Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer
| Autor: | Alessandra Cassano, D. D’Ugo, A. Picciocchi, Michele Basso, I.M. Brunetti, Raffaele Longo, C. Barone, Carmelo Pozzo, Giovanni Schinzari, R. Persiani |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2004 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Time Factors endocrine system diseases Long term follow up medicine.medical_treatment Settore MED/18 - CHIRURGIA GENERALE Glucuronates Pilot Projects Adenocarcinoma Disease-Free Survival Stomach Neoplasms Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Adjuvant therapy Humans Stomach cancer neoplasms Long-term follow-up Etoposide Neoadjuvant therapy Aged Epirubicin Neoplasm Staging Cisplatin Chemotherapy business.industry Cancer General Medicine Middle Aged medicine.disease Survival Analysis Surgery Treatment Outcome Female Laparoscopy business Gastric cancer medicine.drug Follow-Up Studies |
| Popis: | Objective: The prognosis in T3–T4 or N+ gastric cancer is dismal, and the role of adjuvant therapy remains uncertain. Neoadjuvant chemotherapy could improve both resectability and survival. Here, we report the results of the long-term follow-up of a pilot study aimed at evaluating a neoadjuvant treatment in a group of patients carefully staged by computed tomography (CT), endoscopic ultrasound and laparoscopy. Methods: Twenty-five stage II–III patients with histologically proven gastric adenocarcinoma were enrolled in the study. All patients gave informed consent and were thoroughly staged. Patients were treated with epidoxorubicin (40 mg/m2 i.v.) on days 1 and 4, etoposide (VP-16; 100 mg/m2) on days 1, 3 and 4 and cisplatinum (80 mg/m2) on day 2, every 21–28 days for 3 pre-operative cycles before CT clinical restaging followed by laparotomy and D2 gastrectomy. Three further cycles of chemotherapy were planned after radical surgery. Results: Twenty-four patients received the planned pre-operative chemotherapy and underwent surgical resection; total (13 patients) or subtotal (7 patients) R0 D2 gastrectomy was possible in 20 patients. One patient died as a result of gastric bleeding. Perioperative complications occurred in 5 patients (failure of anastomosis in 1 patient and wound infection in the other 4). The pathologic response rate included 7 partial responses (29.1%) and 10 patients with stable disease (41.7%). The main toxicity was grade 3/4 neutropenia (68%), which occurred more frequently during the postoperative chemotherapy, and fatigue (68%). Fever or infection, however, were never observed. The median disease-free survival was 37 months, and median survival has not been reached after 40 months of median follow-up. One-, 2- and 3-year survival rates were 80, 64 and 60%, respectively. Conclusion: The notable long-term survival in the present study suggests a comparison between the neoadjuvant approach, including new drug combinations, and adjuvant chemo- or chemoradio-therapy in locally advanced gastric cancer. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|