Surgical management of cancer of the stomach and gastroesophageal junction after neoadjuvant therapy: the experience of the MRRC and literature review
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Published:2023-02-22
Issue:1
Volume:22
Page:101-109
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ISSN:2312-3168
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Container-title:Siberian journal of oncology
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language:
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Short-container-title:Sib. onkol. ž.
Author:
Skoropad V. Yu.1ORCID, Kudryavtsev D. D.1ORCID, Sokolov P. V.1ORCID, Ivanov S. A.2ORCID, Kaprin A. D.3ORCID
Affiliation:
1. A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia 2. A. Tsyb Medical Radiological Research Centre – branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russia;
RUDN University 3. National Medical Research Radiological Centre of the Ministry of Health of the Russia;
RUDN University
Abstract
Itroduction. Gastric cancer incidence and mortality rates remain very high worldwide, including the Russian Federation. More than 50 % of gastric cancers are locally advanced at presentation [1]. Perioperative or adjuvant chemotherapy is a standard treatment for gastric cancer patients. The use of neoadjuvant chemoradiotherapy is considered very promising.Material and Methods. We present the analysis of the results of surgical treatment of cancer of the stomach and gastrooesophageal junction after various options of neoadjuvant therapy: chemotherapy, chemoradiotherapy, and their combinations. The experience of the Medical Radiological Research Centre (MRRC), including 5 clinical prospective studies and one randomized multicenter clinical trial, was analyzed. A total of 237 patients with histologically proven locally advanced cancer of the stomach and gastro-oesophageal junction were included into the study. Of these patients, 202 received neoadjuvant therapy. Our treatment outcomes were compared with those of randomized trials published over the last 15 years.Results. Of 202 patients who received neoadjuvant therapy, 190 (94 %) underwent surgery (R0 resection: 184 patients). In the early postoperative period, complications were observed in 62 patients (32.6 %). Re-surgery was performed in 11 (5.8 %) patients. Postoperative mortality was 1.6 % (3 patients). Multicenter randomized studies and meta-analyses, as well as the long-term experience of MRRC, have shown that neoadjuvant therapy does not increase the number of postoperative complications and mortality, increases the rate of R0 resections and improves long-term treatment outcomes in patients with resectable locally advanced cancer of the stomach and gastro-oesophageal junction.Conclusion. Analysis of long-term clinical studies conducted at the MRRC as well as the treatment results published by other authors show that in some cases neoadjuvant therapy can lead to soft tissue changes in a surgical area and may complicate surgical management; however, it does not have a negative impact on the rates of postoperative complications and mortality.
Publisher
Tomsk Cancer Research Institute
Subject
Cancer Research,Oncology
Reference20 articles.
1. Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2019 (incidence and mortality). Moscow, 2020. 252 p. (in Russian). 2. Al-Batran S.E., Homann N., Pauligk C., Goetze T.O., Meiler J., Kasper S., Kopp H.G., Mayer F., Haag G.M., Luley K., Lindig U., Schmiegel W., Pohl M., Stoehlmacher J., Folprecht G., Probst S., Prasnikar N., Fischbach W., Mahlberg R., Trojan J., Koenigsmann M., Martens U.M., Thuss-Patience P., Egger M., Block A., Heinemann V., Illerhaus G., Moehler M., Schenk M., Kullmann F., Behringer D.M., Heike M., Pink D., Teschendorf C., Löhr C., Bernhard H., Schuch G., Rethwisch V., von Weikersthal L.F., Hartmann J.T., Kneba M., Daum S., Schulmann K., Weniger J., Belle S., Gaiser T., Oduncu F.S., Güntner M., Hozaeel W., Reichart A., Jäger E., Kraus T., Mönig S., Bechstein W.O., Schuler M., Schmalenberg H., Hofheinz R.D.; FLOT4-AIO Investigators. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019; 393(10184): 1948–57. doi: 10.1016/S0140-6736(18)32557-1. 3. Leong T., Smithers B.M., Haustermans K., Michael M., Gebski V., Miller D., Zalcberg J., Boussioutas A., Findlay M., O’Connell R.L., Verghis J., Willis D., Kron T., Crain M., Murray W.K., Lordick F., Swallow C., Darling G., Simes J., Wong R. TOPGEAR: A Randomized, Phase III Trial of Perioperative ECF Chemotherapy with or Without Preoperative Chemoradiation for Resectable Gastric Cancer: Interim Results from an International, Intergroup Trial of the AGITG, TROG, EORTC and CCTG. Ann Surg Oncol. 2017; 24(8): 2252–8. doi: 10.1245/s10434-017-5830-6. 4. Liu X., Jin J., Cai H., Huang H., Zhao G., Zhou Y., Wu J., Du C., Long Z., Fang Y., Ma M., Li G., Zhou M., Yin J., Zhu X., Zhu J., Sheng W., Huang D., Zhu H., Zhang Z., Lu Q., Xie L., Zhang Z., Wang Y. Study protocol of a randomized 41 phase III trial of comparing preoperative chemoradiation with preoperative chemotherapy in patients with locally advanced gastric cancer or esophagogastric junction2 adenocarcinoma: PREACT. BMC Cancer. 2019; 19. https://doi.org/10.1186/s12885-019-5728-8. 5. Slagter A.E., Jansen E.P.M., van Laarhoven H.W.M., van Sandick J.W., van Grieken N.C.T., Sikorska K., Cats A., Muller-Timmermans P., Hulshof M.C.C.M., Boot H., Los M., Beerepoot L.V., Peters F.P.J., Hospers G.A.P., van Etten B., Hartgrink H.H., van Berge Henegouwen M.I., Nieuwenhuijzen G.A.P., van Hillegersberg R., van der Peet D.L., Grabsch H.I., Verheij M. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. BMC Cancer. 2018; 18(1): 877. doi: 10.1186/s12885-018-4770-2.
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