Full Text:

 

¿µ³²ÀÇ´ëÇмúÁö Vol.24_No.2 Suppl. P.S125-131, Dec. 2007

Review

ÁøÇà À§¾ÏÀÇ Ä¡·á

Treatment of Advanced Gastric Cancer

¼Û¼±±³
¿µ³²´ëÇб³ Àǰú´ëÇÐ ¿Ü°úÇб³½Ç
Ã¥ÀÓÀúÀÚ£º¼Û¼±±³, ´ë±¸±¤¿ª½Ã ³²±¸ ´ë¸íµ¿ 317-1, ¿µ³²´ëÇб³ Àǰú´ëÇÐ ¿Ü°úÇб³½Ç
Tel: (053) 620-3586, Fax: (053) 624-1213
E-mail: sksong@med.yu.ac.kr

December 30, 2007

Abstract

Curative surgery is the most common and desirable treatment for advanced gastric cancer(AGC), but macroscopically curative resection of AGC dose not always mean a curative outcome. For the tailored management of AGC, accurate preoperative stage are made by using abdominal CT, FDG PET and laparoscopy is necessary. In case of T3/T4 lesion, neoadjuvant chemotherapy(NAC) and neoadjuvant chemoradiotherapy(NACR) are effective therapeutic approaches with acceptable toxicity without increasing surgical morbidity and mortality. I recommend the use of a multidisciplinary therapeutic strategy for treatment of AGC. Future applications of newer cytotoxic drugs such as oxaliplatin, capecitabine, irinotecan, and docetaxel or targeted therapies may help to improve the management of AGC.

Key Words: Neoadjuvant chemotherapy, Preoperative staging, Gastric cancer

References

1. Willis S, Truong S, Gribnitz S, et al: Endoscopic ultrasonography in the Preoperative staging of gastric cancer. Accuracy and impact on surgical therapy. Surg Endosc 2000;14:951-4.

2. Mani NB, Suri S, Gupta S, et al: Two-phase dynamic contrast-enhanced computed tomography with water-filling method for staging of gastric carcinoma. Clin Imaging 2001;25:38-43.

3. Sarela AI, Miner TJ, Karpeh MS, et al: Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg 2006;243: 189-195.

4. Kota Mukai, Yasuhiko Ishida, Kunio Okajima, et al: Usefulness of preoperative FDG-PET for detection of gastric cancer. Gastric cancer 2006;9:192-6.

5. Katja Ott, Wolfgang A. Weber, Florian Lordick, et al: Metabolic inaging predicts response, survival and recurrence in adenocarcinomas of the esophagogastrci junction. J of Clin Oncol 2006;24(29):4692-8.

6. Songun I, Keizer HJ, Hermans J, et al: Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTH trial. The Dutch Gastic Cancer Group(DGCG). Eur J Cancer 2006;30:643-9.

7. Nishi M, Omori Y, Miwa K: Japanese classification of gastric cancer. 1st english ed, Kanehara Co, Tokyo, 1995, p16.

8. Maruyama K, Sasako M, Kinoshita T: Role of systematic extended lymph node dissection, Japanese experience. In Nishi M, Schikawa H, Nokajima T, Maruyama K, Tahara E(Eds): Gastric Cancer. Tokyo, Springer-Verlag, 1993.

9. Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ, German Gastric Carcinoma study Froup: Prognostric relevance of systematic lymph node dissection in gastric carcinoma. Br J Surg 1993;80:1015-24.

10. Preusser P, Wilke H, Achterrath W, et al. Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer. J clin Oncol 1989;7: 1310-7.

11. Kelsen D, Karpeh M, Schwartz G, et al. Neoadjuvant therapy of high-risk gastric cancer: a phase II trial of preoperative FAMTX and postoperative intraperitoneal fluoruracil-cisplatin plus intravenous fluorouracil. J Clin Oncol 1996;14:1818-28.

12. Sun-Kyo Song, Sang-Woon Kim. Neoadjuvant chemotherapy with FLEP therapy for advanced gastric cancer: Evaluation of intraaortic and intravenous FLEP infusion. In T. Nakajima, T. Yamaguchi eds: Multimodality therapy for gastric cancer: Springer-Verlag. Tokyo. 1999: 108-12.

13. Songun I, Keizer HJ, Hermans J, et al: Chemotherapy for operable gastric cancer: results of the Dutch randomised FAMTH trial. The Dutch Gastic Cancer Group(DGCG). Eur J Cancer 2006;30:643-9.

14. Hartgrink HH, van de Celde CJ, Putter H, et al. Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Sung Oncol 2004;30:643-9.

15. Cunningham D, Allum WH, Stenning SP, et al: Preioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20.

16. Ychou M, Pignon JP, Lasser P, et al: Phase III preliminary results of preoperative fluorouracil (F) and cisplatin (C) versus surgery alone in adenocarcinoma of stomach and lower esophagus(ASLE): FNCLCC 94012-FFCO9703 trial [abstract]. Proc Am Soc Clin Oncol 2006;24(18S): Abstract 4026.

17. Waish TN, Noonan N, Hollywood D, et al: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462-467, 1996.

18. Ajani JA, Mansfield PF, Janjan N, et al: Multiinstitutional trial of preoperative chemo- radiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol 2004;23:2774-80.

19. Ajani JA, Winter K, Okawara GS, et al: Phase II trial of preoperative chemoradiation in patients with localized gastric adenocarcinoma (RTOG 9904): Quality of combined modality therapy and pathologic respinse. J Clin Oncol 2006;24:3953-8.

20. Hermans J, Bonenkamp M, Boon A, et al: Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 1993;11:1441-7.

21. Earle C, Maroun J: Adjuvant chemotherapy after curative resection for gastric cancer in non-asian patients: revisiting a meta-analysis of randomized trials. Eur J Cancer 1999;35 (7):1059-64.

22. Wansik Yu, Ilwoo Whang, Hoyoung chung, et al: Indications for early postoperative intraperi- toneal chemotherapy of advanced gastric cancer: Results of a prospective randomized trial. World J Surg 2001;25:985-90.

23. Crookes P, Leichman CG, Leichman L, et al: Systemic chemotherapy for gastric carcinoma followed by postoperative intraperitoneal therapy: a final report. Cancer 1997;79:1767-75.

24. Macdonald J: Postoperative combined radiation and chemotherapy improves disease-free survival (DFS) and overall survival(OS) in resected adenocarcinoma of the stomach and gastro- oesophageal junction: Update of the results of Intergroup Study INT-0116(SWOG9008) [abstract]. In: American Society of Clinical Oncology 2004 Gastrointestinal Cancers Symposium; 5-7 June 2004; New Orleans. Alexandria: ASCO. Abstract 6.