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September 2001. Review Article. To the first updating To the second updating
Postoperative chemotherapy as an adjuvant to potentially curative resection of gastric cancer remains investigational despite more than 30 years of investigation in the West.
On the basis of the results from the numerous trials of various adjuvant therapies for patients with gastric carcinoma, the routine use of these therapies cannot be recommended currently ( 1, 5 ).
In Asia the perception of the benefit of adjuvant therapy differs from that in the West. However many of these results have been found only in subgroup analyses, which detracts from their validity. The studies demonstrating a benefit of immunochemotherapy often have lacked treatments controls.
Many newer approaches warrant investigation: more effective chemotherapy combinations or chemoradiotherapy; drugs with newer mechanisms of actions, such as antiangiogenesis inhibitors, metalloproteinase inhibitors, antibodies to oncogenes, or gene therapy; and preoperative therapy of potentially resectable gastric carcinoma ( 1 ).
MacDonald and colleagues demonstrate (in a randomized study) that chemoradiotherapy after resection for gastric cancer (fluorouracil plus leucovorin and radiation) significantly improves relapse-free and overall survival among patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.
Moreover we cite two recent korean studies published in Cancer 2001 about adjuvant chemotherapy.
In the first Jeen and colleagues note that the results of chemotherapy for patients with gastric carcinoma generally have been modest, although regimens developed more recently have produced higher response rates. One such regimen is epirubicin, cisplatin and protracted infusion of 5-fluorouracil (ECF). The advantage of a long-term oral administration of uracil and tegafur (UFT) is that this treatment may be used to mimic the protracted infusion of 5 fluorouracil (5FU). In addition UFT treatment combined with leucovorin had a favourable activity and tolerable toxicity in patients with advanced gastric carcinoma. Instead of the inconvenience of an infusion pump and intravenous catheter for the protracted infusion of 5FU, the authors administered UFT plus leucovorin in an ECF regimen for the treatment of patients with advanced gastric carcinoma ( 6 ).
In the second study Jeung and colleagues underline that adjuvant chemotherapy with 5-FU plus doxorubicin for 60 weeks after D2-3 dissection induced promising survival duration with acceptable toxicities. Full administration of the planned dosage of the combined drugs is recommendable as opposed to early termination of the chemotherapy in gastric carcinoma. Prospective randomized studies based on SDI could induce more information about appropriate dosage and chemotherapy duration of combined regimen for gastric carcinoma ( 7 ).
1) Ken Shimada, Jaffer A Ajani. Adjuvant therapy for gastric canrcinoma patients in the past 15 years. A Review of western and oriental trials. Cancer 1999; 86: 1657-68.
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