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NCI CANCERLIT^® Search: Therapy of Gastric Cancer - June 2002

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National Cancer Institute^®
Ultima Vez Modificado: 1 de junio del 2002

Management of cancer of the stomach in Mulago Hospital Kampala, Uganda.
Adjuvant chemoradiotherapy in gastric cancer: wave goodbye to extensive surgery?
Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer: the effect of undertreatment.
Management of perforated gastric carcinoma: a report of 16 cases and review of world literature.
Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection?
[Basic directions in studying cancer of the resected stomach]
Weekly high-dose 5-fluorouracil (5-FU), leucovorin (LV) and bimonthly cisplatin in patients with advanced gastric cancer.
[Duodenal-pyloric-antrum obstruction and metabolic disturbances: is important an adequate preoperative care?]
Current gene therapy for stomach carcinoma.
Non-infusional 5-fluorouracil, doxorubicin and cisplatin in the treatment of locally advanced or metastatic gastro-oesophageal
[Departmental review of surgical cases in the last 17 years: Stomach cancers]
Gastric cancer--patterns of relapse after surgical resection.
Surgical approaches and outcomes in the treatment of gastric cancer.
Results of radiation therapy in gastric cancer.
Chemotherapy options for gastric cancer.
Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer.
Guidelines for the management of oesophageal and gastric cancer.
[Results of surgical treatment of gastric cancer]
[Total esophagogastrectomy via left throacophrenic access for cancer of the cardia]
[Role of surgery in the treatment of primary gastric lymphoma and assessment of new therapeutic approaches]
Neoadjuvant chemotherapy with CPT-11 and cisplatin downstages locally advanced gastric cancer.
Current status and future perspectives of post-operative adjuvant therapy for gastric carcinoma.
D2-lymphadenectomy improves the survival of patients with peritoneal cytology-positive gastric cancer.
Experience with photodynamic therapy (endoscopic laser therapy) for the treatment of early gastric cancer.
Esophagogastrostomy reconstruction after limited proximal gastrectomy.
The prognosis of stage IV gastric carcinoma patients after curative resection.
[Stomach lymphoma]
Polysaccharides isolated from Echinacea purpurea herba cell cultures to counteract undesired effects of chemotherapy--a pilot study.
Phase II and pharmacokinetic study of GL331 in previously treated Chinese gastric cancer patients.
Probability of lymph node metastasis in small gastric cancer tumor: is it an indication for limited surgery?

1
UI - 12002081
AU - Ibingira CB
TI - Management of cancer of the stomach in Mulago Hospital Kampala, Uganda.
SO - East Afr Med J 2001 May;78(5):233-7
AD - Department of Anatomy, Makerere Medical School, Kampala, Uganda.
OBJECTIVE: To determine the clinical presentation, mode of investigation and management of gastric cancer at New Mulago Hospital. DESIGN: Prospective descriptive study. SETTINGS: Three general surgical wards, Department of Surgery, New Mulago Hospital. SUBJECTS: Thirty five patients were studied within 12 months. RESULTS: Gastric cancer was found to be prevalent in tribes inhabiting volcanic areas of south western Uganda especially the Banyankole (25%). The commonest mode of clinical presentation was epigastric pain, weight loss, constipation, epigastric tenderness, palpable epigastric mass and anaemia. The most accurate mode of investigation was by endoscopy followed by barium meal. The commonest locality was the pyloric atrium (40%) histologically adenocarcinoma (95.5%) predominated. Gastric cancer was found to be more common in patients with blood group O+ve. All patients had been subjected to some kind of medical treatment especially with antiacids, H2 receptor antagonists which contributed to the delay in presentation. The majority of patients (94.5%) presented with advanced disease and no curative surgery was possible. CONCLUSIONS: These results show that early diagnosis of gastric cancer is still a dream at Mulago hospital since most patients present with advanced disease. To address this problem, all health workers should be sensitised on symptoms and signs for early aggressive investigation or an early referral to enable early diagnosis of gastric cancer. The investigatory capacity of rural hospitals should be boosted to enable early detection of gastric cancer.

2
UI - 11923126
AU - Roukos DH
TI - Adjuvant chemoradiotherapy in gastric cancer: wave goodbye to extensive surgery?
SO - Ann Surg Oncol 2002 Apr;9(3):220-1

3
UI - 11923135
AU - Hundahl SA; Macdonald JS; Benedetti J; Fitzsimmons T; Southwest Oncology
TI - Group and the Gastric Intergroup Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer: the effect of undertreatment.
SO - Ann Surg Oncol 2002 Apr;9(3):278-86
AD - Queen's Cancer Institute, Honolulu, Hawaii 96813, USA. shundahl@queens.org
BACKGROUND: Intergroup 0116 (Southwest Oncology Group 9008), a national, multicenter, two-armed, prospective, randomized trial of adjuvant postoperative chemoradiotherapy, has demonstrated significant benefit. METHODS: We prospectively captured complete surgical information, including the treatment of various lymph node stations, for 553 of the 556 eligible participants in this trial. Before any survival analysis, we coded D level by using the Japanese general rules and used the Maruyama program to estimate the likelihood of disease in undissected regional node stations, defining the sum of these estimates as the Maruyama Index of Unresected Disease (MI). We analyzed survival with Cox multivariate regression. RESULTS: Fifty-four percent of participating patients underwent D0 lymphadenectomy. The median MI was 70 (range, 0-429). In contrast to D level, MI proved to be an independent prognostic factor, even with adjustment for the potentially linked variables of T stage and number of positive nodes. We detected no significant interaction between surgical or pathologic variables and the favorable effect of adjuvant treatment, but the power to detect such interaction was generally low. CONCLUSIONS: MI, a measure of unresected regional nodal disease in gastric cancer, proved an independent predictor of survival. Surgical undertreatment, as observed in this trial, clearly undermined survival.

4
UI - 12013286
AU - Kasakura Y; Ajani JA; Fujii M; Mochizuki F; Takayama T
TI - Management of perforated gastric carcinoma: a report of 16 cases and review of world literature.
SO - Am Surg 2002 May;68(5):434-40
AD - Department of Gastrointestinal Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
Perforated gastric carcinoma is rare; however, it is a serious condition associated with complications. To understand the proper management of this disease and to characterize its clinical course we reviewed available data on 16 patients with perforated gastric carcinoma. We collected data on the age and sex of the patients as well as operative findings and histological features of the primary tumor. The depth of invasion and presence of lymph node metastasis were also recorded. The Union Internationale Contre Cancer stage, extent of resection, and surgical method used were reviewed. We also reviewed published information on the management of perforated gastric carcinoma. The carcinoma was stage I in three cases, stage II in one case, stage III in three cases, and stage IV in nine cases. Many patients had distant metastases. Fourteen patients underwent gastrectomy. Two patients whose preoperative condition was poor died of surgery-related complications, but patients with early-stage carcinoma underwent an R0 resection (resection of the primary tumor with negative margins) and had minimal complications. We conclude that the outcome of patients who were able to undergo radical surgery was good and correlated with the stage of cancer. It is important to perform gastrectomy rather than repair the perforation first, and a proper lymphadenectomy should follow--thus a two-step surgery when necessary.

5
UI - 12025834
AU - Martin RC 2nd; Jaques DP; Brennan MF; Karpeh M
TI - Achieving RO resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection?
SO - J Am Coll Surg 2002 May;194(5):568-77
AD - Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BACKGROUND: In gastric adenocarcinoma, only complete resection (R0) translates into survival benefit. Given the potential for increased morbidity and mortality from multiple organ resection we asked the question as to whether extended (multiple organ) resection was justified 1,283 patients underwent gastric resection for adenocarcinoma at Memorial Sloan-Kettering Cancer Center, and were entered and followed in a prospectively recorded database. Four hundred eighteen patients (33%) underwent primary resection and had one or more organs resected in addition to the stomach. Eight hundred twenty-six patients (64%) underwent gastrectomy alone, with 39 patients (3%) not undergoing gastrectomy. Clinicopathologic, operative, and morbidity data were evaluated in this group. Complications were categorized by severity on a scale from 0 to 5, 0 being no complication to 5 being death. Chi-square analysis and the logistic regression method were used to compare and estimate factors significantly associated with having a complication. RESULTS: Three hundred thirty-seven patients had a single additional organ resected, 63 had two organs, and 18 had three organs. Five hundred eighty complications occurred in 33% of patients (404 of 1,283). The perioperative mortality was 4% (48 patients). Logistic regression identified the number of organs resected, two or greater, to be predictive of complications (RR 2.0), as well as age greater than 70 years old (RR 1.57). When excluding minor complications (values 1 and 2), only the number of organs resected (RR 3.8) was a major factor for severe complications (values 3, 4, and 5). CONCLUSIONS: Resection of two or more adjacent organs in advanced gastric adenocarcinoma is associated with a greater risk of developing a complication. The use of a graded surgical complication scale is needed for better reporting and comparison of complications. Achieving an R0 resection should still be considered the goal, even in locally advanced gastric cancer, but resection of additional organs should be performed judiciously.

6
UI - 11676261
AU - Klimenkov AA; Nered SN; Gubina GI
TI - [Basic directions in studying cancer of the resected stomach]
SO - Vestn Ross Akad Med Nauk 2001;(9):71-4
The causes, incidence of, and the time of occurrence of cancer of the stomach resected for benign diseases are analyzed. The outcomes of 384 operations for recurrent gastric cancer, including 174 radical ones, are presented. The highest resectability was noted in late recurrence and following Bilroth-II gastrectomy with long-loop forward colonic anastomosis. The late outcomes depend on the time of recurrence, its location in the remaining part of the stomach, and the presence of lymphogenic metastases. Experience of 16 extirpations of esophagojejunal anastomosis was used to show whether recurrent gastric cancer after gastrectomy with satisfactory immediate and long-term outcomes can be surgically treated. The fate of 292 patients with gastric cancer in whom tumor cells were detected along the line of resection is traced. Preventive resurgery in this group of patients is not unjustifiable as in 80.8% of them recurrence fails to occur at all or is followed by late metastases.

7
UI - 11902492
AU - Lin YC; Chen JS; Wang CH; Wang HM; Chang HK; Liaul CT; Yang TS; Liaw CC;
TI - Liu HE Weekly high-dose 5-fluorouracil (5-FU), leucovorin (LV) and bimonthly cisplatin in patients with advanced gastric cancer.
SO - Jpn J Clin Oncol 2001 Dec;31(12):605-9
AD - Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan. yclinof@adm.cgmh.org.tw
BACKGROUND: A phase II clinical trial was performed to evaluate the activity and toxicity of bimonthly cisplatin and weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin in patients with advanced 23 chemo-naive patients of advanced gastric cancer were enrolled in this study. The regimen consisted of weekly 24-h infusion of 5-FU (2,600 mg/m2) and LV 150 mg and bimonthly cisplatin (25-50 mg/m2) bolus for 12 weeks followed by a 2-week break. RESULTS: There were 10 male and 13 female patients with a median age of 52 years. A total of 428 chemotherapy treatments were given with a mean of 11. Seventeen patients were evaluable for response. There were 41% (7/17) partial response, 18% (3/17) stable disease and 41% (7/17) progressive disease. The grade III or IV toxicity included anorexia 35% (8/23), fatigue 26% (6/23), vomiting 17% (4/23) and mucositis 9% (2/23). One patient developed perforated duodenal stump after chemotherapy. One patient died of hyperammonemia-related coma. The median times to disease progression and overall survival were 3.5 and 7 months, respectively. CONCLUSIONS: This regimen showed modest activity against gastric cancer. However, there was no survival advantage and there was greater toxicity than with weekly high-dose 5-FU-LV alone.

8
UI - 11723480
AU - Leme PL; Rodrigues FC; Malheiros CA
TI - [Duodenal-pyloric-antrum obstruction and metabolic disturbances: is important an adequate preoperative care?]
SO - Rev Assoc Med Bras 2001 Jul-Sep;47(3):177-8

9
UI - 11819868
AU - Xu CT; Huang LT; Pan BR
TI - Current gene therapy for stomach carcinoma.
SO - World J Gastroenterol 2001 Dec;7(6):752-9
AD - Editorial Department, the Journal of Fourth Military Medical University, Xi'an, Shaanxi Province, China. xuct2000@263.net

10
UI - 11859986
AU - Pentheroudakis G; Lim KC; Dunlop DJ; Soukop M; Eatock MM
TI - Non-infusional 5-fluorouracil, doxorubicin and cisplatin in the treatment of locally advanced or metastatic gastro-oesophageal adenocarcinoma.
SO - Acta Oncol 2001;40(7):855-61
AD - Department of Medical Oncology, St Mungo Institute, Glasgow Royal Infirmary, Scotland. penther@ukonline.co.uk
To reduce the Hickman line-associated morbidity of continuous infusion 5-fluorouracil combined with epirubicin and cisplatin (ECF) and to investigate the need for infusional regimens, we conducted a retrospective study in patients with advanced gastro-oesophageal adenocarcinoma. Thirty-six patients, with histologically proven irresectable gastro-oesophageal adenocarcinoma were given: 60 mg/m2 cisplatin on day 1, 35 mg/m2 doxorubicin on day 1 and 500 mg/m2 5-fluorouracil on days 1 and 8 (NIACF) every 3-weeks. A median of 3 cycles was administered. The principal toxicity was myelosuppression with grade III/IV neutropenia in 47% of cycles. Neutropenic fever occurred in 5% of the cycles: non-haematological toxicity was mild and there were no treatment-related deaths. Administered dose intensity was 96.1% for doxorubicin, 93.6% for cisplatin and 90.5% for 5-fluorouracil. There were 16 partial responses and 1 complete response (overall response rate 47%, 95% confidence interval CI 31-63%); 8 patients had stable disease. Median progression-free and overall survival rates were 5 months (95% CI 4-6) and 8 months (95% CI 6-10), respectively. NIACF is a well-tolerated regimen in advanced gastro-oesophageal adenocarcinoma that precludes the need for central venous access, with activity similar to that observed with ECF.

11
UI - 11989244
AU - Maehara Y; Kakechi Y; Sumiyoshi Y; Kimura K; Takesue F; Oiwa H; Baba H;
TI - Adachi Y; Tsujiya S; Haraguchi M; Korenaga T; Okamura T; Tamada R; Ichikichi Y [Departmental review of surgical cases in the last 17 years: Stomach cancers]
SO - Fukuoka Igaku Zasshi 2002 Mar;93(3 Suppl):9-11

12
UI - 11979416
AU - Gunderson LL
TI - Gastric cancer--patterns of relapse after surgical resection.
SO - Semin Radiat Oncol 2002 Apr;12(2):150-61
AD - Department of Radiation Oncology, Mayo Medical School and Mayo Foundation, Rochester, MN 55905, USA.
A knowledge of patterns of relapse after initial treatment with surgery alone is essential to determining the relative importance of both local (irradiation) and systemic adjuvants (chemotherapy, other) to surgery. A presentation of anatomic factors and pathways of tumor spread provides a basis for understanding the subsequent patterns of relapse data found in clinical, autopsy, and reoperative series. Implications for adjuvant therapy are summarized. Copyright 2002, Elsevier Science (USA). All rights reserved.

13
UI - 11979417
AU - Kim HJ; Karpeh MS
TI - Surgical approaches and outcomes in the treatment of gastric cancer.
SO - Semin Radiat Oncol 2002 Apr;12(2):162-9
AD - Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Resection with extended lymphadenectomy in obtaining local-regional control with negative margins remains the only potentially curative modality in the treatment of gastric cancer. Complete (R0) resections, along with depth of invasion and adequate nodal staging, remain the most important prognostic factors. Because current chemotherapy regimens have limited benefit in advanced disease, the effectiveness of local-regional modalities takes on greater significance. The extent of surgical resection varies with the size, depth, location of the primary tumor, and the stage of disease. Studying patterns of recurrent disease and elucidating the impact of positive margins have led to insights into the biology of the disease and the limitations of local-regional therapies. Considerable controversy surrounds the notion of what defines an adequate lymph node dissection (LND). The recommendation of routine extended (D2) lymphadenectomy (ELND) is difficult to justify based on available randomized studies, but ELND may benefit selected patients when performed by surgeons who can accomplish the dissection with acceptable morbidity/mortality rates. An extended LND results in improved staging, allowing standardization of prognostic factors and survival data worldwide. Patient selection remains critical, limiting the role of surgery in advanced disease and reserving aggressive surgical resection for patients with high curative potential. Copyright 2002, Elsevier Science (USA). All rights reserved.

14
UI - 11979418
AU - Willett CG
TI - Results of radiation therapy in gastric cancer.
SO - Semin Radiat Oncol 2002 Apr;12(2):170-5
AD - Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Radiation therapy has been used in the treatment of patients with gastric cancer in two clinical settings: definitive therapy for locally advanced, unresectable tumors and adjuvant therapy following surgery for high-risk disease. For patients with locally advanced, unresectable or subtotally resected gastric carcinoma, radiotherapeutic approaches with and without chemotherapy have been employed, because these tumors appear localized, without clinically detectable metastases. Combined treatment with radiation therapy and chemotherapy appears to prolong survival but rarely results in long-term cure. Although only a modest effect was seen on survival, importantly, these studies established the foundation of contemporary combined-modality therapy and have served to stimulate further clinical investigation in gastric cancer as well as other gastrointestinal disease sites. For patients undergoing resection and lymphadenectomy with curative intent, the development of local or regional failure is common, occurring in 40% to 65% of patients. Sites of local and regional failure following resection include the gastric/tumor bed in 20% to 55%, the anastomosis in 25% to 50%, and the regional nodes in 40% to 50% of patients. Intergroup Trial 0116 (INT 0116), a phase III trial, has recently demonstrated that adjuvant radiation therapy with concurrent and maintenance 5-fluorouracil (5-FU) and leucovorin (LV) reduces local failure and improves survival. Adjuvant therapy is now routinely administered to patients undergoing resection of gastric cancer for high-risk disease. Ongoing trials are now investigating new systemic agents with radiation therapy to establish efficacy compared to 5-FU and LV, as well as evaluating neoadjuvant approaches prior to resection. Copyright 2002, Elsevier Science (USA). All rights reserved.

15
UI - 11979419
AU - Meyerhardt JA; Fuchs CS
TI - Chemotherapy options for gastric cancer.
SO - Semin Radiat Oncol 2002 Apr;12(2):176-86
AD - Department of Adult Oncology, Dana Farber Cancer Institute, Boston, MA 02115, USA.
Most patients diagnosed with gastric cancer in the United States and the Western World will either present with advanced disease or have recurrence after surgery, requiring discussions of chemotherapy. The evolution of chemotherapy for gastric cancer has been mixed with excitement and disappointment. Multiple single-agent chemotherapies have been shown to be only modestly effective in advanced disease, and the search for the best combination of therapy has been difficult. Contemporary combination therapies for advanced gastric cancer, usually containing 5-fluorouracil (5-FU) and/or cisplatin, demonstrate response rates in the 20% to 40% range, with median survivals between 6 and 12 months. While newer, standard chemotherapeutics, including the taxanes and irinotecan, may offer modest additional benefits, each requires further examination in phase III trials. Among patients with curatively resected disease, postoperative chemoradiotherapy appears to improve overall survival significantly. As a greater understanding of the molecular basis of gastric cancer is gained, the inclusion of biologic-based therapies will hopefully advance our ability to treat patients with gastric cancer more effectively. Copyright 2002, Elsevier Science (USA). All rights reserved.

16
UI - 11979420
AU - Tepper JE; Gunderson LL
TI - Radiation treatment parameters in the adjuvant postoperative therapy of gastric cancer.
SO - Semin Radiat Oncol 2002 Apr;12(2):187-95
AD - Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. tepper@radonc.unc.edu
Radiation therapy will be used much more commonly in the treatment of adenocarcinoma of the stomach because of the results of the Intergroup Trial demonstrating an advantage to adjuvant postoperative chemoradiation therapy. Previous descriptions of radiation fields have not emphasized the variation in local spread patterns between tumors located in different portions of the stomach and the varying extent of the primary tumor and lymph node spread. Based on data obtained from surgical and pathologic series, we have recommended a variation in the radiation fields from those routinely applied at the present time. Tumors located primarily in the region of the gastric cardia have the highest risk of nodal involvement in the pericardial region and along the lesser and greater curvature, as well as risk of spread into the periesophageal tissue. However, there is a lower risk of involvement in the distally located nodes, especially in the gastric antrum, periduodenal, and porta hepatis regions. For a patient who has been well evaluated both surgically and pathologically, and found to be node negative, it may not be necessary to treat the nodes in these lower risk sites. Similarly, tumors that originate in the distal stomach, in the region of the gastric antrum, have a high likelihood of spread to the periduodenal, peripancreatic, and porta hepatis nodes, and a lower likelihood of spread to the nodes near the cardia of the stomach, the periesophageal and mediastinal nodes, or to the splenic hilar nodes. Any tumor originating in the stomach has a high propensity of spread to nodes along the greater and lesser curvature, although they are most likely to spread to those sites in close anatomic proximity to the primary tumor mass. Based on such information, we have described the nodal and primary sites that should be treated for different T- and N-stage tumors located in the cardia, body, or antrum of the stomach. These should be used as guides for defining appropriate field arrangements for the adjuvant postoperative therapy of gastric cancer. Copyright 2002, Elsevier Science (USA). All rights reserved.

17
UI - 12049068
AU - Allum WH; Griffin SM; Watson A; Colin-Jones D; Association of Upper
TI - Gastrointestinal Surgeons of Great Britain and Ireland; British Society of Gastroenterology; British Association of Surgical Oncology Guidelines for the management of oesophageal and gastric cancer.
SO - Gut 2002 Jun;50 Suppl 5():v1-23
AD - Department of Surgery, Epsom Hospital, Epsom, Surrey KT1 7EG, United Kingdom

18
UI - 12046427
AU - Malatinec J; Bruncak P; Pelc J; Kovacs V; Cseri J
TI - [Results of surgical treatment of gastric cancer]
SO - Rozhl Chir 2002 May;81(5):240-3
AD - Chirurgicke oddelenie, NsP Lucenec, Slovenska republika.
The authors retrospectively analyse a group (1991-2000) of 129 patients with malignancies of the stomach operated at the Surgical Department of The District Hospital in Lucenec. The operated patients were: males 83 (64%), females 46 (36%), mean age--63.4 years. Elective operations were performed in 78.2% and acute operations in 21.8%. We were able to make resections in 90 (69.8%) patients and palliative operations in 39 (30.2%) patients. On the basis of histologic examinations-adenocarcinomas dominated (120 patients--93%). The postoperative mortality was 4.65% and five-year survival 12%.

19
UI - 11557900
AU - Segol P
TI - [Total esophagogastrectomy via left throacophrenic access for cancer of the cardia]
SO - J Chir (Paris) 2001 Aug;138(4):217-21
AD - Service de Chirurgie Digestive, CHU Caen Cote de Nacre, Caen, France.

20
UI - 11682961
AU - Adani GL; Marcello D; Mazzetti J; Maestroni U; Anania G; Donini A
TI - [Role of surgery in the treatment of primary gastric lymphoma and assessment of new therapeutic approaches]
SO - G Chir 2001 Aug-Sep;22(8-9):273-6
AD - Dipartimento di Scienze Chirurgiche, Anestesiologiche e Radiologiche Sezione di Clinica Chirurgica, Universita degli Studi di Ferrara.
Controversy remains regarding the best treatment for primary gastric lymphoma (PGL). Recent developments in diagnosis and chemotherapy have changed strategies for this disease. Fourteen patients with primary gastric non-Hodgkin's lymphoma underwent surgery. Before surgery 9/14 patients underwent Helicobacter pylori eradication, and 4/14 were treated with chemotherapy. In two patients chemotherapy was not possible because of risk of perforation recurred. Total gastrectomy with N2 lymphadenectomy, splenectomy, biopsy of mesenteric lymph nodes, and hepatic biopsy were done. Then patients underwent post-operative chemotherapy. Involved-field radiation therapy was made in four patients. The overall survival was 64.2 percent. Surgery was the treatment of choice in cases of gastric lymphoma non-responsive to medical therapy and to control complications or when gastroscopy did not supply correct diagnosis.

21
UI - 11992807
AU - Newman E; Marcus SG; Potmesil M; Sewak S; Yee H; Sorich J; Hayek M;
TI - Muggia F; Hochster H Neoadjuvant chemotherapy with CPT-11 and cisplatin downstages locally advanced gastric cancer.
SO - J Gastrointest Surg 2002 Mar-Apr;6(2):212-23; discussion 223
AD - Department of Surgery, New York University School of Medicine, New York, New York 10016, USA. elliot.newman@med.nyu.edu
We examined the role of neoadjuvant therapy in downstaging locally advanced gastric cancer. Preoperative staging was performed with a combination of CT scans, endoscopic ultrasonography and/or laparoscopy, and laparoscopic ultrasonography. Patients with T > or =3 tumors and/or node-positive disease by preoperative clinical staging were eligible for entry. Neoadjuvant therapy consisted of two cycles of CPT-11 (75 mg/m(2)) with cisplatin (25 mg/m(2)) weekly four times every 6 weeks. This was followed by resection with D2 lymph node dissection and two cycles of intraperitoneal chemotherapy with floxuridine and cisplatin. Twenty-two patients were entered into the study (4 with T3N0 disease and 18 with T3N1 disease). Induction chemotherapy was well tolerated with major toxicities being neutropenia and diarrhea. A median of 78%/75% of the planned dosage of CPT-11/cisplatin was delivered. Two patients withdrew consent during the first cycle and were lost to follow-up. One patient progressed to stage IV disease during induction chemotherapy and did not undergo surgery. Nineteen patients underwent surgery. One patient had undetected stage IV disease (liver) and underwent a palliative R2 resection. Of the 18 remaining patients, 17 had curative R0 resections and one had a palliative R1 resection. A median of 21 lymph nodes (range 1 to 121) were examined histologically. There was one postoperative death. Surgical morbidity did not appear to increase after the neoadjuvant regimen. The median postoperative length of hospital stay was 9 days (range 3 to 75 days). Postoperative pathologic staging yielded 16% T3 lesions compared to 85% before treatment based on clinical staging; postoperative American Joint Committee on Cancer staging yielded 37% stage IIIA disease compared to 70% stage IIIA before treatment. With a median follow-up of 15 months, median survival has not yet been reached. We conclude that CPT-11-based neoadjuvant therapy downstages locally advanced gastric cancer. Further follow-up is necessary to determine the ultimate impact of this combination therapy on recurrence and survival.

22
UI - 12017304
AU - Kim R; Yoshida K; Toge T
TI - Current status and future perspectives of post-operative adjuvant therapy for gastric carcinoma.
SO - Anticancer Res 2002 Jan-Feb;22(1A):283-9
AD - Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan. rkim@ipc.hiroshima-u.ac.jp
The clinical benefit of post-operative adjuvant immunochemotherapy for survival of patients with gastric carcinoma is unclear, although a number of prospective randomized controlled studies have been conducted. The current status and future perspectives of post-operative adjuvant chemotherapy in gastric carcinoma have been evaluated in terms of survival benefit. The results of randomized clinical studies vary in accordance with the regimen and sample size. A meta-analysis, however, indicated a survival benefit in patients treated with post-operative adjuvant chemotherapy including mitomycin, anthracyclines, cyclophosphamide, alkylating agents and 5-fluorouracil (odds ratio: 0.8 to approximately 0.82, 95% CI<1.0). The survival benefit was observed in patients with stage II and stage III gastric carcinoma, but not those with stage I. Further, the survival benefit in node-positive and high histological grade subgroups was superior to that in node-negative and low histological grade subgroups. Although combination therapy with mitomycin, 5-fluorouracil and non-specific immunomodulators, such as PSK and OK-432, appeared to improve overall survival without immunomodulators, the survival effect of immunomodulators is still not clear. There are several possible reasons why the survival benefit of adjuvant chemotherapy or immunochemotherapy is small and marginal compared to surgery alone: (i) low efficacy of the chemotherapy regimen; (ii) small sample size; and (iii) differences in chemosensitivity of treated patients based on genetic background. The determination of subgroups responsive to chemotherapy and the development of a rationale-based and molecular-targeted chemotherapy are required to clearly demonstrate whether there is a survival benefit of post-operative adjuvant chemotherapy in gastric carcinoma.

23
UI - 12017305
AU - Inada T; Ogata Y; Kubota T; Ishihara M; Tomikawa M; Ando J; Ozawa I;
TI - Hishinuma S; Shimizu H; Kotake K D2-lymphadenectomy improves the survival of patients with peritoneal cytology-positive gastric cancer.
SO - Anticancer Res 2002 Jan-Feb;22(1A):291-4
AD - Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan. tinada@tcc.pref.tochigi.jp
BACKGROUND: According to the current Japanese Classification of Gastric Cancer, patients with peritoneal cytology-positive (CY1) gastric cancer are classified as stage IV and the curative potential of resection for these patients is regarded as non-curative. MATERIALS AND METHODS: We compared the clinical outcome of CY1 patients (n=55) with those of patients with other non-curative factors (n=87), to clarify the optimal surgical strategy for CY1 patients. RESULTS: The 5-year survival rate of CY1 patients was 10.8%, which was significantly better than that observed in the patients with the other non-curative factors. Among CY1 cases, survival outcome of the patients with lymph node metastasis limited to within group 2 was significantly better than the patients with group 3 lymph node metastasis. CONCLUSION: These results suggested that gastrectomy combined with extended lymphadenectomy should be recommended for patients with gastric cancer who have positive peritoneal cytology as the only non-curative factor.

24
UI - 11813582
AU - Nakamura H; Yanai H; Nishikawa J; Okamoto T; Hirano A; Higaki M; Omori
TI - K; Yoshida T; Okita K Experience with photodynamic therapy (endoscopic laser therapy) for the treatment of early gastric cancer.
SO - Hepatogastroenterology 2001 Nov-Dec;48(42):1599-603
AD - First Department of Internal Medicine, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
BACKGROUND/AIMS: Photodynamic therapy has been developed as an endoscopic laser therapy for gastrointestinal malignant tumors. The targets for curative upper gastrointestinal endoscopic therapy are carcinomas that are considered statistically unlikely to be accompanied with metastases to the lymph nodes. Endoscopic mucosal resection is the therapy of first choice for such carcinomas. In the application of photodynamic therapy, we narrow down its practical indications to patients who are not indicated for curative endoscopic treatment by preoperative examination or those with histologic findings of endoscopic mucosal resection specimens who reject surgical treatment or are at high risk in surgical treatment. METHODOLOGY: The effect of photodynamic therapy using Porfimer sodium and an Excimer dye laser was evaluated endoscopically in 8 lesions of 7 patients with early gastric cancer. RESULTS: Complete responses were obtained in all patients. As side effects, mild photosensitivity was seen in 6 patients and lasted for several months. CONCLUSIONS: Photodynamic therapy was safety employed, with success in 7 patients with early gastric cancer. We conclude that photodynamic therapy can be a useful palliative method with high tumor selectivity in the treatment of early gastric cancer.

25
UI - 11813627
AU - Ichikawa D; Ueshima Y; Shirono K; Kan K; Shioaki Y; Lee CJ; Hamashima T;
TI - Deguchi E; Ikeda E; Mutoh F; Oka T; Kurioka H Esophagogastrostomy reconstruction after limited proximal gastrectomy.
SO - Hepatogastroenterology 2001 Nov-Dec;48(42):1797-801
AD - Department of Surgery, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan. dichykawa@nifty.com
BACKGROUND/AIMS: Recent advances in diagnostic techniques have led to the detection of an increasing number of early gastric cancers in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for these cancers. METHODOLOGY: The clinicopathologic characteristics of 35 patients with early gastric cancer in the upper third of the stomach who underwent three different types of gastrectomies were reviewed retrospectively from hospital undergoing limited proximal gastrectomy with esophagogastrostomy reconstruction had shorter operation times and less blood loss than those for patients undergoing total gastrectomy or proximal gastrectomy with jejunal interposition. No lymph node metastasis was identified in any of these patients. Heartburn due to reflux esophagitis was seen in a few patients of each group, but they were successfully treated by antacids. The extreme reduction in food intake volume was more frequently experienced in patients with total gastrectomy than those with both proximal gastrectomies. When mortality due to other disease was excluded, all patients survived without recurrence. CONCLUSIONS: A limited proximal gastrectomy with esophagogastrostomy reconstruction decreased surgical risk and realized preservation of maximal function.

26
UI - 11813628
AU - Lee JH; Noh SH; Lah KH; Choi SH; Min JS
TI - The prognosis of stage IV gastric carcinoma patients after curative resection.
SO - Hepatogastroenterology 2001 Nov-Dec;48(42):1802-5
AD - Department of Surgery, Yonsei University College of Medicine, C.P.O. Box 8044, 134 Shinchon-dong, Seadaemun-ku, 120-752, Seoul, Korea.
BACKGROUND/AIMS: In the UICC staging system, stage IV contains not only those patients with distant metastasis but also patients with far-advanced T and N status but without distant metastasis. We investigated the prognostic factors of stage IV gastric carcinoma patients, without distant metastasis after curative resection and the role of surgery. METHODOLOGY: One hundred and ninety stage IV gastric carcinoma patients, without distant metastasis were reviewed after RESULTS: Male sex, distal third location, diffuse or infiltrative type and histologically undifferentiated type were common. Of the 190 patients, 52 (27.4%) patients lived more than 3 years. The lymph node ratio (positive lymph node/retrieved lymph node) and combined resection independently affected survival (P = 0.0013, 0.0061, respectively). The perigastric lymph node ratio was well correlated with overall lymph node ratio (r = 0.794, P < 0.001). CONCLUSIONS: With the involvement of an adjacent organ and knowing the perigastric lymph node ratio, the surgeon can decide upon the extent of dissection and postoperative treatment. However, a prospective study is warranted.

27
UI - 11460069
AU - Franciosi CM; Angelini C; Mussi C; Sartori P; Romano F; De Fina S;
TI - Uggeri F [Stomach lymphoma]
SO - Minerva Chir 2001 Aug;56(4):337-43
AD - Divisione di Clinica Chirurgica Generale I, Ospedale San Gerardo, II Universita di Milano, Bicocca, Monza, Milan, Italy.
BACKGROUND: Primitive gastric lymphoma (PGL) is a rare tumour, and although its incidence is rising it is difficult to state the role of the various therapeutic methods in treating this disease. Aim of this study is to point out what sequence of treatment is more effective trying to find out some guidelines which can be useful in clinical practice. METHODS: Retrospective analysis of clinical data of 54 patients with PGL admitted at a University surgical department during 10 years. All the patients underwent neoadjuvant or adjuvant chemotherapy and D2 gastrectomy. Follow-up ranged from 6 to 120 months. Survival was related to: Mushoff's stage of disease, the grade according to the Working Formulation and the sequence of treatment. Statistical analysis was performed by Kaplan-Maier method and the difference between survival curves was compared by log-rank test. RESULTS: Mean postoperative hospital stay was 12 days and morbidity was 18%. Five and 10 years overall survival rates were 70 and 85%. There was a significant difference in survival between patients with high grade PGL and those with intermediate grade (p=0.0188) as well as in those with low grade (p=0.0435). Patients in stages IE-II1E had a significantly longer survival than those in stages IIIE-IVE (p=0.0123). Patients in stages IE-II1E underwent neadjuvant chemotherapy and surgery and survived longer than those in whom surgery preceded chemotherapy (p=0.0293) instead for patients in stages IIIE-IVE neoadjuvant chemotherapy shortened survival (p=0.0403). CONCLUSIONS: In personal opinion, in patients in stages IE-II1E chemotherapy should be carried out before surgery, while in those in stages IIIE-IVE the reverse scheme is more effective in achieving longer survival rates.

28
UI - 11933115
AU - Melchart D; Clemm C; Weber B; Draczynski T; Worku F; Linde K;
TI - Weidenhammer W; Wagner H; Saller R Polysaccharides isolated from Echinacea purpurea herba cell cultures to counteract undesired effects of chemotherapy--a pilot study.
SO - Phytother Res 2002 Mar;16(2):138-42
AD - Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitat, Kaiserstrasse 9, 80801 Munich, Germany. Dieter.Melchart@lrz.tu-muenchen.de
In an open prospective study with matched historical controls we aimed to evaluate whether a polysaccharide fraction isolated from the herb Echinacea purpurea could counteract the undesired effects of chemotherapy. Fifteen patients with advanced gastric cancer undergoing palliative chemotherapy with etoposide, leucovorin and 5-fluorouracil (ELF) received for 10 days (beginning 3 days before chemotherapy) daily i.v. injections of 2 mg of a polysaccharide fraction isolated from Echinacea purpurea herb cell cultures (EPS-EPO VIIa). The median number of leukocytes 14-16 days after chemotherapy was 3630/microL (range 1470-5770) in the patients receiving EPS-EPO VIIa compared with 2370/microL (870-3950) in the patients of the historical control group (p = 0.015). EPS-EPO VIIa had no clinically relevant effects on phagocytic activity of granulocytes or on lymphocyte subpopulations. Sixty-eight adverse events including two deaths were observed, most likely due to chemotherapy and the general condition of the patients. However, an association with the test intervention cannot be ruled out completely. The results of this pilot study suggest that EPS-EPO VIIa might be effective in reducing chemotherapy-induced leukopenia. The efficacy and safety should be investigated in further studies. Copyright 2002 John Wiley & Sons, Ltd.

29
UI - 11976838
AU - Liu JM; Chen LT; Chao Y; Li AF; Wu CW; Liu TS; Shiah HS; Chang JY; Chen
TI - JD; Wu HW; Lin WC; Lan C; Whang-Peng J Phase II and pharmacokinetic study of GL331 in previously treated Chinese gastric cancer patients.
SO - Cancer Chemother Pharmacol 2002 May;49(5):425-8
AD - Division of Cancer Research, National Health Research Institutes, Veterans General Hospital-Taipei, Shipai Road, Taipei, Taiwan.
PURPOSE: A phase II and pharmacokinetic study was designed to assess the efficacy and toxicity profile of an epidophyllotoxin analogue, GL331, in previously treated Chinese gastric cancer patients, with concurrent pharmacokinetic evaluation of the drug's metabolism. MATERIAL AND METHODS: GL331 was given at 200 mg/m(2) as a daily 3-h infusion for 5 days every 4 weeks. RESULTS: Enrolled in the study were 15 patients. One patient died from neutropenic sepsis before evaluation, one patient did not receive the full dose for reasons unrelated to GL331, nine patients had progressive disease with a median survival of 80 days, and five had stable disease with a median survival of 240 days. Grade 3 and 4 myelosuppression occurred in 10 of the 15 patients, with one death from neutropenic sepsis. This patient's peak GL331 concentration was 16.8 microg/ml, which was high compared to the mean peak drug concentration of 6+/-4.1 microg/ml. The mean systemic GL331 clearance was 12.1+/-7.2 l/h per m(2), much lower than 23.3+/-8.2 l/h per m(2) found in the phase I trial. Topoisomerase IIalpha was determined by immunohistochemistry and overexpression was detected in 3 of 11 specimens. CONCLUSIONS: GL331 was ineffective at this dose and schedule in this group of patients in spite of adequate blood levels of the drug.

30
UI - 12056462
AU - Yokota T; Saito T; Teshima S; Yamada Y; Iwamoto K; Takahashi M; Kunii Y;
TI - Murata K; Ishiyama S; Yamauchi H Probability of lymph node metastasis in small gastric cancer tumor: is it an indication for limited surgery?
SO - Int Surg 2001 Oct-Dec;86(4):206-9
AD - Department of Surgery, Sendai National Hospital, Japan. yokota-t@snh.go.jp
The purpose of this study was to determine the factors that are predictive of lymph node metastasis in a small gastric cancer tumor <2 cm in diameter. The clinicopathological features of 17 patients with node-positive small gastric cancer were reviewed from the database of gastric cancer at the Department of Surgery, Sendai National Hospital, Sendai, Japan, and they were compared with those of 131 patients with node-negative cancer. The independent risk factors influencing the lymph node metastasis were determined by multiple logistic regression analysis. Depth of invasion, macroscopic appearance, cancer-stromal relationship, and lymphatic microinvasion were found to be associated with lymph node metastasis. The variables found to be significant risk factors for lymph node metastasis were depth of invasion (P = 0.0250) and lymphatic microinvasion (P = 0.0028). It is possible for even a small gastric cancer tumor to have lymph node metastasis. A surgeon treating a small gastric cancer tumor must consider that although the cure rate is high, >10% of these tumors have lymph node metastases. Because of the possibility of lymph node metastasis, even with accurate knowledge of the depth of cancer invasion, selective performance of local resection or limited surgery with incomplete lymph node dissection is not justified. Accurate preoperative diagnosis and the appropriate decision for surgical indication are important. Large-scale randomized, controlled trials should be performed to show the advantage of limited surgery for gastric cancer.

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