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Sub-category:
Multidisciplinary Treatment
Category:
Esophagus and Stomach
Meeting:
2009 Gastrointestinal Cancers Symposium
Abstract No:
101
Author(s):
T. Yoshikawa, H. Cho, A. Tsuburaya, S. Ito, Y. Iwasaki, H. Imamura, T. Sano, M. Sasako
Abstract:
Introduction: Macroscopically complete resection is essential for the cure of gastric cancer. Although tumors could be macroscopically resectable when microscopically cancer cells or a few disseminated foci are found in the peritoneal cavity (defined as minimal peritoneal metastasis, MPM), prognosis is limited. It remains unclear whether scirrhous gastric cancer with MPM should be treated with primary surgery or with primary chemotherapy. Methods: Prognosis was examined in patients with scirrhous gastric cancer and MPM, who were treated between Jan 01 and Dec 31, 2004 in 30 institutes of Gastric Cancer Surgical Study Group of Japan Clinical Oncology Group (JCOG). Results: MPM was found in 121 patients among 615 patients with macroscopically resectable scirrhous gastric cancer (19.7%). Of those, 99 patients underwent primary resection (group S), while 22 were treated with chemotherapy (group C) including S-1+CDDP (n=14). Median survival time (MST) was 16.3 months and 1-year survival rate was 62.0% for all. MST was 17.2 months in group S which was slightly better than that in group C (13.5 months). Among group S, survival of patients who received postoperative S-1 chemotherapy (n=72) was tended to be better than those without chemotherapy (MST of 17.8 months and 12.4 months, respectively). Conclusions: These results suggested that primary surgery followed by S-1 is recommended for patients with scirrhous gastric cancer with MPM. Induction chemotherapy has some theoretical advantages compared to postoperative chemotherapy, however, it should be done as a test arm of clinical trials. Currently, JCOG 0501 phase III trial, which compares induction chemotherapy of S-1+CDDP followed by surgery and postoperative S-1 (test arm) with primary surgery followed by postoperative S-1 (reference arm) in patients with scirrhous gastric cancer without peritoneal metastasis, has been amended to include the patients with MPM.
Faculty Disclosures
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Abstracts by T. Yoshikawa:
Presentations by T. Yoshikawa:
Educational Book Manuscripts by T. Yoshikawa:
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