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Adjuvant therapy in gastric cancer: updating

Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena.   Italy.

April 2002.     Review Article.   

To the first article about adjuvant therapy in GC
To the first updating

We report two abstracts from the Journal Gastric Cancer about a new amazing oral fluoropyrimidine anticancer drug TS-1, composed of tegafur, gimestat and otastat potassium at a molecular ratio of 1:0.4:1.
This new drug is useful in the neoadjuvant and adjuvant therapy of Gastric Cancer.
Many other interesting case reports are published in another Japanese Journal ( Gan To Kagaku Ryoho ).

Osamu Kobayashi, Kazuo Konishi, Masahiro Kanari, Haruhiko Cho, Takaki Yoshikawa, Akira Tsuburaya, Motonori Sairenji, Hisahiko Motohashi: case report: Unusual survival for more than 2 years with peritoneal metastases of gastric cancer. Gastric Cancer 5 (2002) 1, 47-50.

We report a patient with peritoneal metastases who was successfully treated with a novel oral fluoropyrimidine anticancer drug, TS-1, as first-line chemotherapy. The patient was a 72-year-old man who had undergone curative resection for type 4 gastric cancer with peritoneal dissemination that was located only at the greater omentum. Final findings were P1, T4, N1, and stage IV. Eighteen months after the gastrectomy, his cancer recurred with peritoneal metastases; these were diagnosed by the presence of multiple stenoses of the colon, an abdominal mass, and elevated levels of the serum tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9. He was treated with 100 mg/day of TS-1, given orally, for 28 days, followed by 14 days' rest, as one course. Two courses of the treatment resulted in a marked reduction of the abdominal tumor, without severe toxicity. After 3 courses, barium enema revealed dramatic improvement in the stenoses. Laparoscopy after 11 courses showed neither peritoneal dissemination, nor ascites, and peritoneal lavage cytology was negative. The serum tumor markers were reduced to almost normal levels. Two years after the onset of the peritoneal metastases, the patient is alive without any sign of progressive disease. Our report is the first to demonstrate the advantages of TS-1 as chemotherapy for the treatment of peritoneal metastasis of gastric cancer.

Takashi Iwazawa, Masakatsu Kinuta, Hiroshi Yano, Shigeo Matsui, Shinji Tamagaki, Atsushi Yasue, Kazuyuki Okada, Toshiyuki Kanoh, Takeshi Tono, Yoshiaki Nakano, Shigeru Okamoto, Takushi Monden: case report: An oral anticancer drug, TS-1, enabled a patient with advanced gastric cancer with Virchow's metastasis to receive curative resection. Gastric Cancer 5 (2002) 2, 96-101

We encountered a patient with advanced gastric cancer, with Virchow's lymph node metastasis, who subsequently underwent curative resection after neoadjuvant chemotherapy with the newly developed oral anticancer drug, TS-1. The patient was a 67-year-old woman who had a type 2 tumor in the middle third of the stomach, and Virchow's lymph node metastasis, which was diagnosed by fine-needle aspiration cytology; she also had swollen paraaortic lymph nodes. Curative resection was considered impossible, and TS-1 (100 mg/day) was administered for 28 days in one course, mainly in the outpatient clinic. Although grade 2 stomatitis interrupted the therapy on day 21 of the second course and on day 7 of the third course, the type 2 tumor showed marked remission (partial response; PR) and the metastasis in the Virchow's and paraaortic lymph nodes had completely disappeared after the third course (complete response; CR). Eleven weeks after the completion of the TS-1 treatment, total gastric resection with D3 lymph node dissection was performed. Histopathological examination revealed tumor involvement only in the mucosal and submucosal layers of the stomach and the no. 4d lymph node. Most of the tumor was replaced with fibrosis with granulomatous change in the muscularis propria of the stomach and in the no. 3, no. 6, and no. 7 lymph nodes. This may be the first report of a patient with advanced gastric cancer with Virchow's lymph node metastasis who successfully received curative resection following neoadjuvant chemotherapy with a single oral anticancer drug.

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