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Raptis D, Maak M, Krautz C, Merkel S, Brunner M, Agaimy A, Hartmann A, Semrau S, Ott O, Rainer F, Siebler J, Grützmann R, Hohenberger W, Schildberg CW. Surgical and oncological outcome after extended lymph node dissection for carcinoma of the stomach and the esophagogastric junction: a retrospective analysis from an experienced single center. Arch Med Sci 2021; 20:124-132. [PMID: 38414452 PMCID: PMC10895969 DOI: 10.5114/aoms/141165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 08/10/2021] [Indexed: 02/29/2024] Open
Abstract
Introduction Gastric cancer remains the fourth leading cause of cancer-related death in Europe, while the proportion of adenocarcinomas of the esophagogastric junction has risen by more than one third over recent years. In 2018, 14,700 new cases of gastric cancer were estimated in Germany, while the 5-year relative survival rate is reported to be 33% for women and 30% for men; in the USA almost the same rate was reported, with 31% 5-year survival. Material and methods Between 2001 and 2014, 590 patients with a diagnosis of gastric cancer underwent surgery in our institution, including 120 Siewert type II/III carcinomas of the esophagogastric junction. All patients underwent distal resection of the stomach, gastrectomy or total gastrectomy combined with transhiatal distal esophageal resection. All operations included D2-D3 lymph node dissection (LND). Data were recorded by the cancer registry of the department of surgery and analyzed retrospectively. Results The patients were classified according to the TNM (UICC 2010) and Lauren classification. 29% of the patients underwent primary surgery and 31% received neoadjuvant therapy. The median number of harvested lymph nodes was 33 for patients diagnosed with gastric cancer, and 29 for esophagogastric adenocarcinomas, respectively. The anastomotic leak rate was 3%. In this study, the 5-year overall survival rate was 51% concerning gastric carcinomas, 44% for Siewert type II and 47% for Siewert III cancers of the esophagogastric junction. Conclusions Increased survival with low complication rates were achieved after individualized and multimodal treatment concepts combined with consistently applied extended lymphadenectomy.
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Affiliation(s)
- Dimitrios Raptis
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
- 2 Surgical Department, Aristotle University of Thessaloniki, Ethnikis Thessaloniki, Greece
| | - Matthias Maak
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Krautz
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Susanne Merkel
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Maximilian Brunner
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fietkau Rainer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Siebler
- Department of Internal Medicine 1 – Gastroenterology, Pulmonology and Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Robert Grützmann
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Hohenberger
- Surgical Department, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus-Wilhelm Schildberg
- Department of Surgery, Brandenburg Medical School, University Hospital, Brandenburg/Havel, Germany
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Glimelius B, Stintzing S, Marshall J, Yoshino T, de Gramont A. Metastatic colorectal cancer: Advances in the folate-fluoropyrimidine chemotherapy backbone. Cancer Treat Rev 2021; 98:102218. [PMID: 34015686 DOI: 10.1016/j.ctrv.2021.102218] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
Notwithstanding recent treatment advances in metastatic colorectal cancer (mCRC), chemotherapy with a combination of a fluoropyrimidine and a folate agent, often 5-fluorouracil (5-FU) and leucovorin, remains the backbone of treatment regimens for the majority of patients with mCRC. This is despite a recent focus on molecular-targeted treatments and patient stratification according to mutational status or expression levels of specific genes. Intracellular folate concentration was discovered to be pivotal in the cytotoxic efficacy of 5-FU, paving the way to the current standard combination therapy approach. Subsequent discovery that systemic chemotherapy agents, such as irinotecan and oxaliplatin, can further increase the efficacy of 5-FU-based treatments led to the development of several combination chemotherapy regimens, including FOLFOX, FOLFIRI and FOLFOXIRI. Subsequent efforts to optimise 5-FU-based treatments have focused on 5-FU analogues, initially capecitabine and the combination drug tegafur/gimeracil/oteracil (S-1) and then TAS-102, which has recently been evaluated in phase 3 clinical trials for refractory colorectal cancer. Further approaches taken to improve the efficacy of 5-FU chemotherapy regimens have focused on optimising the route and dosing schedules and regulating folate metabolism. Pharmacokinetic variability caused by the requirement for metabolic conversion of leucovorin has been central to recent research, and the development of agents such as arfolitixorin which bypass the need for metabolic conversion remains promising for future therapeutic candidates. In this review, we summarise the evidence leading to the current treatment regimens employing 5-FU and leucovorin, focusing on recent approaches taken to optimise and refine treatments to improve clinical outcomes in patients with mCRC.
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - Sebastian Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CCM) Charité, University Medicine Berlin, Berlin, Germany
| | - John Marshall
- Georgetown University Medical Center, Washington, DC, USA
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Passardi A, Monti M, Donati C, Foca F, Pagan F, Rapposelli I, Ruscelli S, Bartolini G, Valgiusti M, Matteucci L, Sullo F, Sbaffi S, Crudi L, Frassineti GL, Masini C. Prospective Observational Study Comparing Calcium and Sodium Levofolinate in Combination with 5-Fluorouracil in the FOLFIRI Regimen. Oncologist 2021; 26:e1314-e1319. [PMID: 33764600 DOI: 10.1002/onco.13762] [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: 12/30/2020] [Accepted: 03/12/2021] [Indexed: 11/08/2022] Open
Abstract
LESSONS LEARNED The use of sodium levofolinate (Na-Lev) is safe in combination with continuous infusion 5-fluorouracil in patients with gastrointestinal tumors treated with the FOLFIRI regimen. A comparison with calcium levofolinate (Ca-Lev) showed a similar toxicity profile. The advantages of Na-Lev over Ca-Lev might be the faster drug preparation and the shorter time of drug administration. BACKGROUND The objectives of this study were to compare the safety profiles of sodium levofolinate (Na-Lev) and calcium levofolinate (Ca-Lev) in combination with 5-fluorouracil (5-FU) in the FOLFIRI regimen and to measure the organizational impact of the introduction of Na-Lev on drug production and administration. METHODS The study opened in November 2015 and closed in August 2019. Patients with gastrointestinal cancers who were candidates for treatment with the FOLFIRI regimen were included in this nonrandomized study. Age ≥18 years, life expectancy >3 months, adequate bone marrow reserve, adequate hepatic and renal function, and an ECOG performance status of 0-2 were required. Patients in the Ca-Lev arm received a 2-hour infusion of Ca-Lev followed by 5-FU, whereas those in the Na-Lev arm received Na-Lev and 5-FU administered in a single 48-hour pump. RESULTS Sixty patients were enrolled, 30 in each arm. Patient characteristics were balanced. Grade (G)1-2 adverse events occurred in 18 (60.0%) and 19 (63.4%) patients of Na-Lev and Ca-Lev cohorts, respectively, whereas G3-4 adverse events occurred in 12 (40.0%) and 11 (36.6%) patients, respectively. The use of Na-Lev enabled us to save approximately 13 minutes for drug preparation and 2 hours for treatment administration, per patient per cycle. CONCLUSION Na-Lev showed a reassuring toxicity profile and a favorable impact on drug preparation and administration.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Caterina Donati
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Flavia Pagan
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Ilario Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Martina Valgiusti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Laura Matteucci
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Francesco Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Stefania Sbaffi
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Laura Crudi
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori", Meldola, Italy
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Ratti M, Hahne JC, Toppo L, Castelli E, Petrelli F, Passalacqua R, Barni S, Tomasello G, Ghidini M. Major innovations and clinical applications of disodium-levofolinate: a review of available preclinical and clinical data. Ther Adv Med Oncol 2019; 11:1758835919853954. [PMID: 31210799 PMCID: PMC6552345 DOI: 10.1177/1758835919853954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
The association of folinate salts with 5-fluorouracil (5-FU) represents a gold standard in the treatment of many cancers. In several clinical trials, the simultaneous administration of calcium–folinic acid (Ca-FA) and the prolonged infusion of 5-FU resulted in a better clinical response compared with fluoropyrimidine alone and 5-FU bolus. However, the simultaneous infusion of 5-FU and Ca-FA mixed in the same infusion pump is hindered by the crystallization of calcium salts, which eventually leads to catheter obstruction and damage. The sodium salt of leucovorin-disodium levofolinate (Na-Lv) is a novel molecule with a pharmacological profile similar to Ca-FA. Owing to its higher solubility, it can be safely mixed with 5-FU in a single pump without the risk of precipitation and catheter occlusion. The efficacy and safety of Na-Lv have been widely examined in preclinical and clinical phase II studies in combination with various schedules of 5-FU and in several cancer types. PubMed, EMBASE, SCOPUS and Web of Science databases were searched from inception to November 2018 to retrieve available published phase I and II series, including Western patients. Compared with Ca-FA, Na-Lv shows a more favourable efficacy and toxicity profile in terms of overall response rate, progression-free survival, time to progression and occurrence of severe adverse events. Moreover, it allows treatment time to be shortened, decreasing the number of required human resources for drug administration and limiting the occurrence of catheter damage.
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Affiliation(s)
- Margherita Ratti
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Jens Claus Hahne
- Division of Molecular Pathology, The Institute for Cancer Research, Sutton, UK
| | - Laura Toppo
- Oncology Unit, Dept Medicine, Hospital of Voghera, Italy
| | | | - Fausto Petrelli
- Oncology Unit, Oncology Department, ASST of Bergamo Ovest, Treviglio, Italy
| | - Rodolfo Passalacqua
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Sandro Barni
- Oncology Unit, Oncology Department, ASST of Bergamo Ovest, Treviglio, Italy
| | - Gianluca Tomasello
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Michele Ghidini
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Viale Concordia, 1, Cremona CR, 26100, Italy
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Shen H, Ye XY, Li XF, Pan WS, Yuan Y. Severe esophageal bleeding in colorectal cancer due to antitumor therapy: A case report. Oncol Lett 2015; 10:3660-3662. [PMID: 26788187 DOI: 10.3892/ol.2015.3742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 05/20/2015] [Indexed: 01/14/2023] Open
Abstract
Colorectal cancer is the third most common type of cancer worldwide, with >1 million cases diagnosed each year. Gastrointestinal bleeding is a common complication of colorectal cancer and is usually associated with the erosion and hemorrhage of the primary tumor. However, in patients who undergo a radical hemicolectomy and do not develop local recurrence, gastrointestinal bleeding may be a result of medical treatments or comorbidities. Esophageal bleeding in such patients is rare. Here, a case of severe esophageal bleeding due to anti-angiogenesis therapy with bevacizumab, and chemotherapy with the FOLFIRI regimen (irinotecan, folinic acid and 5-fluorouracil) in a patient with colorectal cancer is reported, and the possible pathogenesis of this event is analyzed based on the existing literature, in order to provide a reference for such cases.
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Affiliation(s)
- Hong Shen
- Department of Medical Oncology, Second Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xian-Yun Ye
- Department of Medical Oncology, Second Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiao-Fen Li
- Department of Medical Oncology, Second Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Second Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Ying Yuan
- Department of Medical Oncology, Second Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Zemanová M, Staňková B, Ušiaková Z, Tvrzická E, Pazdro A, Petruželka L, Zeman M. Serum adiponectin relates to shortened overall survival in men with squamous cell esophageal cancer treated with preoperative concurrent chemoradiotherapy: a pilot study. Med Sci Monit 2014; 20:2351-7. [PMID: 25408239 PMCID: PMC4247235 DOI: 10.12659/msm.891088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/10/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The convergence of nutritional, genetic, and inflammatory factors plays a significant role in the pathophysiology of squamous cell esophageal cancer (SCEC). The parameters of inflammation, indices of nutritional status, and adipocyte-derived hormones such as leptin, adiponectin, and resistin have been shown to be prognostic factors in some gastrointestinal and pancreatic cancers. MATERIAL/METHODS Forty-two patients with SCEC were subjected to a multimodal regimen of concurrent neoadjuvant chemoradiotherapy (CRT) followed by surgery. We retrospectively analyzed the impact of pretreatment values of serum leptin, adiponectin, resistin, soluble leptin receptor, C-reactive protein, TNF alpha, leukocytes, and indices of nutritional status (BMI, plasma total protein, albumin, cholesterol, and triacylglycerols) on overall survival (OS). RESULTS Univariate analysis revealed significant a negative correlation between OS and serum adiponectin (p=0.027), and a positive relationship was found between serum albumin (p=0.002), cholesterol (p=0.049) level, and OS. In multivariate analysis, only the trend (p=0.086) for negative serum adiponectin association with the OS was observed. CONCLUSIONS In men with SCEC treated by neoadjuvant concurrent CRT and esophagectomy, high pretreatment level of serum adiponectin was associated with shorter OS while the serum albumin and cholesterol were associated with longer OS.
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Affiliation(s)
- Milada Zemanová
- Clinic of Oncology, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Barbora Staňková
- 4 Department of Internal Medicine, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Zuzana Ušiaková
- Clinic of Oncology, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Tvrzická
- 4 Department of Internal Medicine, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Alexandr Pazdro
- 3 Clinic of Surgery, 1 Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Luboš Petruželka
- Clinic of Oncology, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Miroslav Zeman
- 4 Department of Internal Medicine, 1 Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
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Schildberg CW, Weidinger T, Hohenberger W, Wein A, Langheinrich M, Neurath M, Boxberger F. Metastatic adenocarcinomas of the stomach or esophagogastric junction (UICC stage IV) are not always a palliative situation: a retrospective analysis. World J Surg 2014; 38:419-25. [PMID: 24146196 DOI: 10.1007/s00268-013-2293-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastric cancer is one of the most common cancers. Unfortunately, it is often diagnosed at the advanced stage International Union Against Cancer stage IV. This induced us to carry out an interdisciplinary analysis of this patient group with the Department of Internal Medicine 1. Our aim was to discuss cancers classified initially as unresectable in a meeting of the interdisciplinary tumor board after palliative chemotherapy, and to refer selected patients for surgery after establishing resectability. The outcome of the chemotherapy, operation method, complication rate, and long-term survival were analyzed. METHODS From 1999 to 2008, 76 patients with metastatic gastric cancer or carcinoma of the esophagogastric junction were discussed by the interdisciplinary tumor board of the University of Erlangen and classified initially as unresectable. The patients then received palliative chemotherapy according to the AIO regimen (weekly high-dose 5-fluorouracil/folinic acid [FU/FA] in a 24 h infusion), plus irinotecan. If the tumor was subsequently classified as resectable, the patient underwent either gastric resection or gastrectomy with DII-III dissection. Metastases were resected depending on their location (liver). Peritoneal carcinomatosis was treated additionally by HIPEC. Statistical analysis was with SPSSS version 20. RESULTS Surgical and general complications and hospital mortality were acceptable. There were no cases of anastomotic leak, but one patient died of fulminant pneumonia. The R0 resection rate was 69 %, and four patients had long-term survival of more than 60 months. There were significant survival advantages. CONCLUSIONS Metastatic gastric cancer or carcinoma of the esophagogastric junction can become resectable after downsizing the tumor with palliative chemotherapy. Long-term survival is achieved in some cases. Therefore, every patient with this type of cancer should be discussed by the interdisciplinary tumour board after palliative chemotherapy to provide him with a chance of cure after re-evaluation.
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Affiliation(s)
- Claus W Schildberg
- Department of Surgery, University of Erlangen/Nürnberg, Krankenhausstrasse 12, 91054, Erlangen, Germany,
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