Abstract
Metastatic gastric cancer is associated with poor prognosis despite of advances in chemotherapy and surgery. According to current clinical guidelines surgical treatment for stage IV gastric cancer patients is indicated only for urgent complications. New approach for the management of patients with initially unresectable or metastatic gastric cancer includes primary systemic chemotherapy and following surgical resection if the patients are able to undergo complete resection. This approach is known as conversion surgery. In the review with presentation of own experience the results of conversion surgery for gastric cancer with distant metastases of various localization (liver, paraaortic lymph nodes and peritoneum) were reported. These results allow to define indications for this treatment strategy. 15 conversion surgery cases are presented, 12 of them were combined with HIPEC or PIPAC. Median progression-free survival was 18 months. Conclusion: literature analysis and own experience have shown that conversion surgery after chemotherapy increases the overall survival of patients with oligometastatic gastric cancer who underwent complete resection as compared with palliative chemotherapy. However the clear selection criteria for conversion surgery are needed from randomized controlled trials.References
Ferlay J., Soerjomataram I., Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012 // Int. J. Cancer. - 2015. -Vol. 136(5). - E359-86. - DOI: 10.1002/ijc.29210
Каприн А.Д., Старинский В.В., Петрова ГВ. Злокачественные новообразования в России в 2017 г., 2017. - с. 11-12.
Cunningham D., Allum W.H., Stenning S.P. et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer // N. Engl. J. Med. - 2006. - Vol. 355(1). - P. 11-20. - DOI: 10.1056/NEJMoa055531
Cunningham D., Allum W.H., Stenning S.P. et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer // N. Engl. J. Med. - 2006. - Vol. 355(1). - P. 11-20. - DOI: 10.1056/NEJMoa055531
Al-Batran S.E., Homann N., Pauligk C. et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial // Lancet. - 2019. - Vol. 393(10184). - P. 1948-1957. - DOI: 10.1016/S0140-6736(18)32557-1
Fujitani K., Yang H.K., Mizusawa J. et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial // Lancet Oncol. - 2016. - Vol. 17(3). - P. 309-318. - DOI: 10.1016/S1470-2045(15)00553-7
Al-Batran S.E., Homann N., Pauligk C. et al. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial // JAMA Oncol. - 2017. - Vol. 3(9). - P. 1237-1244. - DOI: 10.1001/jamaoncol.2017.0515
Yoshida K., Yamaguchi K., Okumura N. et al. Is conversion therapy possible in stage IV Gastric Cancer: the proposal of new biological categories of classification // Gastric Cancer. - 2016. - Vol. 19(2). - P. 329-338. - DOI: 10.1007/s10120-015-0575-z
Thomassen I., van Gestel YR., van Ramshorst B. et al. Peritoneal carcinomatosis of gastric origin: a population-based study on incidence, survival and risk factors // Int. J. Cancer. - 2014. - Vol. 134(3). - P. 622-628. - DOI: 10.1002/ijc.28373
Chau I., Norman A.R., Cunningham D. et al. Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer-pooled analysis from three multicenter, randomized, controlled trials using individual patient data // J. Clin. Oncol. - 2004. - Vol. 22(12). - P. 2395-2403. - DOI: 10.1200/JCO.2004.08.154
Glehen O., Gilly F.N., Boutitie F. et al. Toward curative treatment of peritoneal carcinomatosis from non-ovarian origin by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy: a multi-institutional study of 1,290 patients // Cancer. - 2010. - Vol. 116(24). - P. 5608-5618. - DOI: 10.1002/cncr.25356
Huang J.Y, Xu YY, Sun Z. et al. Comparison different methods of intraoperative and intraperitoneal chemotherapy for patients with gastric cancer: a meta-analysis // Asian Pac. J. Cancer Prev. - 2012. - Vol. 13(9). - P. 4379-4385.
Yonemura Y, Elnemr A., Endou Y et al. Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer // World J. Gastrointest. Oncol. - 2010. - Vol. 2(2). - P. 85-97. - DOI: 10.4251/wjgo.v2.i2.85
Gill R.S., Al-Adra D.P., Nagendran J. et al. Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity // J. Surg. Oncol. - 2011. - Vol. 104(6). - P. 692-698. - DOI: 10.1002/jso.22017
Chia C.S., You B., Decullier E. et al. Patients with Peritoneal Carcinomatosis from Gastric Cancer Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is Cure a Possibility? // Ann Surg. Oncol. - 2016. - Vol. 23(6). - P. 1971-9. - DOI: 10.1245/s10434-015-5081-3
Каприн А.Д., Хомяков В.М., Рябов А.Б. и др. Внутрибрюшная аэрозольная химиотерапия под давлением у больных диссеминированным раком желудка // Журнал: Онкология. Журнал им. П.А. Герцена. - 2016. - Т. 5(2). - С. 12-18. - DOI: 10.17116/onkolog20165212-18
Chan DY, Syn N.L., Yap R. et al. Conversion Surgery PostIntraperitoneal Paclitaxel and Systemic Chemotherapy for Gastric Cancer Carcinomatosis Peritonei. Are We Ready? // J. Gastrointest. Surg. - 2017. - Vol. 21(3). - P. 425-433. - DOI: 10.1007/s11605-016-3336-3
Yamaguchi K., Yoshida K., Tanahashi T. et al. The long-term survival of stage IV Gastric Cancer patients with conversion therapy // Gastric Cancer. - 2018. - Vol. 21(2). - P. 315-323. - DOI: 10.1007/s10120-017-0738-1
Fukuchi M., Ishiguro T., Ogata K. et al. Prognostic Role of Conversion Surgery for Unresectable Gastric Cancer // Ann Surg Oncol. - 2015. - Vol. 22(11). - P. 3618-3624. - DOI: 10.1245/s10434-015-4422-6
Boku N., Yamamoto S., Fukuda H. et al. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study // Lancet Oncol. - 2009. - Vol. 10(11). - P. 1063-1069. - DOI: 10.1016/S1470-2045(09)70259-1
Ying-Yang Liao, Ning-Fu Peng, Di Long et al. Hepatectomy for liver metastases from gastric cancer: a systematic review // BMC Surg. - 2017. - Vol. 17. - P. 14. - DOI: 10.1186/s12893-017-0215-0
Markar S.R., Mackenzie H., Mikhail S. et al. Surgical resection of hepatic metastases from Gastric Cancer: outcomes from national series in England // Gastric Cancer. - 2017. - Vol. 20(2). - P. 379-386. - DOI: 10.1007/s10120-016-0604-6
Nagae A., Nishikawa K., Maeda S. et al. A Case of Hepatic Resection after Neoadjuvant Chemotherapy for Single Liver Metastasis from Gastric Cancer with Positive Human Epidermal Growth Factor Receptor 2. - 2018. - Vol. 45(13). - P. 2423-2425.
Kinoshita T., Kinoshita T., Saiura A. et al. Multicentre analysis of long-term outcome after surgical resection for gastric cancer liver metastases // Br. J. Surg. - 2015. - Vol. 102(1). - P. 102-107. - DOI: 10.1002/bjs.9684
Kunisaki C., Akiyama H., Nomura M. et al. Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study // Ann Surg Oncol. - 2006. - Vol. 13(5). - P. 659-667.
Sasako M., Sano T., Yamamoto S. et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer // N. Engl. J. Med. - 2008. - Vol. 359(5). - P. 453-62. - DOI: 10.1056/NEJMoa0707035
Fujimura T., Nakamura K., Oyama K. et al. Selective lymphadenectomy of para-aortic lymph nodes for advanced gastric cancer // Oncol. Rep. - 2009. - Vol. 22(3). - P. 509-514.
Yoshikawa T., Sasako M., Yamamoto S. et al. Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer // Br. J. Surg. -2009. - Vol. 96(9). - P. 1015-1022. - DOI: 10.1002/bjs.6665
Tsuburaya A., Mizusawa J., Tanaka Y et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis // Br. J. Surg. - 2014. - Vol. 101(6). - P. 653-60. - DOI: 10.1002/bjs.9484
Al-Batran S.E., Goetze T.O., Mueller D.W. et al. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction - a phase III trial of the German AIO/ CAO-V/CAOGI // BMC Cancer. 2017. - Vol. 17(1). - P. 893. - DOI: 10.1186/s12885-017-3918-9
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2020