, Kidane B, Kim C, Kosyachkova E, Krahn M, Krishnan T, Kristjanson M, Lee S, Lee-Ying R, Lelond S, Liu HW, Meyers D, Mulder K, Paul J, Planincic E. Report from the 25th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Gastric and Gastroesophageal Cancers, Winnipeg, Manitoba, 26-27 October 2023. Curr Oncol 2024; 31:5987-6006. [PMID: 39451751 PMCID: PMC11505746 DOI: 10.3390/curroncol31100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 09/20/2024] [Accepted: 09/21/2024] [Indexed: 10/26/2024] Open
Abstract
The 25th Annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Winnipeg, Manitoba, on 26-27 October 2023. The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; oncology nurses; pharmacists; and a family physician in oncology (FPO) participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of gastroesophageal cancers.
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Affiliation(s)
- Ralph Wong
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Brady Anderson
- Western Manitoba Cancer Center, Brandon, MB R7A 5M8, Canada;
| | - Bashir Bashir
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | | | - Haji Chalchal
- Allan Blair Cancer Centre, Regina, SK S4T 7T1, Canada;
| | - Janine Davies
- BC Cancer Centre, Vancouver, BC V5Z 4E6, Canada; (J.D.); (S.G.); (T.K.)
| | - Anahita Dehmoobed
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | | | - Abhijit Ghose
- Chinook Regional Hospital, Lethbridge, AB T1J 1W5, Canada
| | - Sharlene Gill
- BC Cancer Centre, Vancouver, BC V5Z 4E6, Canada; (J.D.); (S.G.); (T.K.)
| | - Vallerie Gordon
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Susan Green
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Pamela Hebbard
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | | | - Shuying Ji
- Shared Health Manitoba, Winnipeg, MB R2N 0E2, Canada;
| | - Hatim Karachiwala
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; (H.K.); (R.L.-Y.)
| | - Biniam Kidane
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A 1R9, Canada;
| | - Christina Kim
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | | | - Marianne Krahn
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Tharani Krishnan
- BC Cancer Centre, Vancouver, BC V5Z 4E6, Canada; (J.D.); (S.G.); (T.K.)
| | - Mark Kristjanson
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Sangjune Lee
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada;
| | - Richard Lee-Ying
- Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; (H.K.); (R.L.-Y.)
| | - Stephanie Lelond
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Hong-Wei Liu
- Central Alberta Cancer Center, Red Deer, AB T4N 6R2, Canada;
| | - Daniel Meyers
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Karen Mulder
- Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada;
| | - James Paul
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
| | - Elvira Planincic
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (B.B.); (A.D.); (V.G.); (S.G.); (P.H.); (M.K.); (M.K.); (S.L.); (D.M.); (E.P.); (J.P.)
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Janiczek-Polewska M, Kolenda T, Poter P, Kozłowska-Masłoń J, Jagiełło I, Regulska K, Malicki J, Marszałek A. Diagnostic Potential of miR-143-5p, miR-143-3p, miR-551b-5p, and miR-574-3p in Chemoresistance of Locally Advanced Gastric Cancer: A Preliminary Study. Int J Mol Sci 2024; 25:8057. [PMID: 39125625 PMCID: PMC11311514 DOI: 10.3390/ijms25158057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Gastric cancer (GC) is one of the most frequently diagnosed cancers in the world. Although the incidence is decreasing in developed countries, the treatment results are still unsatisfactory. The standard treatment for locally advanced gastric cancer (LAGC) is gastrectomy with perioperative chemotherapy. The association of selected microRNAs (miRNAs) with chemoresistance was assessed using archival material of patients with LAGC. Histological material was obtained from each patient via a biopsy performed during gastroscopy and then after surgery, which was preceded by four cycles of neoadjuvant chemotherapy (NAC) according to the FLOT or FLO regimen. The expression of selected miRNAs in the tissue material was assessed, including miRNA-21-3p, miRNA-21-5p, miRNA-106a-5p, miRNA-122-3p, miRNA-122-5p, miRNA-143-3p, miRNA-143-5p, miRNA-203a-3p, miRNA-203-5p, miRNA-551b-3p, miRNA-551b-5p, and miRNA-574-3p. miRNA expression was assessed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). The response to NAC was assessed using computed tomography of the abdomen and chest and histopathology after gastrectomy. The statistical analyses were performed using GraphPad Prism 9. The significance limit was set at p < 0.05. We showed that the expression of miR-143-3p, miR-143-5p, and miR-574-3p before surgery, and miR-143-5p and miR-574-3p after surgery, decreased in patients with GC. The expression of miR-143-3p, miR-143-5p, miR-203a-3p, and miR-551b-5p decreased in several patients who responded to NAC. The miRNA most commonly expressed in these cases was miRNA-551b-5p. Moreover, it showed expression in a patient whose response to chemotherapy was inconsistent between the histopathological results and computed tomography. The expression of miR-143-3p, miR-143-5p, miR-203a-3p, and miR-551b-5p in formalin-fixed paraffin-embedded tissue (FFPET) samples can help differentiate between the responders and non-responders to NAC in LAGC. miR-143-3p, miR-143-5p, and miR-574-3p expression may be used as a potential diagnostic tool in GC patients. The presence of miR-551b-5p may support the correct assessment of a response to NAC in GC via CT.
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Affiliation(s)
- Marlena Janiczek-Polewska
- Department of Clinical Oncology, Greater Poland Cancer Centre, 61-866 Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Tomasz Kolenda
- Laboratory of Cancer Genetics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
- Research and Implementation Unit, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Paulina Poter
- Department of Clinical Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Joanna Kozłowska-Masłoń
- Laboratory of Cancer Genetics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
- Research and Implementation Unit, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, 61-614 Poznan, Poland
| | - Inga Jagiełło
- Department of Clinical Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Katarzyna Regulska
- Research and Implementation Unit, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
- Pharmacy, Greater Poland Cancer Centre, 61-866 Poznan, Poland
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, Collegium Pharmaceuticum, 60-806 Poznan, Poland
| | - Julian Malicki
- Department of Electroradiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Andrzej Marszałek
- Department of Clinical Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Centre, 61-866 Poznan, Poland
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Dawood T, Rashid YA, Khan SR, Jabbar AA, Zahir MN, Moosajee MS. Outcomes of locally advanced gastric and gastroesophageal adenocarcinoma cancers treated with neoadjuvant FLOT in a tertiary care hospital in Pakistan. Ecancermedicalscience 2024; 18:1705. [PMID: 39021541 PMCID: PMC11254397 DOI: 10.3332/ecancer.2024.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 07/20/2024] Open
Abstract
Background and aim Docetaxel, oxaliplatin, leucovorin and 5-fluorouracil (FLOT) may improve overall survival (OS) in patients with locally advanced gastric and gastroesophageal cancer. Our study aims to determine the pathological response in these patients with the FLOT chemotherapy in the Neoadjuvant setting. This is the first study conducted in our country. Methods We conducted a retrospective cross-sectional study from March 2018 to December 2020. After ethical review committee approval, all patients who fulfilled the inclusion criteria and received treatment at our tertiary care center were included in the study. SPSS version 22 was used for data analysis. Frequencies and percentages were calculated for categorical. Values were presented as mean ± standard deviation (SD) for continuous variables. The chi-square test was used to determine the difference between categorical variables. A p-value of ≤0.05 was considered the level of significance. Kaplan-Meier curves were used to calculate survival analysis. Results Out of 41, 35 patients with locally advanced resectable gastric or gastroesophageal adenocarcinoma were included in our study analysis. The entire cohort had a male predominance, with a mean age of 59. All patients received neoadjuvant FLOT. Pathological treatment response achieved was 77%, of which 66% had partial and 11% had complete response. There is a significant association of pathological response with age, gender, stage, grade, co-morbid and number of chemotherapy cycles received (p-value =<0.05). The OS was 80% with the mean OS was 2.6 years (31 months). Conclusion Our study shows comparable response rates to other studies conducted internationally. Our findings confirm that FLOT is an effective and well-tolerated perioperative regimen with reasonable response rates in the Pakistani population. A more extensive longitudinal study would ensure these preliminary results in the local patient population.
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Affiliation(s)
- Tasneem Dawood
- Department of Medical Oncology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Yasmin Abdul Rashid
- Department of Medical Oncology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Saqib Raza Khan
- Department of Medical Oncology, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Adnan Abdul Jabbar
- Department of Medical Oncology, Dr. Ziauddin Hospital, Karachi 74700, Pakistan
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Egebjerg K, Andersen TS, Bæksgaard L, Garbyal R, Siemsen M, Achiam M, Mau-Sørensen PM. Implementation of perioperative FLOT compared to ECX/EOX chemotherapy regimens in resectable esophagogastric adenocarcinomas: an analysis of real-world data. Acta Oncol 2024; 63:322-329. [PMID: 38745482 PMCID: PMC11332447 DOI: 10.2340/1651-226x.2024.35431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/16/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Perioperative 5-FU, leucovorin, oxaliplatin, and docetaxel (FLOT) is recommended in resectable esophagogastric adenocarcinoma based on randomised trials. However, the effectiveness of FLOT in routine clinical practice remains unknown as randomised trials are subject to selection bias limiting their generalisability. The aim of this study was to evaluate the implementation of FLOT in real-world patients. METHODS Retrospectively collected data were analysed in consecutive patients treated before or after the implementation of FLOT. The primary endpoint was complete pathological response (pCR) and secondary endpoints were margin-free resection (R0), overall survival (OS), relapse-free survival (RFS) tolerability of chemotherapy and surgical complications. RESULTS Mean follow-up time for patients treated with FLOT (n = 205) was 37.7 versus 47.0 months for epirubicin, cis- or oxaliplatin, and capecitabine (ECX/EOX, n = 186). Surgical resection was performed in 88.0% versus 92.0%; pCR were observed in 3.8% versus 2.4%; and R0 resections were achieved in 78.0% versus 86.0% (p = 0.03) in the ECX/EOX and FLOT cohorts, respectively. Survival analysis indicated no significant difference in RFS (p = 0.17) or OS (p = 0.37) between the cohorts with a trend towards increased OS in performance status 0 (hazard ratio [HR] = 0.73, 95% confidence interval [CI]: 0.50-1.04). More patients treated with ECX/EOX completed chemotherapy (39% vs. 28%, p = 0.02). Febrile neutropenia was more common in the FLOT cohort (3.8% vs. 11%, p = 0.0086). 90-days mortality (1.2% vs. 0%) and frequency of anastomotic leakage (8% vs. 6%) were equal and low. INTERPRETATION Patients receiving FLOT did not demonstrate improved pCR, RFS or OS. However, R0 rate was improved and patients in good PS trended towards improved OS.
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Affiliation(s)
- Kristian Egebjerg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Tobias Sørup Andersen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lene Bæksgaard
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. k
| | - Rajendra Garbyal
- Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mette Siemsen
- Department of Thoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michael Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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9
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Geerts JFM, van der Zijden CJ, van der Sluis PC, Spaander MCW, Nieuwenhuijzen GAP, Rosman C, van Laarhoven HWM, Verhoeven RHA, Wijnhoven BPL, Lagarde SM, Mostert B. Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT. Cancers (Basel) 2024; 16:1291. [PMID: 38610969 PMCID: PMC11011191 DOI: 10.3390/cancers16071291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The FLOT4-AIO trial (2019) showed improved survival with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) compared to anthracyclin triplets in gastric cancer treatment. It is unclear whether these results extend to real-world scenarios in the Netherlands. This study aimed to compare outcomes of perioperative FLOT to anthracyclin triplets in a real-world Dutch gastric cancer population. Methods: Patients diagnosed with resectable (cT2-4a/cTxN0-3/NxM0) gastric or gastro-esophageal junction carcinoma between 2015-2021 who received neoadjuvant FLOT or anthracyclin triplets were selected from the Netherlands Cancer Registry. The primary outcome was overall survival (OS), analyzed through multivariable Cox regression. Secondary outcomes included pathological complete response (pCR), neoadjuvant chemotherapy cycle completion, surgical resection rates, and adjuvant therapy. Results: Adjusted OS showed no significant survival benefit (HR = 0.88, 95% CI 0.77-1.01, p = 0.07), even though the median OS was numerically improved by 8 months with FLOT compared to anthracyclin triplets (48.1 vs. 39.9 months, p = 0.16). FLOT patients were more likely to undergo diagnostic staging laparoscopies (74.2% vs. 44.1%, p < 0.001), had higher rates of completing neoadjuvant chemotherapy (OR = 1.35, 95% CI 1.09-1.68, p = 0.007), receiving adjuvant therapy (OR = 1.34, 95% CI 1.08-1.66, p = 0.08), and achieving pCR (OR = 1.52, 95% CI 1.05-2.20, p = 0.03). No significant differences were observed in (radical) resection rates. Conclusion(s): Real-world data showed no significant OS improvement for FLOT-treated patients compared to anthracyclin triplets, despite more staging laparoscopies. However, FLOT patients demonstrated higher rates of neoadjuvant therapy completion, proceeding to adjuvant therapy, and increased pCR rates. Therefore, we recommend the continued use of neoadjuvant FLOT therapy in the current clinical setting.
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Affiliation(s)
- Julie F M Geerts
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | | | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1105 AZ Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1105 AZ Amsterdam, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), 3511 LC Utrecht, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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10
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Rawicz-Pruszyński K, Endo Y, Tsilimigras DI, Munir MM, Resende V, Kim A, Beane J, Pelc Z, Sędłak K, Pawlik TM. Neoadjuvant Chemotherapy Improves Oncological Outcomes and Long-Term Survival Among Elderly Patients with Locally Advanced Gastric Cancer: A Propensity Score Matched Analysis. Ann Surg Oncol 2024; 31:753-761. [PMID: 37985525 DOI: 10.1245/s10434-023-14569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION In the USA, approximately half of newly diagnosed patients with GC are 75 years or older. The objective of the current population-based study was to investigate the impact of neoadjuvant chemotherapy (NAC) on the outcomes of elderly patients with locally advanced GC. PATIENTS AND METHODS Patients aged > 75 years were identified from the National Cancer Database (NCDB). The primary outcome of the study was overall survival (OS). Secondary outcomes included lymph node (LN) harvest, surgical margin status, and 30-day mortality. To minimize the effect of selection bias on the assessed outcome between the two study groups (NAC versus no NAC), propensity score matching (PSM) was performed. RESULTS After PSM, a total of 1958 patients were included in both groups. NAC utilization increased from 2013 to 2019 (21% versus 42.7%, ptrend < 0.001). On pathologic analysis, patients who received NAC were more likely to have ≥ 16 LNs evaluated (NAC 60.1% versus no NAC 55.5%, p = 0.044) and negative resection margins (NAC 88.6% versus no NAC 83%, p = 0.001). Patients who received NAC were also less likely to experience 30-day mortality following resection (NAC 4.1% versus no NAC 7.1%). Receipt of NAC was associated with improved 1-year (73.9% versus 68.3%), 3-year (48.2% versus 43.5%), and 5-year OS (36.9% versus 30.5%) compared with patients who underwent upfront surgery (p = 0.01). CONCLUSIONS Receipt of NAC was associated with improved oncological outcomes among elderly patients undergoing resection for locally advanced GC.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Yutaka Endo
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Vivian Resende
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Alex Kim
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Joal Beane
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA.
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11
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Pugaev DM, Lyubchenko LN, Ryabov AB, Kaprin AD. Early-onset gasrtric cancer (review). SIBERIAN JOURNAL OF ONCOLOGY 2024; 22:153-171. [DOI: 10.21294/1814-4861-2023-22-6-153-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Objective. Early-onset gastric cancer (EOGC) constitutes a serious medical and social problem. Early-onset gastric cancer accounts for approximately 6% of all malignant epithelial neoplasms.Material and Methods. We reviewed retrospective and prospective randomized trials using Medline and Elibrary databases.Results. The applied significance of the molecular genetic classifications consist in the formation of groups for evaluating prognosis of the disease using multifactorial analysis. This classification indicates that EOGC diagnosed at a locally advanced stage and primary dissemination is most often caused by GS (TCGA) and MSS/EMT(ACRG) subtypes and is characterized by mutations in CDH1, RhoA, CLDN18-ARHGAP genes. These changes are accompanied by the prevalence of diffuse histological type of gastric cancer according to the Lauren classification and ulcerated or infiltrative type according to the Borrmann classification (type III and IV) with the presence of high-grade adenocarcinoma with a signet ring cell component.Conclusion. Considering the aggressiveness of gastric cancer in young patients, who more frequently present with locally advanced and metastatic disease at the time of diagnosis, there is a need for increased cancer alertness among physicians of other specialties, early endoscopic controls to detect cancer at early stages and benefit from both surgical and multimodal treatment.
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Affiliation(s)
- D. M. Pugaev
- Kommunarka Moscow Multidisciplinary Clinical Center, Moscow City Health Department
| | - L. N. Lyubchenko
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology – branch National Medical Research Radiological Centre of the Ministry of Health of the Russia;
National Medical Research Radiological Centre of the Ministry of Health of the Russia
| | - A. B. Ryabov
- P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia;
National Medical Research Radiological Centre of the Ministry of Health of the Russia
| | - A. D. Kaprin
- RUDN University;
P.A. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia;
National Medical Research Radiological Centre of the Ministry of Health of the Russia
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12
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Rawicz-Pruszyński K, Tsilimigras DI, Endo Y, Munir MM, Katayama E, Benavides JG, Sędłąk K, Pelc Z, Pawlik TM. Improved guideline compliance and textbook oncologic outcomes among patients undergoing multimodal treatment and minimally invasive surgery for locally advanced gastric cancer. J Gastrointest Surg 2024; 28:10-17. [PMID: 38353069 DOI: 10.1016/j.gassur.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC. METHODS In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively). CONCLUSIONS An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States; Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Jose Guevara Benavides
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Katarzyna Sędłąk
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Withey SJ, Owczarczyk K, Grzeda MT, Yip C, Deere H, Green M, Maisey N, Davies AR, Cook GJ, Goh V. Association of dynamic contrast-enhanced MRI and 18F-Fluorodeoxyglucose PET/CT parameters with neoadjuvant therapy response and survival in esophagogastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106934. [PMID: 37183047 PMCID: PMC10769883 DOI: 10.1016/j.ejso.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Better predictive markers are needed to deliver individualized care for patients with primary esophagogastric cancer. This exploratory study aimed to assess whether pre-treatment imaging parameters from dynamic contrast-enhanced MRI and 18F-fluorodeoxyglucose (18F-FDG) PET/CT are associated with response to neoadjuvant therapy or outcome. MATERIALS AND METHODS Following ethical approval and informed consent, prospective participants underwent dynamic contrast-enhanced MRI and 18F-FDG PET/CT prior to neoadjuvant chemotherapy/chemoradiotherapy ± surgery. Vascular dynamic contrast-enhanced MRI and metabolic 18F-FDG PET parameters were compared by tumor characteristics using Mann Whitney U test and with pathological response (Mandard tumor regression grade), recurrence-free and overall survival using logistic regression modelling, adjusting for predefined clinical variables. RESULTS 39 of 47 recruited participants (30 males; median age 65 years, IQR: 54, 72 years) were included in the final analysis. The tumor vascular-metabolic ratio was higher in patients remaining node positive following neoadjuvant therapy (median tumor peak enhancement/SUVmax ratio: 0.052 vs. 0.023, p = 0.02). In multivariable analysis adjusted for age, gender, pre-treatment tumor and nodal stage, peak enhancement (highest gadolinium concentration value prior to contrast washout) was associated with pathological tumor regression grade. The odds of response decreased by 5% for each 0.01 unit increase (OR 0.95; 95% CI: 0.90, 1.00, p = 0.04). No 18F-FDG PET/CT parameters were predictive of pathological tumor response. No relationships between pre-treatment imaging and survival were identified. CONCLUSION Pre-treatment esophagogastric tumor vascular and metabolic parameters may provide additional information in assessing response to neoadjuvant therapy.
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Affiliation(s)
- Samuel J Withey
- Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kasia Owczarczyk
- Department of Clinical Oncology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mariusz T Grzeda
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Connie Yip
- Department of Radiation Oncology, National Cancer Centre, Singapore
| | - Harriet Deere
- Department of Pathology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mike Green
- Department of Pathology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nick Maisey
- Department of Medical Oncology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew R Davies
- Department of Surgery, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gary J Cook
- School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; The King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, United Kingdom
| | - Vicky Goh
- Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
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Karim F, Amin A, Liu M, Vishnuvardhan N, Amin S, Shabbir R, Swed B, Khan U. Role of Checkpoint Inhibitors in the Management of Gastroesophageal Cancers. Cancers (Basel) 2023; 15:4099. [PMID: 37627127 PMCID: PMC10452271 DOI: 10.3390/cancers15164099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE This article reviews the essential clinical trials that have led to these immunotherapy approvals and explores the use of predictive biomarkers, such as PD-L1 expression and MSI status, to identify patients who are most likely to benefit from immunotherapies. METHODS This case review series describe findings from different clinical trials and contribute to the evolving understanding of the role of CPIs in managing advanced gastroesophageal cancers and may lead to improved treatment options and patient outcomes. Ongoing clinical trials also hold promise for expanding treatment options and improving patient outcomes in the future. METHODS The systematic review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol has not been registered. A systematic literature review was conducted to identify relevant clinical trials and studies that describe the role of immune checkpoint inhibitors in managing advanced gastroesophageal cancers. Electronic database (PubMed, Clinicaltrials.gov, Society of Immunotherapy of Cancer, Aliment Pharmacology & Therapeutics, BMC cancer, Molecular Cancer Research, Nature Reviews Molecular Cell Biology, American Association for Cancer Research, Science, Nature, Cancer Discovery, Journal of the National Cancer Institute, Advanced Immunology, Oncotarget, Nature Medicine, Nature Genetics, Gut, Pathology and Oncology Research, Journal of Clinical Oncology, The New England Journal of Medicine, Gastrointestinal oncology, JAMA Oncology, Journal of Gastrointestinal Oncology, Current Oncology, Annals of Oncology, The Lancet, JCO Oncology Practice, Future Oncology, Gastric Cancer, CA: A Cancer Journal for Clinicians, American Journal of Gastroenterology, Gastroenterology, Journal of the National Cancer Institute, International Journal of Epidemiology, Helicobacter, Gastroenterology Review) were searched using a combination of relevant keywords and MESH terms. The search encompassed articles published up to 5/2023. Additionally, manual searches of reference lists of selected articles and pertinent review papers were conducted to ensure comprehensive coverage of relevant studies. Studies were included if they provided insights into clinical trials evaluating the efficacy and safety of CPIs in treating advanced gastroesophageal cancers. Relevant case reviews and trials exploring combination therapies involving CPIs were also considered. Articles discussed in the utilization of predictive biomarkers were included to assess their impact on treatment outcomes. Data from selected studies were extracted to inform the narrative review. Key findings were summarized, including clinical trial designs, patient populations, treatment regimens, response rates, progression-free survival (PFS), overall survival (OS), and adverse events. The role of predictive biomarkers, particularly PD-L1 expression and MSI status, in identifying patients likely to benefit from CPIs was critically evaluated based on study results. Ongoing clinical trials investigating novel combination strategies and exploring the broader scope of CPIs in gastroesophageal cancers were also highlighted. The collected data were synthesized to provide a comprehensive overview of the crucial clinical trials that have contributed to the approval of CPIs for advanced gastroesophageal cancers. The role of CPIs in different lines of therapy, including first-line regimens, was discussed. Furthermore, the evolving landscape of predictive biomarkers was examined, emphasizing their potential significance in optimizing patient selection for CPI therapy. Ongoing clinical trials were reviewed to underscore the continuous efforts in expanding treatment options and improving patient outcomes in the future.
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Affiliation(s)
- Frederic Karim
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA; (A.A.); (M.L.); (S.A.); (R.S.)
| | - Adina Amin
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA; (A.A.); (M.L.); (S.A.); (R.S.)
| | - Marie Liu
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA; (A.A.); (M.L.); (S.A.); (R.S.)
| | - Nivetha Vishnuvardhan
- Hematology/Oncology, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA;
| | - Saif Amin
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA; (A.A.); (M.L.); (S.A.); (R.S.)
| | - Raffey Shabbir
- Internal Medicine, New York-Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA; (A.A.); (M.L.); (S.A.); (R.S.)
| | - Brandon Swed
- Hematology/Oncology, Weill Cornell Medicine, 515 6th Street, Brooklyn, NY 11215, USA; (B.S.); (U.K.)
| | - Uqba Khan
- Hematology/Oncology, Weill Cornell Medicine, 515 6th Street, Brooklyn, NY 11215, USA; (B.S.); (U.K.)
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Ubels S, Verstegen MHP, Klarenbeek BR, Bouwense S, van Berge Henegouwen MI, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Nieuwenhuijzen G, Polat F, Schouten J, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C. Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study. Br J Surg 2023; 110:852-863. [PMID: 37196149 PMCID: PMC10364505 DOI: 10.1093/bjs/znad123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Anastomotic leak is a severe complication after oesophagectomy. Anastomotic leak has diverse clinical manifestations and the optimal treatment strategy is unknown. The aim of this study was to assess the efficacy of treatment strategies for different manifestations of anastomotic leak after oesophagectomy. METHODS A retrospective cohort study was performed in 71 centres worldwide and included patients with anastomotic leak after oesophagectomy (2011-2019). Different primary treatment strategies were compared for three different anastomotic leak manifestations: interventional versus supportive-only treatment for local manifestations (that is no intrathoracic collections; well perfused conduit); drainage and defect closure versus drainage only for intrathoracic manifestations; and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis. The primary outcome was 90-day mortality. Propensity score matching was performed to adjust for confounders. RESULTS Of 1508 patients with anastomotic leak, 28.2 per cent (425 patients) had local manifestations, 36.3 per cent (548 patients) had intrathoracic manifestations, 9.6 per cent (145 patients) had conduit ischaemia/necrosis, 17.5 per cent (264 patients) were allocated after multiple imputation, and 8.4 per cent (126 patients) were excluded. After propensity score matching, no statistically significant differences in 90-day mortality were found regarding interventional versus supportive-only treatment for local manifestations (risk difference 3.2 per cent, 95 per cent c.i. -1.8 to 8.2 per cent), drainage and defect closure versus drainage only for intrathoracic manifestations (risk difference 5.8 per cent, 95 per cent c.i. -1.2 to 12.8 per cent), and oesophageal diversion versus continuity-preserving treatment for conduit ischaemia/necrosis (risk difference 0.1 per cent, 95 per cent c.i. -21.4 to 1.6 per cent). In general, less morbidity was found after less extensive primary treatment strategies. CONCLUSION Less extensive primary treatment of anastomotic leak was associated with less morbidity. A less extensive primary treatment approach may potentially be considered for anastomotic leak. Future studies are needed to confirm current findings and guide optimal treatment of anastomotic leak after oesophagectomy.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Moniek H P Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, The Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Willem Haveman
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Joos Heisterkamp
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Fatih Polat
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pritam Singh
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital, Guildford, UK
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Leongito M, Palaia R, Casaretti R, Tatangelo F, Foschini F, Di Mauro A, Belli A, Albino V. Role of shrinkage in esophageal-gastric junction cancer. Clin Case Rep 2023; 11:e6982. [PMID: 37312927 PMCID: PMC10258958 DOI: 10.1002/ccr3.6982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/15/2022] [Accepted: 02/05/2023] [Indexed: 06/15/2023] Open
Abstract
The esophagus undergoes shrinkage after resection and fixation. The surgical in situ margin is greater than the specimen margin, measured by the pathologist. The length of disease-free margins is critical to therapeutic planning. We propose specimen fixing to avoid discrepancies between the operative finding and the pathological result.
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Affiliation(s)
- Maddalena Leongito
- Chirurgia oncologica gastro‐pancreaticaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Raffaele Palaia
- Chirurgia oncologica gastro‐pancreaticaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Rossana Casaretti
- OncologiaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Fabiana Tatangelo
- Anatomia patologicaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Francesca Foschini
- OncologiaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Annabella Di Mauro
- Anatomia patologicaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Andrea Belli
- Chirurgia oncologica gastro‐pancreaticaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
| | - Vittorio Albino
- Chirurgia oncologica gastro‐pancreaticaIstituto Nazionale Tumori – IRCCS – Fondazione G. PascaleNapoliItaly
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17
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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18
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Ubels S, Matthée E, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen MI, Daams F, Dekker JWT, van Det MJ, van Esser S, Griffiths EA, Haveman JW, Nieuwenhuijzen G, Siersema PD, Wijnhoven B, Hannink G, van Workum F, Rosman C, Heisterkamp J, Polat F, Schouten J, Singh P, Eshuis WJ, Kalff MC, Feenstra ML, van der Peet DL, Stam WT, Van Etten B, Poelmann F, Vuurberg N, Willem van den Berg J, Martijnse IS, Matthijsen RM, Luyer M, Curvers W, Nieuwenhuijzen T, Taselaar AE, Kouwenhoven EA, Lubbers M, Sosef M, Lecot F, Geraedts TC, van den Wildenberg F, Kelder W, Lubbers M, Baas PC, de Haas JW, Hartgrink HH, Bahadoer RR, van Sandick JW, Hartemink KJ, Veenhof X, Stockmann H, Gorgec B, Weeder P, Wiezer MJ, Genders CM, Belt E, Blomberg B, van Duijvendijk P, Claassen L, Reetz D, Steenvoorde P, Mastboom W, Klein Ganseij HJ, van Dalsen AD, Joldersma A, Zwakman M, Groenendijk RP, Montazeri M, Mercer S, Knight B, van Boxel G, McGregor RJ, Skipworth RJ, Frattini C, Bradley A, Nilsson M, Hayami M, Huang B, Bundred J, Evans R, Grimminger PP, van der Sluis PC, Eren U, Saunders J, Theophilidou E, Khanzada Z, Elliott JA, Ponten J, King S, Reynolds JV, Sgromo B, Akbari K, Shalaby S, Gutschow CA, Schmidt H, Vetter D, Moorthy K, Ibrahim MA, Christodoulidis G, Räsänen JV, Kauppi J, Söderström H, Koshy R, Manatakis DK, Korkolis DP, Balalis D, Rompu A, Alkhaffaf B, Alasmar M, Arebi M, Piessen G, Nuytens F, Degisors S, Ahmed A, Boddy A, Gandhi S, Fashina O, Van Daele E, Pattyn P, Robb WB, Arumugasamy M, Al Azzawi M, Whooley J, Colak E, Aybar E, Sari AC, Uyanik MS, Ciftci AB, Sayyed R, Ayub B, Murtaza G, Saeed A, Ramesh P, Charalabopoulos A, Liakakos T, Schizas D, Baili E, Kapelouzou A, Valmasoni M, Pierobon ES, Capovilla G, Merigliano S, Constantinoiu S, Birla R, Achim F, Rosianu CG, Hoara P, Castro RG, Salcedo AF, Negoi I, Negoita VM, Ciubotaru C, Stoica B, Hostiuc S, Colucci N, Mönig SP, Wassmer CH, Meyer J, Takeda FR, Aissar Sallum RA, Ribeiro U, Cecconello I, Toledo E, Trugeda MS, Fernández MJ, Gil C, Castanedo S, Isik A, Kurnaz E, Videira JF, Peyroteo M, Canotilho R, Weindelmayer J, Giacopuzzi S, De Pasqual CA, Bruna M, Mingol F, Vaque J, Pérez C, Phillips AW, Chmelo J, Brown J, Koshy R, Han LE, Gossage JA, Davies AR, Baker CR, Kelly M, Saad M, Bernardi D, Bonavina L, Asti E, Riva C, Scaramuzzo R, Elhadi M, Ahmed HA, Elhadi A, Elnagar FA, Msherghi AA, Wills V, Campbell C, Cerdeira MP, Whiting S, Merrett N, Das A, Apostolou C, Lorenzo A, Sousa F, Barbosa JA, Devezas V, Barbosa E, Fernandes C, Smith G, Li EY, Bhimani N, Chan P, Kotecha K, Hii MW, Ward SM, Johnson M, Read M, Chong L, Hollands MJ, Allaway M, Richardson A, Johnston E, Chen AZ, Kanhere H, Prasad S, McQuillan P, Surman T, Trochsler M, Schofield W, Ahmed SK, Reid JL, Harris MC, Gananadha S, Farrant J, Rodrigues N, Fergusson J, Hindmarsh A, Afzal Z, Safranek P, Sujendran V, Rooney S, Loureiro C, Fernández SL, Díez del Val I, Jaunoo S, Kennedy L, Hussain A, Theodorou D, Triantafyllou T, Theodoropoulos C, Palyvou T, Elhadi M, Ben Taher FA, Ekheel M, Msherghi AA. Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:974-982. [PMID: 36732207 DOI: 10.1016/j.ejso.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences. METHODS TENTACLE - Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20-60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment. RESULTS FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2-0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5-1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4-1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5-1.4). CONCLUSION Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.
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Affiliation(s)
- Sander Ubels
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Eric Matthée
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Moniek Verstegen
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan Klarenbeek
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Bouwense
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group, Almelo, the Netherlands
| | - Stijn van Esser
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frans van Workum
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Fatih Polat
- Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jeroen Schouten
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pritam Singh
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Racz K, Legner A, Böhme F, Sebesta C. [Gastric cancer]. Wien Med Wochenschr 2023; 173:227-231. [PMID: 37071301 DOI: 10.1007/s10354-023-01011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
Gastric cancers are relativ commonly cancer types. The therapy options have changed in the last years as well in the surgery as in the oncology, it is worth to look at the etiology, diagnosis and therapy.
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Affiliation(s)
- Krisztina Racz
- 2. Medizinische Abteilung, Klinik Donaustadt, Donaustadt, Österreich.
| | - Andras Legner
- Chirurgische Abteilung, Klinik Donaustadt, Donaustadt, Österreich
| | - Felix Böhme
- 2. Medizinische Abteilung, Klinik Donaustadt, Donaustadt, Österreich
| | - Christian Sebesta
- 2. Medizinische Abteilung, Klinik Donaustadt, Donaustadt, Österreich
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Hingorani M, Goody R, Bozas G, Zahid K, Mitton DJ, Jain P, Wong V, Roy R. Neoadjuvant Management of Adenocarcinoma of the Esophagus and Esophagogastric Junction: Review of Randomized Evidence and Definition of Optimum Treatment Algorithm. Oncology 2023; 101:553-564. [PMID: 37015204 DOI: 10.1159/000527716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/13/2022] [Indexed: 04/06/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (nCT) or chemoradiotherapy (nCRT) are accepted standards of care for the management of adenocarcinoma of the esophagus and gastroesophageal junction. SUMMARY The MRC-OEO2 study established the role of 2 cycles of neoadjuvant cisplatin/fluoropyrimidine. More recently, the FLOT-AIO4 study demonstrated the superiority of perioperative FLOT chemotherapy (5FU, oxaliplatin, and docetaxel) compared to ECX (epirubicin, cisplatin, and capecitabine) regime. The results from the pivotal CROSS study established neoadjuvant CRT as a new standard of care in OG cancer. The survival benefits observed in FLOT and CROSS studies are similar [FLOT - hazard ratio 0.75 (0.62-0.92); CROSS - 0.741 (0.55-0.98)]. KEY MESSAGES Both nCT and nCRT have been shown to be associated with survival benefit compared to surgery alone. We have performed a comprehensive review of the available evidence to define the optimum treatment algorithm and identify specific patient sub-groups who may be appropriate for the use of one or more of these neoadjuvant options.
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Affiliation(s)
- Mohan Hingorani
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
| | - Rebecca Goody
- Bexley Institute of Oncology, St James University Teaching Hospitals, Leeds, UK
| | - Georgios Bozas
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
| | - Khwaja Zahid
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
| | | | - Prashant Jain
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
| | - Vincent Wong
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
| | - Rajarshi Roy
- Queen Centre of Oncology, Castle Hill Hospital, Cottingham, UK
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21
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Boyer C, Sefrioui D, Cohen R, Chautard R, Perrier M, Lebrun H, Goujon G, Hautefeuille V, Dior M, Walter T, Mary F, Manfredi S, Caroli-Bosc FX, Cervantes B, Coriat R, Deluche E, Zaanan A, Olivier R, Bouché O, Piessen G, Lecomte T, Louvet C, Michel P, Aparicio T, André T, Taieb J, Randrian V, Tougeron D. Prognosis and chemosensitivity of non-colorectal alimentary tract cancers with microsatellite instability. Dig Liver Dis 2023; 55:123-130. [PMID: 35397988 DOI: 10.1016/j.dld.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Data on outcomes of microsatellite instable and/or mismatch repair deficient (dMMR/MSI) digestive non-colorectal tumors are limited. AIMS To evaluate overall survival (OS) of patients with dMMR/MSI digestive non-colorectal tumor. METHODS All consecutive patients with a dMMR/MSI digestive non-colorectal tumor were included in this French retrospective multicenter study. RESULTS One hundred and sixteen patients were included with a mean age of 63.6 years and 32.6% with a Lynch syndrome. Most tumors were oesophago-gastric (54.3%) or small bowel (32.8%) adenocarcinomas and at a localized stage at diagnosis (86.7%). In patients with localized tumors and R0 resection, median OS was 134.0 ± 64.2 months. Median disease-free survival (DFS) was 100.3 ± 65.7 months. Considering oesophago-gastric tumors, median DFS was improved when chemotherapy was added to surgery (not reached versus 22.8 ± 10.0 months, p = 0.03). In patients with advanced tumors treated by chemotherapy, median OS was 14.2 ± 1.9 months and median progression-free survival was 7.4 ± 1.6 months. CONCLUSION dMMR/MSI digestive non-colorectal tumors are mostly diagnosed at a non-metastatic stage with a good prognosis. Advanced dMMR/MSI digestive non-colorectal tumors have a poor prognosis with standard chemotherapy.
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Affiliation(s)
- Claire Boyer
- Hepato-Gastroenterology Department, Poitiers University Hospital, University of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - David Sefrioui
- Department of Hepatogastroenterology, Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Rouen 76000, France
| | - Romain Cohen
- Medical Oncology Department, Assistance Publique-Hôpitaux de Pari, Saint Antoine Hospital, Sorbonne University, Paris 75012, France
| | - Romain Chautard
- Department of Hepato-Gastroenterology and Digestive Oncology, Tours University hospital, Tours 37000, France
| | - Marine Perrier
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims 51000, France
| | - Hugo Lebrun
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille University, Lille 59000, France
| | - Gael Goujon
- Gastroenterology Department, Bichat Hospital, Paris 75018, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital Sud, Amiens 80000, France
| | - Marie Dior
- Department of Hepato-Gastroenterology and Digestive Oncology, Louis Mourier Hospital, Colombes 92700, France
| | - Thomas Walter
- Department of Digestive Oncology, Edouard Herriot Hospital, Lyon 69000, France
| | - Florence Mary
- Gastroenterology Department, Avicenne Hospital, Bobigny 93000, France
| | - Silvain Manfredi
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University hospital, Dijon 21000, France
| | - Francois-Xavier Caroli-Bosc
- Department of Hepato-Gastroenterology and Digestive Oncology, Angers University hospital, Angers 49000, France
| | - Baptiste Cervantes
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris 75014, France
| | - Romain Coriat
- Department of Hepato-Gastroenterology and Digestive Oncology, Cochin Hospital, Paris 75014, France
| | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges 87000, France
| | - Aziz Zaanan
- Department of Gastroenterology and Digestive Oncology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris, 75015, France
| | - Raphael Olivier
- Hepato-Gastroenterology Department, Poitiers University Hospital, University of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - Olivier Bouché
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims 51000, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille University, Lille 59000, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, Tours University hospital, Tours 37000, France
| | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris 75014, France
| | - Pierre Michel
- Department of Hepatogastroenterology, Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Rouen 76000, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Assistance Publique-Hôpitaux de Paris, Saint Louis Hospital, Paris University, Paris 75010, France
| | - Thierry André
- Medical Oncology Department, Assistance Publique-Hôpitaux de Pari, Saint Antoine Hospital, Sorbonne University, Paris 75012, France
| | - Julien Taieb
- Department of Gastroenterology and Digestive Oncology, Assistance Publique-Hôpitaux de Paris, European Georges Pompidou Hospital, Paris, 75015, France
| | - Violaine Randrian
- Hepato-Gastroenterology Department, Poitiers University Hospital, University of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - David Tougeron
- Hepato-Gastroenterology Department, Poitiers University Hospital, University of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France.
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22
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Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
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23
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Rowsell A, Sodergren SC, Vassiliou V, Darlington AS, Guren MG, Alkhaffaf B, Moorbey C, Dennis K, Terada M. Systematic review of health-related quality of life (HRQoL) issues associated with gastric cancer: capturing cross-cultural differences. Gastric Cancer 2022; 25:665-677. [PMID: 35689705 PMCID: PMC9225973 DOI: 10.1007/s10120-022-01309-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
The treatment landscape for gastric cancer (GC) is constantly evolving with therapies affecting all aspects of health-related quality of life (HRQoL) which need careful monitoring. While there are HRQoL measures designed specifically to capture issues relevant to patients with GC, these might be outdated and only relevant to patients in westernised cultures. This review identifies the patient-reported measures used to assess HRQoL of patients with GC and compares the HRQoL measures used across cultures including East Asia, where GC is more prevalent. We conducted a systematic review of publications between January 2001 and January 2021. A total of 267 papers were identified; the majority (66%) of studies involved patients from East Asian countries. Out of the 24 HRQoL questionnaires captured, the European Organisation for Research and Treatment of Cancer Core Cancer measure (QLQ-C30) was the most widely used (60% of all studies and 62% of those involving patients from East Asian countries), followed by its gastric cancer-specific module (QLQ-STO22, 34% of all studies and 41% from East Asia). Eight questionnaires were developed within East Asian countries and, of the 20 studies including bespoke questions, 16 were from East Asia. There were six qualitative studies. HRQoL issues captured include diarrhoea, constipation, reflux, abdominal pain and abdominal fulness or bloating, difficulty swallowing, restricted eating, and weight loss. Psychosocial issues related to these problems were also assessed. Issues relating to the compatibility of some of the westernised measures within East Asian cultures were highlighted.
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Affiliation(s)
- Alison Rowsell
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Samantha C Sodergren
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | | | - Anne-Sophie Darlington
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Marianne G Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bilal Alkhaffaf
- Department of Oesophago-Gastric & Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Chantelle Moorbey
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, K1H 8L6, Canada
- Department of Radiology, University of Ottawa, Ottawa, K1N 6N5, Canada
| | - Mitsumi Terada
- Asian Partnerships Office, Department of International Clinical Development/International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
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24
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Ben Kridis W, Rejab H, Mzali R, Daoud J, Khanfir A. Localized stomach cancer: Perioperative or postoperative approach? A meta‐analysis of phase III studies. JGH OPEN 2022; 6:236-240. [PMID: 35475203 PMCID: PMC9021713 DOI: 10.1002/jgh3.12727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022]
Abstract
Background and Aim Despite the development and standardization of surgical techniques in the treatment of localized gastric adenocarcinoma, the loco‐regional and metastatic recurrence rate remains high. A combined radiochemotherapeutic regimen (the MacDonald regimen) as well as perioperative chemotherapy allows a significant improvement in the survival of patients with localized gastric adenocarcinoma with a reduction in the recurrence rate compared to surgery alone. The purpose of this review is to specify the best therapeutic approach in the treatment of localized gastric cancer. Methods We performed a systemic search of Medline, Embase, and the Cochrane Central Register of Controlled Trials using PubMed, Google Scholar, and Ovid without language restriction. Hazard ratio (HR) with 95% confidence interval (CI) was reported. Results We pooled 727 patients from two phase III randomized controlled trials. There was a benefit of perioperative chemotherapy versus surgery alone on the overall survival (OS) (HR = 0.72, 95% CI: 0.55–0.95) and on disease free survival (DFS) (HR = 0.65, CI: 0.50–0.85). Adjuvant chemotherapy was superior to surgery alone based on OS and disease free survival (CLASSIC study HR = 0.72, CI: 0.52–1 and HR = 0.56, CI: 0.44–0.72, respectively). Adjuvant radiochemotherapy was superior to surgery alone (HR = 1.35, 95% CI: 1.09–1.66; P = 0.005). Conclusion A face‐to‐face comparison of perioperative chemotherapy versus adjuvant chemotherapy versus chemoradiotherapy is necessary.
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Affiliation(s)
- Wala Ben Kridis
- Department of Oncology Habib Bourguiba Hospital University of Sfax Tunisia Sfax Tunisia
| | - Haitham Rejab
- Department of Surgery Habib Bourguiba Hospital Sfax Sfax Tunisia
| | - Rafik Mzali
- Department of Surgery Habib Bourguiba Hospital Sfax Sfax Tunisia
| | - Jamel Daoud
- Department of Radiotherapy Habib Bourguiba Hospital Sfax Sfax Tunisia
| | - Afef Khanfir
- Department of Oncology Habib Bourguiba Hospital University of Sfax Tunisia Sfax Tunisia
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25
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Zylstra J, Whyte GP, Beckmann K, Pate J, Santaolalla A, Gervais-Andre L, Russell B, Maisey N, Waters J, Tham G, Lagergren J, Green M, Kelly M, Baker C, Van Hemelrijck M, Goh V, Gossage J, Browning M, Davies A. Exercise prehabilitation during neoadjuvant chemotherapy may enhance tumour regression in oesophageal cancer: results from a prospective non-randomised trial. Br J Sports Med 2022; 56:402-409. [PMID: 35105604 DOI: 10.1136/bjsports-2021-104243] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is increasing evidence for the use of exercise in cancer patients and data supporting enhanced tumour volume reduction following chemotherapy in animal models. To date, there is no reported histopathological evidence of a similar oncological benefit in oesophageal cancer. METHODS A prospective non-randomised trial compared a structured prehabilitation exercise intervention during neoadjuvant chemotherapy and surgery versus conventional best-practice for oesophageal cancer patients. Biochemical and body composition analyses were performed at multiple time points. Outcome measures included radiological and pathological markers of disease regression. Logistic regression calculated ORs with 95% CI for the likelihood of pathological response adjusting for chemotherapy regimen and chemotherapy delivery. RESULTS Comparison of the Intervention (n=21) and Control (n=19) groups indicated the Intervention group had higher rates of tumour regression (Mandard TRG 1-3 Intervention n=15/20 (75%) vs Control n=7/19 (36.8%) p=0.025) including adjusted analyses (OR 6.57; 95% CI 1.52 to 28.30). Combined tumour and node downstaging (Intervention n=9 (42.9%) vs Control n=3 (15.8%) p=0.089) and Fat Free Mass index were also improved (Intervention 17.8 vs 18.7 kg/m2; Control 16.3 vs 14.7 kg/m2, p=0.026). Differences in markers of immunity (CD-3 and CD-8) and inflammation (IL-6, VEGF, INF-y, TNFa, MCP-1 and EGF) were observed. CONCLUSION The results suggest improved tumour regression and downstaging in the exercise intervention group and should prompt larger studies on this topic. TRIAL REGISTRATION NUMBER NCT03626610.
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Affiliation(s)
- Janine Zylstra
- Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK.,School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Greg P Whyte
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.,Centre for Health and Human Performance, London, UK
| | - Kerri Beckmann
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | - James Pate
- Centre for Health and Human Performance, London, UK
| | - Aida Santaolalla
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | | | - Beth Russell
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | - Nick Maisey
- Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Justin Waters
- Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Gemma Tham
- Physiotherapy, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jesper Lagergren
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | - Michael Green
- Pathology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Mark Kelly
- Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Cara Baker
- Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Vicky Goh
- Clinical Cancer Imaging, King's College London, London, UK
| | - James Gossage
- Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Mike Browning
- Anaesthesia and Intensive Care Medicine, Maidstone and Tunbridge Wells Hospital NHS Trust, Maidstone, UK
| | - Andrew Davies
- Gastrointestinal Medicine and Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK .,School of Cancer and Pharmaceutical Studies, King's College London, London, UK
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26
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Ramaswamy A, Bajaj K, Talwar V, Prabhash K, Batra U, Dhabhar B, Sharma M, Ghadyalpatil N, CT S, Goyal G, Muzamil J, Bhatt A, Jain P, Ranade A, Kamath M, Gawande JP, Thippeswamy R, Mirani J, Reddy N, Ganguly S, Mishra SK, Madabhavi I, HP S, Panda SS, Patil S, Bhargava P, Ostwal V. Ramucirumab in Indian Patients with Advanced Gastric Cancer-Does Borderline Performance Status and Heavy Burden of Disease in Real World Practice Impact Clinical Benefit? South Asian J Cancer 2022; 11:24-30. [PMID: 35833042 PMCID: PMC9273313 DOI: 10.1055/s-0041-1728980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Vikas OstwalBackground Ramucirumab is considered a standard of care as second-line therapy (CT2) in advanced gastric cancers (AGCs). The aim of this study was to assess practice patterns and outcomes with ramucirumab among Indian patients with AGCs. Materials and Methods A computerized clinical data entry form was formulated by the coordinating center's (Tata Memorial Hospital) medical oncologists and disseminated through personal contacts at academic conferences as well as via email for anonymized patient data entry. The data was analyzed for clinical characteristics, response rates, and survival outcomes. Results A total of 26 physicians contributed data, resulting in 55 patients receiving ramucirumab and being available for analysis. Median age was 53 years (range: 26-78), 69.1% of patients had greater than two sites of disease, and baseline Eastern Cooperative Oncology Group's performance score (ECOG PS) ≥ 2 was seen in 61.8% of patients. Ramucirumab was used as monotherapy in 10.9% of patients, while the remaining 89.1% received ramucirumab combined with chemotherapy. Median event-free survival (EFS) and median overall survival (OS) with ramucirumab were3.53 months (95% CI: 2.5-4.57) and 5.7 months (95% CI: 2.39-9.0), respectively. Common class specific grade adverse events seen with ramucirumab included gastrointestinal (GI) hemorrhage (9.1% - all grades) and uncontrolled hypertension (Grade 3/4 - 3.6%). Conclusions Ramucirumab appears to have similar efficacy in Indian AGC patients when compared with real-world data from other countries in terms of median EFS, but OS appears inferior due to more patients having borderline ECOG PS and high metastatic disease burden. GI hemorrhages appear more common than published data, although not unequivocally related to ramucirumab.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Kripa Bajaj
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Vineet Talwar
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Kumar Prabhash
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Ullas Batra
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Boman Dhabhar
- Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Mansi Sharma
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | | | - Satish CT
- HCG Group of Hospital, Bangalore, Karnataka, India
| | - Gautam Goyal
- Department of Oncology, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Javvid Muzamil
- Department of Medical Oncology, Khyber Superspeciality Institute, Srinagar, Kashmir, J…K, India
| | - Amit Bhatt
- Avinash Cancer Clinic, Pune, Maharashtra, India
| | - Parveen Jain
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | | | | | - Jayant Pundlik Gawande
- Aditya Birla Memorial Hospital, Aditya Birla Hospital Marg, Chinchwad, Pune, Maharashtra, India
| | - Ravi Thippeswamy
- Sri Shankara Cancer Hospital Basavangudi, Bangalore, Karnataka, India
| | - Jimmy Mirani
- Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Neelesh Reddy
- Columbia Asia Hospital Yeshwantpur, Bangalore, Karnataka, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | | | | | - Soumya Surath Panda
- Department of Medical Oncology, IMS … SUM Hospital, Bhubaneswar, Odisha, India
| | - Shekar Patil
- HCG Group of Hospital, Bangalore, Karnataka, India
| | - Prabhat Bhargava
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
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27
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Perioperative Chemotherapy with FLOT Scheme in Resectable Gastric Adenocarcinoma: A Preliminary Correlation between TRG and Radiomics. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11199211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Perioperative chemotherapy (p-ChT) with a fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) scheme is the gold standard of care for locally advanced gastric cancer. We aimed to test CT radiomics performance in early response prediction for p-ChT. Patients with advanced gastric cancer who underwent contrast enhanced CT prior to and post p-ChT were retrospectively enrolled. Histologic evaluation of resected specimens was used as the reference standard, and patients were divided into responders (TRG 1a-1b) and non-responders (TRG 2-3) according to their Becker tumor regression grade (TRG). A volumetric region of interest including the whole tumor tissue was drawn from a CT portal-venous phase before and after p-ChT; 120 radiomic features, both first and second order, were extracted. CT radiomics performances were derived from baseline CT radiomics alone and ΔRadiomics to predict response to p-ChT according to the TRG and tested using a receiver operating characteristic (ROC) curve. The final population comprised 15 patients, 6 (40%) responders and 9 (60%) non-responders. Among pre-treatment CT radiomics parameters, Shape, GLCM, First order, and NGTDM features showed a significant ability to discriminate between responders and non-responders (p < 0.011), with Cluster Shade and Autocorrelation (GLCM features) having AUC = 0.907. ΔRadiomics showed significant differences for Shape, GLRLM, GLSZM, and NGTDM features (p < 0.007). MeshVolume (Shape feature) and LongRunEmphasis (GLRLM feature) had AUC = 0.889. In conclusion, CT radiomics may represent an important supportive approach for the radiologic evaluation of advanced gastric cancer patients.
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28
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Stiles BM, Vimolratana M. Commentary: Not a "checkmate," but great progress. J Thorac Cardiovasc Surg 2021; 164:438-439. [PMID: 34654561 DOI: 10.1016/j.jtcvs.2021.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Brendon M Stiles
- Department of Cardiothoracic and Vascular Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY.
| | - Marc Vimolratana
- Department of Cardiothoracic and Vascular Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY
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29
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Cabral F, Ramos P, Monteiro C, Casaca R, Pinto I, Abecasis N. Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer. Cir Esp 2021; 99:521-526. [PMID: 34353591 DOI: 10.1016/j.cireng.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/20/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. METHODS We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. RESULTS A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3-5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. CONCLUSIONS Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.
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Affiliation(s)
| | - Paulo Ramos
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
| | | | - Rui Casaca
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
| | - Iola Pinto
- Mathematics and Applications Center, Instituto Superior de Engenharia de Lisboa, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno Abecasis
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
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30
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Wang F, Zhang X, Li Y, Tang L, Qu X, Ying J, Zhang J, Sun L, Lin R, Qiu H, Wang C, Qiu M, Cai M, Wu Q, Liu H, Guan W, Zhou A, Zhang Y, Liu T, Bi F, Yuan X, Rao S, Xin Y, Sheng W, Xu H, Li G, Ji J, Zhou Z, Liang H, Zhang Y, Jin J, Shen L, Li J, Xu R. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (Lond) 2021; 41:747-795. [PMID: 34197702 PMCID: PMC8360643 DOI: 10.1002/cac2.12193] [Citation(s) in RCA: 423] [Impact Index Per Article: 105.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
There exist differences in the epidemiological characteristics, clinicopathological features, tumor biological characteristics, treatment patterns, and drug selections between gastric cancer patients from the Eastern and Western countries. The Chinese Society of Clinical Oncology (CSCO) has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually. Taking into account regional differences, giving full consideration to the accessibility of diagnosis and treatment resources, these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China. The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis, treatment, follow-up, and screening of gastric cancer. Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines, this updated guideline integrates the results of major clinical studies from China and overseas for the past year, focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations. For the comprehensive treatment of non-metastatic gastric cancer, attentions were paid to neoadjuvant treatment. The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated. For the comprehensive treatment of metastatic gastric cancer, recommendations for immunotherapy were included, and immune checkpoint inhibitors from third-line to the first-line of treatment for different patient groups with detailed notes are provided.
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31
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Murphy CF, Elliott JA, Docherty NG, Mohamed AA, Vincent RP, Ravi N, Reynolds JV, le Roux CW. Exaggerated postprandial GLP-1 secretion following esophagectomy is not associated with gastric emptying and intestinal transit. Dis Esophagus 2021; 34:5907940. [PMID: 32944747 DOI: 10.1093/dote/doaa098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/09/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022]
Abstract
Esophagectomy causes postprandial symptoms associated with an exaggerated postprandial gut hormone response. This study aimed to compare the gastrointestinal transit time of patients 1 year after esophagectomy with unoperated controls, including its relation to satiety gut hormone release. In this cross-sectional study, consecutive, disease-free patients after esophagectomy with pyloroplasty were compared with unoperated control subjects to assess gastric emptying (GE) and cecal arrival time (CAT). Serial plasma samples were collected before, and for 300 minutes after, a mixed-meal challenge. Body composition was assessed, and symptom scores were calculated. Eleven patients 1 year post-esophagectomy (age: 62.6 ± 9.8, male: 82%) did not show a significantly different GE pattern compared with 10 control subjects (P = 0.245). Rather, patients could be categorized bimodally as exhibiting either rapid or slow GE relative to controls. Those with rapid GE trended toward a higher postprandial symptom burden (P = 0.084) without higher postprandial glucagon-like peptide-1 (GLP-1) secretion (P = 0.931). CAT was significantly shorter after esophagectomy (P = 0.043) but was not significantly associated with GE, GLP-1 secretion, or symptom burden. Neither early nutrient delivery to the proximal small intestine nor to the colon explains the exaggerated postprandial GLP-1 response after esophagectomy. GE varies significantly in these patients despite consistent pyloric management.
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Affiliation(s)
- C F Murphy
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - J A Elliott
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.,National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - N G Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
| | - A A Mohamed
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - R P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, UK
| | - N Ravi
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - J V Reynolds
- National Oesophageal and Gastric Centre, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - C W le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland
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Nrf2/Keap1-Pathway Activation and Reduced Susceptibility to Chemotherapy Treatment by Acidification in Esophageal Adenocarcinoma Cells. Cancers (Basel) 2021; 13:cancers13112806. [PMID: 34199909 PMCID: PMC8200109 DOI: 10.3390/cancers13112806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Inflammation caused by acidic reflux contributes to disease progression in Barrett’s esophagus. Little is known, whether esophageal cancer cells are influenced by acidic reflux and whether reflux influences cancer cell physiology, targeting the Nrf2/Kepa1- and the NFκB-pathway. The understanding mechanisms of the acidic susceptibility in cells from advanced stages of Barrett’s esophagus will provide further evidence, whether it should be prevented during chemotherapy for EAC treatment. Abstract Chronic acid reflux causes cellular damage and inflammation in the lower esophagus. Due to these irritating insults, the squamous epithelium is replaced by metaplastic epithelium, which is a risk factor for the development of esophageal adenocarcinoma (EAC). In this study, we investigated the acid susceptibility in a Barrett’s cell culture in vitro model, using six cell lines, derived from squamous epithelium (EPC1 and EPC2), metaplasia (CP-A), dysplasia (CP-B), and EAC (OE33 and OE19) cells. Cells exposed to acidic pH showed a decreased viability dependent on time, pH, and progression status in the Barrett’s sequence, with the highest acid susceptibility in the squamous epithelium (EPC1 and EPC2), and the lowest in EAC cells. Acid pulsing was accompanied with an activation of the Nrf2/Keap1- and the NFκB-pathway, resulting in an increased expression of HO1—independent of the cellular context. OE33 showed a decreased responsiveness towards 5-FU, when the cells were grown in acidic conditions (pH 6 and pH 5.5). Our findings suggest a strong damage of squamous epithelium by gastroesophageal reflux, while Barrett’s dysplasia and EAC cells apparently exert acid-protective features, which lead to a cellular resistance against acid reflux.
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Does a high Mandard score really define a poor response to chemotherapy in oesophageal adenocarcinoma? Br J Cancer 2021; 124:1653-1660. [PMID: 33742143 PMCID: PMC8110771 DOI: 10.1038/s41416-021-01290-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/16/2020] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND A high Mandard score implies a non-response to chemotherapy in oesophageal adenocarcinoma. However, some patients exhibit tumour volume reduction and a nodal response despite a high score. This study examines survival and recurrence patterns in these patients. METHODS Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. Computed tomography-estimated tumour volume change was examined in a subgroup of consecutive patients. RESULTS Five hundred and fifty-five patients were included. Median survival was 55 months (Mandard 1-3) and 21 months (Mandard 4 and 5). In the Mandard 4 and 5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75 vs 28.74%, systemic 24.59 vs 48.42%) and circumferential resection margin positivity (22.95 vs 68.11%). Complete nodal response independently predicted improved survival (hazard ratio 0.34 (0.16-0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (-16.3 vs -7.7 cm3, p = 0.033) with no significant difference between Mandard groups. CONCLUSION Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.
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Murphy CF, Fanning M, Raftery N, Elliott JA, Docherty NG, Donohoe CL, Ravi N, le Roux CW, Reynolds JV. Early experience with a nutrition and survivorship clinic in esophageal cancer. Dis Esophagus 2021; 34:5860595. [PMID: 32566939 DOI: 10.1093/dote/doaa061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Improved cure rates in esophageal cancer care have increased focus on health-related quality of life (HRQL) in survivorship. To optimize recovery after esophagectomy, particularly nutritional well-being, a personalized multidisciplinary survivorship clinic was established at this center. Assessments at 6 and 12 months postoperatively include validated European Organization for the Research and Treatment of Cancer (EORTC) symptom and health-related quality of life (HRQL) questionnaires, functional status review, anthropometry, and biochemical screening for micronutrient deficiencies. 75 patients, at a mean age of 63 years, 84% male, 85% with adenocarcinoma, and 73% receiving multimodal therapy were included. Mean preoperative body mass index (BMI) was 27.5 (4.3) kg m -2. 6- and 12-month assessments were completed by 66 (88%) and 37 (93%) recurrence-free patients, respectively. Mean body weight loss at 6 months was 8.5 ± 6.6% and at 12 months 8.8 ± 7.3%. Of the 12-month cohort, micronutrient deficiency was present in 27 (79.4%) preoperatively and 29 (80.6%) after 1 year (P = 0.727), most commonly iron deficiency (preoperative: 16 [43.2%] and postoperative: 17 [45.9%] patients, P = 0.100). 26 (70.3%) of these patients also had clinically significant dumping syndrome persisting to 12 months after surgery. We describe a novel follow-up support structure for esophageal cancer patients in the first year of survivorship. This may serve as an exemplar model with parallel application across oncological care.
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Affiliation(s)
- Conor F Murphy
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland
| | - Nicola Raftery
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Jessie A Elliott
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.,Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - Claire L Donohoe
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute for Biomedical Science, University College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Center for Esophageal and Gastric Cancer, Department of Surgery, Trinity Centre for Health Sciences, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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Felismino TC, de Oliveira ACF, Alves ACF, da Costa Junior WL, Coimbra FJF, de Souza Begnami MDF, Riechelmann RP, de Jesus VHF, de Mello CAL. Primary Tumor Location Is a Predictor of Poor Prognosis in Patients with Locally Advanced Esophagogastric Cancer Treated with Perioperative Chemotherapy. J Gastrointest Cancer 2021; 51:484-490. [PMID: 31179509 DOI: 10.1007/s12029-019-00258-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Esophagogastric cancer (EGC) is a leading neoplasm worldwide. Perioperative chemotherapy (periCT) is currently a standard of care for most patients (pts). Prevalence of esophagogastric junction (EGJ) tumors is increasing over the last years. METHODS The aim of this study was to retrospectively search for prognostic factors in pts. with locally advanced EGC treated with periCT. Three-year overall survival (OS) and Event-Free Survival (EFS) were main end-points. HER-2 positive tumors were defined by immunohistochemistry or FISH. RESULTS Between June/2007 and November/2015, 128 pts. started periCT for esophagogastric junction (EGJ) or gastric adenocarcinoma (GC). Median age was 59.5 y and 64% were male. Primary site was EGJ in 27% and 65% were cN+. Diffuse subtype was seen in 42%. Ninety-seven pts. were assessed for HER-2; 14 (14.4%) were positive. After median follow-up time of 45 m, 48 deaths occurred. The 3-year OS and EFS rate was 61.3% and 51.2%, respectively. Main prognostic factors were: AJCC ypT3-T4yN1-N3 (HR 6.75 p 0.002) and EGJ primary (HR 2.64, p 0.004). Overall HER-2 was not prognostic. Still, a difference in 3-year OS was observed for GC/HER2+ compared to EGJ/HER2+ (88.9% versus 20%, p = 0.002). This difference is greater for 3-year EFS with no patient with EGJ/HER2+ free-of-event against 62.5% for GC/HER+ (p = 0.011). CONCLUSION In our analysis, pathological staging and primary site were main prognostic factors. Moreover, a small group of EGJ/HER2+ had very poor survival.
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Affiliation(s)
- Tiago Cordeiro Felismino
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil.
| | - Audrey Cabral Ferreira de Oliveira
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil
| | - Ana Caroline Fonseca Alves
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil
| | | | | | | | - Rachel P Riechelmann
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil
| | - Victor Hugo Fonseca de Jesus
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil
| | - Celso Abdon Lopes de Mello
- Medical Oncology Department, AC Camargo Cancer Center, Rua Professor Antônio Prudente 211, Liberdade, São Paulo, SP CEP: 01509-010, Brazil
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Harada G, Bonadio RRDCC, de Araújo FCC, Victor CR, Sallum RAA, Junior UR, Cecconello I, Takeda FR, de Castria TB. Induction Chemotherapy for Locally Advanced Esophageal Cancer. J Gastrointest Cancer 2021; 51:498-505. [PMID: 31240598 DOI: 10.1007/s12029-019-00266-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR). METHODS We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients' characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors. RESULTS One hundred and three patients were studied, with a median age of 62 years (range 37-84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026). CONCLUSIONS Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.
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Affiliation(s)
- Guilherme Harada
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- Centro de Oncologia, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | | | | | - Carolina Ribeiro Victor
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Rubens Antonio Aissar Sallum
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Ivan Cecconello
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Flávio Roberto Takeda
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Tiago Biachi de Castria
- Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Centro de Oncologia, Hospital Sírio-Libanês, Sao Paulo, Brazil
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Ramaswamy A, Bhargava P, Ostwal V. Real-World Long-Term Outcomes with Perioperative EOX in D2 Gastrectomy: a Meaningful Look While We Switch to FLOT-4. J Gastrointest Cancer 2021; 51:703-708. [PMID: 31956953 DOI: 10.1007/s12029-020-00358-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Data regarding long-term survival and prognosis in loco-regionally advanced, non-metastatic gastric cancers (GC) using perioperative chemotherapy and D2 lymphadenectomies from India is scarce. MATERIALS AND METHODS The study is a retrospective evaluation of locally advanced gastric cancers who received epirubicin-oxaliplatin-capecitabine (EOX) as perioperative therapy from May 2013 to December 2015 at Tata Memorial Hospital, Mumbai. The report concentrates on long-term survival outcomes and prognostic factors. Event-free survival (EFS) and overall survival (OS) were calculated using Kaplan-Meier method. RESULTS Two hundred and sixty-eight patients were started on EOX regimen, of which 200 patients (74.6%) underwent definitive resection with D2 lymphadenectomy. With a median follow-up of 52.7 months, the estimated median 3-year and 5-year EFS were 38.5% and 36.3% respectively. The estimated median 3-year and 5-year OS were 41.7% and 37.6% respectively. Patients younger than age 40 years [HR 1.55 (1.034-2.321); p = 0.034] and with poorly differentiated histology [HR 0.65 (0.446-0.944); p = 0.024] had inferior OS compared to their counterparts. CONCLUSIONS Long-term OS in Indian patients in non-metastatic GC with EOX chemotherapy and D2 lymphadenectomy is similar to previously published Western data. Younger Indian patients fare worse than their older counterparts and this needs further evaluation.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, TMH Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Prabhat Bhargava
- Department of Medical Oncology, TMH Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India
| | - Vikas Ostwal
- Department of Medical Oncology, TMH Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai, 400012, India.
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Ahmed N, Owen J, Abdalmassih M, Khan J, Nugent Z, Qing G, Martineau P, Rathod S, Dubey A, Bashir B, Chowdhury A, Buduhan G. Outcome of Locally Advanced Esophageal Cancer Patients Treated With Perioperative Chemotherapy and Chemoradiotherapy Followed by Surgery. Am J Clin Oncol 2021; 44:10-17. [PMID: 33105233 DOI: 10.1097/coc.0000000000000773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES Perioperative chemotherapy (P-CT) or neoadjuvant chemoradiation (C-RT) followed by surgical resection is the standard of care for locally advanced esophageal cancer (LAEC). We present an institutional review and outcome of patients with LAEC treated with neoadjuvant C-RT or P-CT followed by surgery. METHODS Patients were identified through the Manitoba Cancer Registry. Overall survival (OS), recurrence-free survival (RFS), and time to recurrence (TTR) were compared using proportion hazard regression analysis. Metabolic and pathologic response rates were compared by the Fisher exact test. RESULTS Sixty-seven patients were treated with C-RT and 32 with P-CT. Fifty-two percent of the patients had pretreatment and posttreatment positron emission tomography scans before surgery. Ninety-five percent of the patients in C-RT and 91% in P-CT had a partial metabolic response or stable disease. Sixty-one percent of C-RT and 34% of P-CT patients had tumor regression grade (TRG) 0 to 1; 39% of C-RT and 66% of P-CT had TRG 2 to 3 (P=0.018). Median OS was 37 and 18 months for patients with TRG 0 to 1 and 2 to 3, respectively (P=0.013, hazard ratio [HR]=1.96). Three-year OS was 43% versus 37% (P=0.37, HR=1.30), RFS was 34% versus 26% (P=0.87, HR=0.96), and median TTR was 30 versus 13 months (P=0.07, HR=0.59) for C-RT and P-CT, respectively. CONCLUSIONS C-RT was associated with a higher degree of pathologically tumor regression. Patients with major tumor regression had a better outcome than those with minimal to poor response. There was a trend toward improved TTR with C-RT but no difference in OS or RFS.
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Affiliation(s)
- Naseer Ahmed
- Research Institute in Oncology and Hematology, CancerCare Manitoba
- Department of Radiology, Section of Radiation Oncology
| | - Justin Owen
- Department of Radiology, Section of Radiation Oncology
| | | | | | | | - Gefei Qing
- Department of Pathology, Rady Faculty of Health Sciences, University of Manitoba
| | | | | | - Arbind Dubey
- Department of Radiology, Section of Radiation Oncology
| | - Bashir Bashir
- Department of Radiology, Section of Radiation Oncology
| | | | - Gordon Buduhan
- Research Institute in Oncology and Hematology, CancerCare Manitoba
- Department of Surgery, Section of Thoracic Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Operative Results and Perioperative Morbidity After Intensified Neoadjuvant Chemotherapy with FLOT for Gastroesophageal Adenocarcinoma Impact of Intensified Neoadjuvant Treatment. J Gastrointest Surg 2021; 25:58-66. [PMID: 32040809 DOI: 10.1007/s11605-019-04511-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/29/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perioperative treatment is the standard of care in Western Europe for locally advanced gastric cancer (GC) and adenocarcinoma of the gastroesophageal junction (GEJ). Intensified neoadjuvant treatment within the NeoFLOT trial proved to be safe and effective. Yet, the influence of such intensification with 6 cycles of FLOT in the neoadjuvant setting has not been analyzed regarding its possible impact on perioperative results. MATERIALS AND METHODS A total of 537 patients were enrolled in this study; of whom, 132 had followed a standard neoadjuvant protocol (CTx), 356 had not received any neoadjuvant treatment (NoCTx), and 49 patients had undergone an intensified chemotherapy within the NeoFLOT trial (IntCTx) with 6 cycles of FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) every 2 weeks. RESULTS Our results reveal no significant difference in perioperative morbidity or mortality with regard to the neoadjuvant treatment. Postoperative bleeding and hematoma occurred less frequently in the IntCTx group compared to the NoCTx and the CTx groups (2.0% vs. 5.33% vs. 5.1%). Postoperative lymph fistulas were slightly more frequent in the IntCTx group (4.1% vs. 0.3% vs. 1.6%). Patients treated within the NeoFLOT trial had a higher risk for blood transfusions (OR 5.5; 95%-KI, 2.49-12.19), whereas patients without neoadjuvant therapy had the longest ICU stay (mean 8.3 vs. CTx 4.5 vs. IntCTx 6.7 days). CONCLUSION The results of the current study indicate that also an intensification of neoadjuvant chemotherapy with 6 preoperative cycles of FLOT does not significantly increase perioperative complications. Thus, prolonged neoadjuvant chemotherapy with FLOT is safe for patients with locally advanced GC or GEJ tumors.
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Cabral F, Ramos P, Monteiro C, Casaca R, Pinto I, Abecasis N. Impact of perioperative chemotherapy on postoperative morbidity after gastrectomy for gastric cancer. Cir Esp 2020. [PMID: 33293027 DOI: 10.1016/j.ciresp.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The use of perioperative chemotherapy (CT) in patients with advanced gastric carcinoma increases their overall survival. This therapy may also increase the number of patients with R0 resection. Potential drawbacks of this therapy, besides its toxicity, include increased surgical morbidity. METHODS We retrospectively evaluated the records of patients undergoing gastrectomy with curative intent, for carcinoma, at our institution between January 2009 and August 2018. They were divided into two groups: direct surgery (SURG) and perioperative CT (CHEMO). Patients with other neoadjuvant therapies and cardia Siewert I and II carcinomas were excluded. The primary objective was to evaluate the impact of perioperative CT on surgical morbidity. As secondary objectives, resection radicality and total lymph node count were compared between the two groups. RESULTS A total of 307 patients (97 direct surgery and 210 perioperative CT) were evaluated. Median age was 67 years old. The overall major surgical morbidity (Clavien-Dindo 3-5) was 10.6% in the CHEMO group and 12.4 in the SURG group (p=0.643). There was no statistically significant difference between the surgical radicality (R0 98% in the SURG group vs 97.5% CHEMO group (p=0.865). There was an increase in the total number of lymph nodes retrieved in the specimen in the CHEMO group (25 vs 22, p=0.001), a difference that was not maintained in the subgroup analysis as a function of the surgery performed. CONCLUSIONS Perioperative CT in gastric carcinoma does not increase surgical morbidity, surgical radicality and total lymph node count.
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Affiliation(s)
| | - Paulo Ramos
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
| | | | - Rui Casaca
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
| | - Iola Pinto
- Mathematics and Applications Center, Instituto Superior de Engenharia de Lisboa, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno Abecasis
- Instituto Português Oncologia Lisboa, Lisboa, Portugal
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Khan N, Donohoe CL, Phillips AW, Griffin SM, Reynolds JV. Signet ring gastric and esophageal adenocarcinomas: characteristics and prognostic implications. Dis Esophagus 2020; 33:5831347. [PMID: 32378712 DOI: 10.1093/dote/doaa016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Controversy exists as to the relevance of the signet ring carcinoma (SRC) histological subtype of esophagogastric adenocarcinoma to long-term prognosis, with some studies reporting a worsened oncological outcome and others no clinically relevant impact. A retrospective analysis of outcomes of patients who underwent surgery with curative intent in two high-volume centers (2000-2015) was undertaken. Tumors were analyzed according to location (esophageal, junctional or gastric). Propensity score matching (PSM) analysis was used to match patients with signet ring histology to those without (195 SRC vs. 573 non-SRC), based on age, tumor location, use of neoadjuvant and adjuvant chemotherapy and pathological stage. A total of 2,500 patients with esophagogastric adenocarcinomas were treated, of whom 198 (7.9%) had signet ring histology. Signet ring tumors were more likely to have positive lymph nodes at pathological analysis (59% vs. 50%, P = 0.009). The 5-year survival rate for patients with early signet ring tumors (Stage 0/I/IIa) was 65% versus 85% for other early cancers (P < 0.003). Patients with esophageal signet ring tumors had a particularly poor prognosis with 23% 2-year survival and none alive at 5 years. With PSM, overall survival (OS) was significantly poorer in the signet ring group (44.3 ± 8.6 vs. 59.8 ± 8.5 months, 5-year OS 41% vs. 50%, P = 0.027). Signet ring cells within esophagogastric adenocarcinoma are associated with a poorer prognosis. Genomic studies to identify the composition of such tumors as well as identify strategies to improve treatment for this subtype are warranted.
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Affiliation(s)
- Niall Khan
- National Esophageal and Gastric Cancer Centre, St. James's Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Claire L Donohoe
- National Esophageal and Gastric Cancer Centre, St. James's Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland.,Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Alexander W Phillips
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - S Michael Griffin
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - John V Reynolds
- National Esophageal and Gastric Cancer Centre, St. James's Hospital, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
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Shah MA, Enzinger P, Ko AH, Ocean AJ, Philip PA, Thakkar PV, Cleveland K, Lu Y, Kortmansky J, Christos PJ, Zhang C, Kaur N, Elmonshed D, Galletti G, Sarkar S, Bhinder B, Pittman ME, Plotnikova OM, Kotlov N, Frenkel F, Bagaev A, Elemento O, Betel D, Giannakakou P, Lenz HJ. Multicenter Phase II Study of Cabazitaxel in Advanced Gastroesophageal Cancer: Association of HER2 Expression and M2-Like Tumor-Associated Macrophages with Patient Outcome. Clin Cancer Res 2020; 26:4756-4766. [PMID: 32641434 PMCID: PMC8209413 DOI: 10.1158/1078-0432.ccr-19-3920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/31/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE We examined cabazitaxel, a novel next-generation taxoid, in patients with metastatic gastric cancer in a multicenter phase II study. PATIENTS AND METHODS Patients who have progressed on one or more prior therapies for locally advanced, unresectable, or metastatic disease were eligible, and prior taxane therapy was allowed. Taxane-naïve and pretreated cohorts were analyzed independently for efficacy. The primary endpoint for both cohorts was progression-free survival (PFS) using RECIST 1.1, using a Simon's two-stage design (10% significance and 80% power) for both cohorts. Comprehensive molecular annotation included whole exome and bulk RNA sequencing. RESULTS Fifty-three patients enrolled in the taxane-naïve cohort (Arm A) and 23 patients in the prior-taxane cohort (Arm B), from January 8, 2013, to April 8, 2015: median age 61.7 years (range, 35.5-91.8 years), 66% male, 66% Caucasian. The most common adverse events included neutropenia (17% Arm A and 39% Arm B), fatigue/muscle weakness (13%), and hematuria (12%). In Arm A, the 3-month PFS rate was 28% [95% confidence interval (CI), 17%-42%] and did not meet the prespecified efficacy target. The 3-month PFS rate in Arm B was 35% (95% CI, 16%-57%) and surpassed its efficacy target. HER2 amplification or overexpression was associated with improved disease control (P = 0.003), PFS (P = 0.04), and overall survival (P = 0.002). An M2 macrophage signature was also associated with improved survival (P = 0.031). CONCLUSIONS Cabazitaxel has modest activity in advanced gastric cancer, including in patients previously treated with taxanes. Her2 amplification/overexpression and M2 high macrophage signature are potential biomarkers for taxane efficacy that warrant further evaluation.
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Affiliation(s)
- Manish A Shah
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York.
- Englander Institute of Precision Medicine, Meyer Cancer Center, New York, New York
| | - Peter Enzinger
- Dana-Farber Cancer Center, Medical Oncology, Boston, Massachusetts
| | - Andrew H Ko
- University of California San Francisco, Medical Oncology, San Francisco, California
| | - Allyson J Ocean
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Philip Agop Philip
- Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Prashant V Thakkar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Kyle Cleveland
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Yao Lu
- Division of Biostatistics and Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jeremy Kortmansky
- Yale Cancer Center, Division of Medical Oncology and Hematology, New Haven, Connecticut
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Chao Zhang
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Navjot Kaur
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Dina Elmonshed
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Giuseppe Galletti
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Sandipto Sarkar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Bhavneet Bhinder
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
- Englander Institute of Precision Medicine, Meyer Cancer Center, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Meredith E Pittman
- Department of Anatomic and Clinical Pathology, Weill Cornell, New York, New York
| | | | | | | | | | - Olivier Elemento
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Doron Betel
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Paraskevi Giannakakou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heinz-Josef Lenz
- University of Southern California, Norris Cancer Center, Medical Oncology, Los Angeles, California
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FLOT Neoadjuvant Chemotherapy Followed by Laparoscopic D2 Gastrectomy in the Treatment of Locally Resectable Advanced Gastric Cancer. Can J Gastroenterol Hepatol 2020; 2020:1702823. [PMID: 32566545 PMCID: PMC7277051 DOI: 10.1155/2020/1702823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prognosis of patients with advanced gastric cancer remains unsatisfactory, highlighting the need for improved therapeutic strategies. We analyzed 23 resectable advanced gastric cancer patients who received FLOT followed by laparoscopic gastrectomy with D2 lymphadenectomy to evaluate the efficacy and safety. METHODS Patients aged 18-75 years with gastric adenocarcinoma (stage cT3-4 and/or N + M0) underwent neoadjuvant FLOT therapy (four preoperative and four postoperative 2-week cycles) at Shanghai East Hospital. Laparoscopic gastrectomy was scheduled 3-4 weeks after completion of the last cycle of preoperative chemotherapy. The type of surgical procedure was determined by the location and extent of the primary tumor. RESULTS 23 patients were reviewed in the study. 20 patients (81.2%) received four courses of FOLT therapy, while 3 patients (18.8%) received three courses of treatment. There were 3 (13.0%) complete responses, 13 (56.5%) partial responses, 4 (26.1%) of stable disease, and 1 (4.3%) of progressive disease. The clinical efficacy response rate was 69.6%. The R0 resection rate was 91.3%. Only one patient exhibited grade III postoperative complications. The pathologic complete remission was 13%. The common grade 3/4 adverse events from chemotherapy were leucopenia (17.4%), neutropenia (30.4%), anemia (13%), anorexia (13%), and nausea (17.4%). Postoperative complications occurred in 5 patients (26.1%). There was no treatment-related mortality or reoperation. The most reason for not completing chemotherapy was the patient's request. CONCLUSIONS These findings suggest that FLOT neoadjuvant chemotherapy, followed by laparoscopic D2 gastrectomy, is effective and safe in advanced, resectable advanced gastric cancer.
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Global updates in the treatment of gastric cancer: a systematic review. Part 2: perioperative management, multimodal therapies, new technologies, standardization of the surgical treatment and educational aspects. Updates Surg 2020; 72:355-378. [PMID: 32306277 DOI: 10.1007/s13304-020-00771-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022]
Abstract
Gastric cancer is the fifth malignancy and the third cause of cancer death worldwide, according to the global cancer statistics presented in 2018. Its definition and staging have been revised in the eight edition of the AJCC/TNM classification, which took effect in 2018. Novel molecular classifications for GC have been recently established and the process of translating these classifications into clinical practice is ongoing. The cornerstone of GC treatment is surgical, in a context of multimodal therapy. Surgical treatment is being standardized, and is evolving according to new anatomical concepts and to the recent technological developments. This is leading to a massive improvement in the use of mini-invasive techniques. Mini-invasive techniques aim to be equivalent to open surgery from an oncologic point of view, with better short-term outcomes. The persecution of better short-term outcomes also includes the optimization of the perioperative management, which is being implemented on large scale according to the enhanced recovery after surgery principles. In the era of precision medicine, multimodal treatment is also evolving. The long-time-awaited results of many trials investigating the role for preoperative and postoperative management have been published, changing the clinical practice. Novel investigations focused both on traditional chemotherapeutic regimens and targeted therapies are currently ongoing. Modern platforms increase the possibility for further standardization of the different treatments, promote the use of big data and open new possibilities for surgical learning. This systematic review in two parts assesses all the current updates in GC treatment.
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Pereira MA, Ramos MFKP, Dias AR, Cardili L, Ribeiro RRE, Charruf AZ, de Castria TB, Zilberstein B, Ceconello I, Avancini Ferreira Alves V, Ribeiro U, de Mello ES. Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer. J Surg Oncol 2020; 121:795-803. [PMID: 31773740 DOI: 10.1002/jso.25785] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. METHODS Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. RESULTS Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low-LNRR and high-LNRR. High-LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR (P = .956). High-LNRR had better disease-free survival (DFS) than low-LNRR (P < .001). In multivariate analysis, only LNRR associated with DFS. CONCLUSION High-LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.
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Affiliation(s)
- Marina Alessandra Pereira
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Andre Roncon Dias
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leonardo Cardili
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renan Ribeiro E Ribeiro
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amir Zeide Charruf
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tiago Biachi de Castria
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ivan Ceconello
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Ulysses Ribeiro
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Evandro Sobroza de Mello
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Liu N, Xu Y, Rahnemai-Azar AA, Abbott DE, Weber SM, Lidor AO. National Underutilization of Neoadjuvant Chemotherapy for Gastric Cancer. J Gastrointest Surg 2020; 24:949-958. [PMID: 31792901 PMCID: PMC7486798 DOI: 10.1007/s11605-019-04439-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since the publication of the landmark MAGIC trial in 2006, neoadjuvant chemotherapy has become the standard of care for stage II/III gastric cancer. Nevertheless, many patients still do not begin their treatment with neoadjuvant chemotherapy. The objective of our study was to identify factors associated with underutilization of neoadjuvant chemotherapy for stage II/III gastric cancer. METHODS Patients with pathological stage II and III primary gastric cancer between 2004 and 2015 were identified from the American College of Surgeons National Cancer Database. Patients who received neoadjuvant chemotherapy were compared with those who underwent surgery only or surgery followed by chemotherapy. Predictors of receipt of neoadjuvant chemotherapy were identified using multivariable logistic regression model. Median survival was calculated for each treatment strategy. RESULTS We included 15,947 patients with pathological stage II/III gastric cancer. The proportion of patients receiving neoadjuvant chemotherapy increased from less than 5% before 2006 to 27.5% in 2015. On multivariable analysis, factors associated with no receipt of neoadjuvant therapy included treatment year before 2006 and age greater than 80. Treatment at high-volume centers, academic research programs, or integrated network cancer programs and undergoing total/subtotal or en bloc gastrectomy predicted receipt of neoadjuvant chemotherapy. CONCLUSIONS Ten years after the publication of the MAGIC trial, fewer than 1/3 of patients with stage II/III gastric cancer are receiving neoadjuvant chemotherapy, which has been shown to improve disease-specific survival. Further studies are needed to understand these disparities and ensure both patients and providers are having evidence-based discussions about multimodal therapy for gastric cancer.
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Affiliation(s)
- Natalie Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amir A Rahnemai-Azar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Anne O Lidor
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,Department of Surgery, Division of Minimally Invasive, Foregut, and Bariatric Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792-7375, USA.
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Agnes A, Biondi A, Laurino A, Persiani R, D'Ugo D. Global updates in the treatment of gastric cancer: a systematic review. Part 1: staging, classification and surgical treatment. Updates Surg 2020; 72:341-353. [PMID: 32157635 DOI: 10.1007/s13304-020-00736-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer (GC) is the fifth malignancy and the third cause of cancer death worldwide, according to the global cancer statistics presented in 2018. Its definition and staging have been revised in the eight edition of the AJCC/TNM classification, which took effect in 2018. Novel molecular classifications for GC have been recently established and the process of translating these classifications into clinical practice is ongoing. The cornerstone of GC treatment is surgical, in a context of multimodal therapy. Surgical treatment is being standardized, and is evolving according to new anatomical concepts and to the recent technological developments. This is leading to a massive improvement in the use of mini-invasive techniques. Mini-invasive techniques aim to be equivalent to open surgery from an oncologic point of view, with better short-term outcomes. The persecution of better short-term outcomes also includes the optimization of the perioperative management, which is being implemented on large scale according to the enhanced recovery after surgery principles. In the era of precision medicine, multimodal treatment is also evolving. The long-time-awaited results of many trials investigating the role for preoperative and postoperative management have been published, changing the clinical practice. Novel investigations focused both on traditional chemotherapeutic regimens and targeted therapies are currently ongoing. Modern platforms increase the possibility for further standardization of the different treatments, promote the use of big data, and open new possibilities for surgical learning. This systematic review in two parts assesses all the current updates in GC treatment.
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Affiliation(s)
- Annamaria Agnes
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy. .,General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefro-Urologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy.
| | - Antonio Laurino
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Domenico D'Ugo
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
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Beeharry MK, Zhang TQ, Liu WT, Gang ZZ. Optimization of perioperative approaches for advanced and late stages of gastric cancer: clinical proposal based on literature evidence, personal experience, and ongoing trials and research. World J Surg Oncol 2020; 18:51. [PMID: 32151257 PMCID: PMC7063816 DOI: 10.1186/s12957-020-01819-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The high incidence of gastric cancer (GC) and paradoxical high prevalence of advanced stage GC, amounting to around 2/3 at time of diagnosis, have urged doctors and researchers around the world not only to ameliorate the detection rate of GC at early stages but also to optimize the clinical management of GC at advanced stages. CONTENT We hereby recommend a more goal-oriented multimodality approach with objectives to increase survival rate and improve survival status. Based on precision and accurate clinical staging at diagnosis, we suggest that advanced stage GC (AGC) patients should be channeled into different treatment plans according to their disease status where they can be subjected to comprehensive measures involving chemo, radio, immunological, or target therapies depending on the pathophysiological behavior of their tumor. Patients assessed as potentially resectable cT4N + M0 can undergo neoadjuvant chemotherapy with intent of tumor downsizing and downgrading followed by surgery with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) to decrease the incidence of peritoneal dissemination due to surgical trauma and adjuvant chemotherapy and radiation in cases of bulky nodal metastasis. In cases with distal metastasis, conversion therapy is recommended with the possibility of surgery of curative intent in case of favorable response. The options of alternate treatment options such as trans-catheter arterial chemoembolization (TACE) for limited liver lesions or neoadjuvant intraperitoneal plus systemic chemotherapy (NIPS) for peritoneal carcinomatosis have to be negotiated. With surgery as the cornerstone for cancer treatment, there is acknowledgment of the significance of perioperative comprehensive approaches but there has not been some consensus guiding clinical application. Henceforth, in this review, based on past literature, current guidelines and ongoing clinical trials, we have shared a proposal of the current treatment modalities in practice for the advanced stages of gastric cancer. CONCLUSION Even though surgery is the golden standard of radical cancer treatment, clinical reality shows that without proper perioperative management, patients undergoing radical resections manifest high rates of recurrence and metastasis. Hence, in this review, we have outlined a clinical agenda to optimize the management of advanced stage GC with objective to improve survival outcome and quality of life of patients.
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Affiliation(s)
- Maneesh Kumarsing Beeharry
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tian Qi Zhang
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wen Tao Liu
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Zhu Zheng Gang
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Greally M, Ilson DH. The Multidisciplinary Management of Early Distal Esophageal and Gastroesophageal Junction Cancer. ESOPHAGEAL CANCER 2020:251-273. [DOI: 10.1007/978-3-030-29832-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Ramos MFKP, de Castria TB, Pereira MA, Dias AR, Antonacio FF, Zilberstein B, Hoff PMG, Ribeiro U, Cecconello I. Return to Intended Oncologic Treatment (RIOT) in Resected Gastric Cancer Patients. J Gastrointest Surg 2020; 24:19-27. [PMID: 31745892 DOI: 10.1007/s11605-019-04462-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/30/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative chemotherapy (CMT) or chemoradiotherapy (CRT) is commonly recommended for gastric cancer (GC) patients in order to improve survival. However, some factors that prevent patients from return to intended oncologic treatment (RIOT) may increase the risk of recurrence and decrease the survival benefits achieved with curative resection. The aim of this study was to determine the frequency and factors associated with inability to RIOT and their impact on survival. METHODS This retrospective study included stage II/III GC patients treated with potentially curative gastrectomy. Patients who could return to intended oncologic treatment (RIOT group) and those who could not (inability to RIOT group) were analyzed. RESULTS Of the 313 eligible GC patients, 89 (28.4%) and 85 (27.2%) patients receive CRT and CMT, respectively, representing a RIOT rate of 55.6%. The main reason was attributed to general poor performance status (30.2%), followed by surgical postoperative complications (POC) (20.1%). Older age, higher ASA, D1 lymphadenectomy, and major POC were related to inability to RIOT. Older age, neutrophil-lymphocyte ratio (NLR), and major POC were independent risk factors for inability to RIOT. Five-year DFS and OS were worse for the inability to RIOT group than for the RIOT group (p = 0.008 and p = 0.004, respectively). In multivariate analyses, absence of neoadjuvant therapy, total gastrectomy, pT3/T4, pN+, and inability to RIOT were associated with worse DFS. Type of gastrectomy, lymphadenectomy, pN status, Rx resection, and RIOT group were associated with OS. CONCLUSION Older age, high NLR, and major POC were risk factors for inability to RIOT. RIOT was an independent predictor of survival.
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Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil.
| | - Tiago Biachi de Castria
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Marina Alessandra Pereira
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Andre Roncon Dias
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Fernanda Fronzoni Antonacio
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Bruno Zilberstein
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Paulo Marcelo Gehm Hoff
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Ulysses Ribeiro
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
| | - Ivan Cecconello
- Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo, SP, 01249000, Brazil
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