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Luo H, Peng L, Wang N, Zhang J, Zheng X, Sun Y, Fan C, Ge H. Early brain metastasis of advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy followed by surgery: A case report and literature review. Cancer Biol Ther 2018; 19:875-878. [PMID: 29580147 DOI: 10.1080/15384047.2018.1456600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy and surgery followed by early brain metastasis is rare. A 52-y-old male patient who was diagnosed with advanced gastric cancer (cT4N2M0, stage ШB). Radiological examinations after three cycles of preoperative chemotherapy with a modified FOLFOX6 (mFOLFOX6) regimen showed a partial response (PR) had been achieved. The patient underwent curative surgery consisting of proximal gastrectomy, and D2 lymph node dissection. The lack of abnormal gastric cancer cells in the primary lesion or lymph nodes confirmed a pathological complete response (pCR). Postoperative chemotherapy with oral S-1 was administrated. However, during the second cycles of postoperative chemotherapy, the patient experienced headaches, projectile vomiting and convulsion. Upon further examination, a tumor representing metastasis to the brain was recognized by cranial enhanced magnetic resonance imaging (MRI) examination and cytopathology of cerebrospinal fluid. In addition to documenting the case report, we reviewed the literature associated to features of metastatic brain malignancies that form from gastric cancer. In short, advanced gastric cancer patents achieved pCR after preoperative chemotherapy typically have good prognosis; however, great attention should be paid on detecting metastatic events.
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Affiliation(s)
- Hui Luo
- a Division of Graduate, The second clinical medical school and the second affiliated hospital of Zhengzhou University , Zhengzhou , China.,c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Liangqun Peng
- b Department of General Surgery , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Nan Wang
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Jiangong Zhang
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Xiaoli Zheng
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Yanan Sun
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Chengcheng Fan
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
| | - Hong Ge
- c Department of Radiation Oncology , The affiliated cancer hospital of Zhengzhou University , Zhengzhou , China
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Abstract
OPINION STATEMENT Two cycles of neoadjuvant cisplatin and fluoropyrimidine (CF) and 6 cycles of perioperative CF with or without epirubicin are an evidence-based approach in operable esophageal and esophagogastric junctional adenocarcinomas. Three-drug regimens with anthracycline or taxane are associated with significantly higher tumor regression rates, with an expected increase in toxicity. In order to achieve an R0 resection and consequently a survival advantage, in selected patients having a risk of a threatened margin or incomplete resection, chemotherapy might be continued beyond 2 cycles if a response has been demonstrated. In metastatic setting, multidrug combination regimens have demonstrated a significant survival benefit when compared to single-agent regimes. A three-drug regimen should be considered for fit patients and/or when a response is required for symptom control. The expected increase in toxicity needs to be carefully considered and discussed with patients. The choice to use a taxane in first-line setting may limit the options of second-line treatment to irinotecan-containing regimens and also precludes the use of anthracyclines in the first line. For this reason, we prefer to reserve taxane-based therapy for the second-line setting.
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Kim S, Paget-Bailly S, Messager M, Nguyen T, Mathieu P, Lamfichekh N, Fein F, Fratté S, Cléau D, Lakkis Z, Jary M, Sakek N, Jacquin M, Foubert A, Bonnetain F, Mariette C, Fiteni F, Borg C. Perioperative docetaxel, cisplatin, and 5-fluorouracil compared to standard chemotherapy for resectable gastroesophageal adenocarcinoma. Eur J Surg Oncol 2017; 43:218-225. [DOI: 10.1016/j.ejso.2016.06.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/20/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022] Open
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Abstract
Gastric cancer is one of the most common malignant tumors in the world, and radical surgery is still the most effective treatment. Since gastric cancer screening is not popular in China and early cases are usually asymptomatic, advanced gastric cancer accounts for the vast majority. The prognosis of patients with advanced gastric cancer after surgery alone is still poor. With regard to improving the long-term survival of patients with advanced gastric cancer, the importance of multimodality therapy has been gradually recognized. Perioperative treatment is an important part of multimodality therapy. Nowadays, the perioperative treatment for advanced gastric cancer consists of preoperative chemotherapy, preoperative chemoradiotherapy, targeted therapy, and immune therapy.
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Fiteni F, Paget-Bailly S, Messager M, N'Guyen T, Lakkis Z, Mathieu P, Lamfichekh N, Picard A, Benzidane B, Cléau D, Bonnetain F, Borg C, Mariette C, Kim S. Docetaxel, Cisplatin, and 5-Fluorouracil as perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma. Cancer Med 2016; 5:3085-3093. [PMID: 27726290 PMCID: PMC5119963 DOI: 10.1002/cam4.885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 12/25/2022] Open
Abstract
Docetaxel, cisplatin, and 5‐fluorouracil (DCF) significantly improved overall survival in metastatic gastroesophageal adenocarcinoma (GEA). The aim of this study was to assess efficacy of DCF regimen as perioperative chemotherapy compared with surgery alone in patients with resectable GEA. We identified 789 patients who underwent surgery alone and 62 patients who received at least one cycle of DCF regimen consisting of docetaxel (75 mg/m2 on day 1), cisplatin (75 mg/m2 on day 1), and 5‐fluorouracil (750 mg/m2/day on continuous perfusion on days 1 to 5), every 3 weeks. Overall survival was compared using Cox proportional hazards regression model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched‐pair analysis. In Cox multivariate analysis weighted by IPTW, DCF group was associated with favorable overall survival (OS) compared with the surgery group (HR = 0.59; 95% CI, 0.45–0.78; P = 0.0003). For the matched‐pair analysis (comparing 41 patients for each group with the same baseline characteristics), median OS was 22 months and 57 months for the surgery group and DCF group, respectively (log‐rank P = 0.0011). In Cox multivariate analysis, DCF group was associated with favorable OS compared with the surgery group (HR = 0.29; 95% IC, 0.14–0.64; P = 0.0019). In the matched‐pair population, major complications (Dindo‐Clavien grade 3–5) arose in six patients (14.63%) in the DCF group and seven patients (17.07%) in the surgery group (P = 1). Perioperative DCF chemotherapy is superior to surgery alone in terms of OS. A randomized phase III trial should compare DCF to standard perioperative regimens.
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Affiliation(s)
- Frédéric Fiteni
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Mathieu Messager
- Lille University Hospital, Department of Digestive Surgery, Lille, France.,FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France
| | - Thierry N'Guyen
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Pierre Mathieu
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Najib Lamfichekh
- Department of Surgery, Nord Franche Comté Hospital, Montbeliard, France
| | - Alain Picard
- Department of Surgery, Nord Franche Comté Hospital, Belfort, France
| | - Bilell Benzidane
- Department of Oncology and Radiotherapy, Nord Franche Comté Hospital, Montbeliard, France
| | - Denis Cléau
- Department of Gastroenterology, Hospital of Vesoul, Vesoul, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,University of Franche-Comté, Besançon, EA 3181, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Unit 1098, INSERM, University of Franche-Comté, Besançon, France.,Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France
| | - Christophe Mariette
- Lille University Hospital, Department of Digestive Surgery, Lille, France.,FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.,Unit 1098, INSERM, University of Franche-Comté, Besançon, France.,Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France
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Wang X, Zhao L, Liu H, Zhong D, Liu W, Shan G, Dong F, Gao W, Bai C, Li X. A phase II study of a modified FOLFOX6 regimen as neoadjuvant chemotherapy for locally advanced gastric cancer. Br J Cancer 2016; 114:1326-33. [PMID: 27172250 PMCID: PMC4984457 DOI: 10.1038/bjc.2016.126] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/11/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background: We evaluated the efficacy and safety of the modified FOLFOX6 (mFOLFOX6) regimen as
a neoadjuvant chemotherapy in gastric cancer patients. Methods: Seventy-three patients with T2–T4 or N+ were enroled. Preoperative
chemotherapy consisted of three cycles of mFOLFOX6. The primary end points were
the response rate and the R0 resection rate. Prognostic factors for overall
survival (OS) were investigated using univariate and multivariate analyses. Results: Sixty-seven (91.8%) patients completed 3 cycles, with grade 3–4
toxicity arising in 33.0%. The radiology response rate was 45.8%.
Sixty-seven (91.8%) patients receiving radical surgery showed different
levels of histological regression of the primary tumour, with a ⩾50%
regression rate of 49.2%. ypTNM stage (HR 4.045, 95% CI
1.429–11.446) and tumours of diffuse and mixed type (HR 9.963, 95% CI
1.937–51.235; HR 8.890, 95% CI 1.157–68.323, respectively) were
significantly associated with OS. The pathologic regression rate (GHR;
⩾2/3/<2/3, ⩾50%/<50%) was
statistically significantly associated with OS according to a univariate
analysis. Conclusions: Perioperative mFOLFOX6 was a tolerable and effective regimen for gastric cancer.
The ypTNM stage was an independent predictor of survival. GHR
⩾50%/<50% could be used as a surrogate marker for
selecting a postoperative chemotherapy regimen.
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Affiliation(s)
- Xiang Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100032, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100032, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Dingrong Zhong
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Liu
- Department of Radiation, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guangliang Shan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Fen Dong
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of basic Medicine, Peking Union Medical College, Beijing 100005, China
| | - Weisheng Gao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100032, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Kim S, Fiteni F, Paget-Bailly S, Ghiringhelli F, Lakkis Z, Jary M, Fein F, Bonnetain F, Mariette C, Borg C. The impact of taxane-based preoperative chemotherapy in gastroesophageal signet ring cell adenocarcinomas. J Hematol Oncol 2015; 8:52. [PMID: 25976888 PMCID: PMC4440289 DOI: 10.1186/s13045-015-0148-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/06/2015] [Indexed: 12/13/2022] Open
Abstract
The benefit of preoperative chemotherapy in resectable gastroesophageal adenocarcinomas was not observed in signet ring cell subtype. However, the potential interest of taxane-based preoperative chemotherapy on this subtype is still an unresolved issue. Nineteen patients with localized signet ring cell adenocarcinomas received taxane-based regimens, and 17 patients underwent surgery. Complete resection was achieved in 80 %, and median overall survival was 40.8 months (95 % confidence interval (CI), 20.2—not reached). Even though one patient achieved a complete pathological response, seven patients had an upstaging of their tumors at surgery. The potential benefits of taxane-based chemotherapy seem to be limited to a reduced number of patients.
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Affiliation(s)
- Stefano Kim
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Clinical Investigational Centre, CIC-1431, University Hospital of Besançon, Besançon, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
| | - Frederic Fiteni
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
| | - Sophie Paget-Bailly
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
| | | | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France.
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France.
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. .,EA 3181 University of Franche-Comté, Besançon, Besançon, France.
| | | | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besancon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France. .,Clinical Investigational Centre, CIC-1431, University Hospital of Besançon, Besançon, France. .,INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
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