Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.

[Inflammatory bowel diseases and upper gastrointestinal tract]

Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis are inflammatory diseases with a flare-up evolution and an unknown etiology. Inflammatory lesions of the upper gastrointestinal tract are more and more often described in Crohn's disease and ulcerative colitis. The aim of this article was to review the inflammatory lesions of the esophagus, stomach and duodenum currently described in the IBD.

[Results of a retrospective study on radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma]

PURPOSE

We aimed to evaluate therapeutic results of radiotherapy for gastric mucosa-associated lymphoid tissue (MALT) lymphomas.

PATIENTS AND METHODS

We reviewed retrospectively the records of 11 patients presenting with gastric MALT lymphoma treated between 1993 and 2014. Patients with low-grade lymphoma in failure after helicobacter eradication had exclusive gastric external radiotherapy. Chemotherapy followed by radiotherapy were indicated in case of high grade lymphoma. Radiotherapy doses range between 30 and 40Gy (2Gy per fraction, five fractions per week).

RESULTS

All tumours were IE stage. Seven patients with low-grade lymphoma had radiotherapy. Four patients with high-grade lymphoma received chemotherapy then radiotherapy. Ten patients are in complete remission after treatment achievement. Five and 10 years disease-free survival are 100%. No severe toxicity was seen.

CONCLUSION

Eradication of Helicobacter pylori is the mainstay of treatment of gastric MALT. External irradiation is an effective and well-tolerated treatment modality in case of resistance to helicobacter eradication.

[Chemotherapy and chemoradiotherapy indications in the treatment of locally advanced gastric carcinoma]

Currently, there is no international consensus on the best treatment regimen for patients with advanced resectable gastric carcinoma. Three approaches exist abroad continents. In France and Europe, perioperative chemotherapy and gastrectomy with D1.5 lymph-node dissection is the current standard. In Japan and South Korea, postoperative adjuvant chemotherapy after surgery with D2 lymph-node dissection is the standard treatment. In the United States, where limited lymph-node dissection is frequently performed, adjuvant chemoradiotherapy after surgery is the standard treatment. In France, postoperative chemoradiotherapy indications are discussed in limited settings: patients with locally advanced gastric cancer or lymph node involvement discovered on the pathologic report of the gastrectomy without preoperative chemotherapy delivery or in case of non-carcinologic resection (R1). Exclusive chemoradiotherapy can be proposed in patients unfit for surgery.

[Rare complication of a post-traumatic left diaphragmatic hernia]

Diaphragmatic hernia is a post-traumatic lesion specific trauma that may go unnoticed. The left hemidiaphragm is the most frequently affected. The diagnosis is then made at the occasion of a complication, especially gastric volvulus. The authors report the case of a young man aged 26 years old with a gastric volvulus on post-traumatic diaphragmatic hernia diagnosed by CT.

[Peritonitis by perforation on gastric cancer at the Gabriel Touré teaching hospital]

OBJECTIVE

Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital.

PATIENTS AND METHOD

A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame.

RESULTS

We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality.

CONCLUSION

Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer.