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Sample records for inoperable advanced gastric

  1. [A case of S-1/CDDP chemotherapy for inoperable advanced gastric cancer which led to gastrectomy with histological complete response].

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    Kobayashi, Kenji; Tanizaki, Keiko; Aoki, Taro; Takachi, Kou; Nishioka, Kiyonori; Matsumoto, Takashi; Komori, Takamichi; Chono, Teruhiro; Kato, Aya; Hyuga, Satoshi; Watanabe, Risa; Uemura, Yoshio

    2011-11-01

    As the treatment for inoperable advanced gastric cancer, S-1/CDDP combination therapy (SP chemotherapy) has become a standard treatment. In our hospital, a second course of chemotherapy was performed on an outpatient basis in order to improve a traditional QOL. In this case, it showed remarkable effects in 15 months after starting chemotherapy. Then gastrectomy was performed. Histological findings of the resected specimens confirmed pCR in all tumors. We report on progress of this case and explain about the ingenuity of SP chemotherapy.

  2. Neoadjuvant Chemotherapy Creates Surgery Opportunities For Inoperable Locally Advanced Breast Cancer

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    Wang, Minghao; Hou, Lingmi; Chen, Maoshan; Zhou, Yan; Liang, Yueyang; Wang, Shushu; Jiang, Jun; Zhang, Yi

    2017-01-01

    Neoadjuvant chemotherapy (NAC), the systematic chemotherapy given to patients with locally advanced and inoperable breast caner, has been proven to be of great clinical values. Many scientific reports confirmed NAC could effectively eliminate sub-clinical disseminated lesions of tumor, and improve long-term and disease-free survival rate of patients with locally advanced breast cancer (LABC); however, up to now, LABC is still a serious clinical issue given improved screening and early diagnosis. This study, with main focus on inoperable LABC, investigated the values of NAC in converting inoperable LABC into operable status and assessed the prognosis. Sixty-one patients with inoperable LABC were initially treated with neoadjuvant chemotherapy; their local conditions were improved to operable status. Radical surgery was exerted on 49 patients. Original chemotherapy was performed after surgery, followed by local radiotherapy. And endocrine therapy was optional according to the hormone receptor status. The quality of life for most patients with skin diabrosis was obviously improved because their local conditions were under control. For all recruited cases, the survival duration and life quality were significantly improved in patients who finished both NAC and surgery compared to those who did not. Further more, this study demonstrates improved prognostic consequences.

  3. Prolonged survival in advanced thymoma: Effectiveness of sequential multiple lines of chemotherapy in an inoperable case

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    BERGONZI, MANUELA; ORLANDONI, GIULIO; CORBELLA, FRANCO; GOBBI, PAOLO G.

    2011-01-01

    A standard therapeutic approach for advanced malignant thymoma has yet to be defined given the rarity of this condition. We present a patient with advanced thymoma, evaluated as inoperable at diagnosis due to multiple serosal metastases. The strong constitution and determination of the patient allowed treatment with six distinct and subsequent chemotherapy regimens, all administered on an outpatient basis. A survival of 64 months from diagnosis was achieved. A favorable clinical response was obtained after the first three treatment lines, with the disappearance of all lesions on both computed tomography and positron emission tomography (PET) images. However, this result was not confirmed by surgical exploration of the thorax, undertaken with the aim of radical excision of possible residual disease. The presence of multiple pleural nodules, not evident on the imaging techniques, prevented even limited tumor debulking. The chemotherapy lines administered following detection of the lessions, stabilized the disease for a further 2 years, while a satisfactory quality of life was maintained. Only in the last months did the tumor progress and signs of cardiotoxicity appear, with the latter constituting the eventual cause of death. This case is important since the medical literature does not indicate non-cross-resistant regimens for advanced thymoma following second-line chemotherapy, and the sequence of regimens presented in this case study may serve as a feasible outline program. Moreover, we highlight the known possibility of false-negative PET studies, which can occur despite the claimed glucose avidity of thymoma tissue. PMID:22866110

  4. The role of airway stent placement in the management of tracheobronchial stenosis caused by inoperable advanced lung cancer.

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    Furukawa, Kinya; Ishida, Junzo; Yamaguchi, Gaku; Usuda, Jitsuo; Tsutsui, Hidemitsu; Saito, Makoto; Konaka, Chimori; Kato, Harubumi

    2010-04-01

    To our knowledge there is no in-depth report on the benefits of airway stenting, which focuses specifically on patients with inoperable advanced lung cancer causing severe central airway obstruction. We evaluated the role of airway stenting as one aspect of the multidisciplinary management of advanced lung cancer. We performed airway stenting in 40 lung cancer patients, placing a total of 58 stents. Stenting was done as a final modality in 22 patients with terminal-stage lung cancer (group A). The other 18 patients received additional therapy after stenting (group B), 12 (66.7%) of whom were treatment-naïve on admission. The performance status (PS) and Hugh-Jones classification (H-J) scores improved in both groups after stenting: from 3.56 to 2.48 (P = 0.001) and 4.29 to 3.20 (P = 0.004) in group A, and from 3.15 to 1.25 (P Airway stenting followed by adjuvant therapy may improve the survival of treatment-naïve patients with severe symptomatic airway obstruction caused by advanced lung cancer.

  5. Prealbumin/CRP Based Prognostic Score, a New Tool for Predicting Metastasis in Patients with Inoperable Gastric Cancer

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    Ali Esfahani

    2016-01-01

    Full Text Available Background. There is a considerable dissimilarity in the survival duration of the patients with gastric cancer. We aimed to assess the systemic inflammatory response (SIR and nutritional status of these patients before the commencement of chemotherapy to find the appropriate prognostic factors and define a new score for predicting metastasis. Methods. SIR was assessed using Glasgow Prognostic Score (GPS. Then a score was defined as prealbumin/CRP based prognostic score (PCPS to be compared with GPS for predicting metastasis and nutritional status. Results. 71 patients with gastric cancer were recruited in the study. 87% of patients had malnutrition. There was a statistical difference between those with metastatic (n=43 and those with nonmetastatic (n=28 gastric cancer according to levels of prealbumin and CRP; however they were not different regarding patient generated subjective global assessment (PG-SGA and GPS. The best cut-off value for prealbumin was determined at 0.20 mg/dL and PCPS could predict metastasis with 76.5% sensitivity, 63.6% specificity, and 71.4% accuracy. Metastatic and nonmetastatic gastric cancer patients were different in terms of PCPS (P=0.005. Conclusion. PCPS has been suggested for predicting metastasis in patients with gastric cancer. Future studies with larger sample size have been warranted.

  6. Intensity-Modulated and Image-Guided Radiotherapy in Patients with Locally Advanced Inoperable Pancreatic Cancer after Preradiation Chemotherapy

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    M. Sinn

    2014-01-01

    Full Text Available Background. Radiotherapy (RT in patients with pancreatic cancer is still a controversial subject and its benefit in inoperable stages of locally advanced pancreatic cancer (LAPC, even after induction chemotherapy, remains unclear. Modern radiation techniques such as image-guided radiotherapy (IGRT and intensity-modulated radiotherapy (IMRT may improve effectiveness and reduce radiotherapy-related toxicities. Methods. Patients with LAPC who underwent radiotherapy after chemotherapy between 09/2004 and 05/2013 were retrospectively analyzed with regard to preradiation chemotherapy (PRCT, modalities of radiotherapy, and toxicities. Progression-free (PFS and overall survival (OS were estimated by Kaplan-Meier curves. Results. 15 (68% women and 7 men (median age 64 years; range 40–77 were identified. Median duration of PRCT was 11.1 months (range 4.3–33.0. Six patients (27% underwent conventional RT and 16 patients (73% advanced IMRT and IGRT; median dosage was 50.4 (range 9–54 Gray. No grade III or IV toxicities occurred. Median PFS (estimated from the beginning of RT was 5.8 months, 2.6 months in the conventional RT group (conv-RT, and 7.1 months in the IMRT/IGRT group (P=0.029; median OS was 11.0 months, 4.2 months (conv-RT, and 14.0 months (IMRT/IGRT; P=0.141. Median RT-specific PFS for patients with prolonged PRCT > 9 months was 8.5 months compared to 5.6 months for PRCT 9 months group, with 19.0 months compared to 8.5 months in the PRCT  <  9 months group (P=0.049. Conclusions. IGRT and IMRT after PRCT are feasible and effective options for patients with LAPC after prolonged preradiation chemotherapy.

  7. Parenteral Nutrition for Patients Treated for Locally Advanced Inoperable Tumors of the Head and Neck

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    2016-08-10

    Squamous Cell Carcinoma of the Hypopharynx Stage III; Squamous Cell Carcinoma of the Hypopharynx Stage IV; Laryngeal Squamous Cell Carcinoma Stage III; Laryngeal Squamous Cell Carcinoma Stage IV; Oropharyngeal Squamous Cell Carcinoma Stage III; Oropharyngeal Squamous Cell Carcinoma Stage IV; Squamous Cell Carcinoma of the Oral Cavity Stage III; Squamous Cell Carcinoma of the Oral Cavity Stage IV; Locally Advanced Malignant Neoplasm

  8. Women with inoperable or locally advanced breast cancer -- what characterizes them?

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    El-Charnoubi, Waseem Asim Ghulam; Svendsen, Jesper Brink; Tange, Ulla Brix;

    2012-01-01

    Breast cancer is the most common cancer among Danish women. Locally advanced breast cancer occurs in a relatively large proportion of all new primary breast cancer diagnoses and for unexplained reasons 20-30% of women with breast cancer wait more than eight weeks from the initial breast cancer...

  9. Image Guided Hypofractionated 3-Dimensional Radiation Therapy in Patients With Inoperable Advanced Stage Non-Small Cell Lung Cancer

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    Osti, Mattia Falchetto [Institute of Radiation Oncology, La Sapienza University, Sant' Andrea Hospital, Rome (Italy); Agolli, Linda, E-mail: lindaagolli@yahoo.it [Institute of Radiation Oncology, La Sapienza University, Sant' Andrea Hospital, Rome (Italy); Valeriani, Maurizio; Falco, Teresa; Bracci, Stefano; De Sanctis, Vitaliana; Enrici, Riccardo Maurizi [Institute of Radiation Oncology, La Sapienza University, Sant' Andrea Hospital, Rome (Italy)

    2013-03-01

    Purpose: Hypofractionated radiation therapy (HypoRT) can potentially improve local control with a higher biological effect and shorter overall treatment time. Response, local control, toxicity rates, and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer (NSCLC) who received HypoRT. Methods and Materials: Thirty patients with advanced NSCLC were enrolled; 27% had stage IIIA, 50% had stage IIIB, and 23% had stage IV disease. All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each. Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position. Toxicities were graded according to Radiation Therapy Oncology Group morbidity score. Survival rates were estimated using the Kaplan-Meier method. Results: The median follow-up was 13 months (range, 4-56 months). All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes. The overall response rate after radiation therapy was 83% (3 patients with complete response and 22 patients with partial response). The 2-year overall survival and progression-free survival rates were 38.1% and 36%, respectively. Locoregional recurrence/persistence occurred in 11 (37%) patients. Distant metastasis occurred in 17 (57%) patients. Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients (17%) and grade 3 in 1 patient; grade 1 to 2 esophagitis in 12 patients (40%) and grade 3 in 1 patient; and grade 1 to 2 pneumonitis in 6 patients (20%) and grade 3 in 2 patients (7%). Thirty-three percent of patients developed grade 1 to 2 late toxicities. Only 3 patients developed grade 3 late adverse effects: esophagitis in 1 patient and pneumonitis in 2 patients. Conclusions: Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC. Randomized

  10. PIVKA-II-producing advanced gastric cancer.

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    Takano, Shigetsugu; Honda, Ichiro; Watanabe, Satoshi; Soda, Hiroaki; Nagata, Matsuo; Hoshino, Isamu; Takenouchi, Toshinao; Miyazaki, Masaru

    2004-08-01

    We describe the case of a 68-year-old man with primary advanced adenocarcinoma of the stomach, who displayed extremely high plasma levels of protein induced by vitamin K antagonist (PIVKA)-II (15 600 mAU/ml) and normal levels of alphafetoprotein (AFP) (4 ng/ml). Ultrasonography and dynamic computed tomography ruled out hepatocellular carcinoma (HCC) or liver metastasis. After preoperative chemotherapy, pancreatico-spleno total gastrectomy with D2 lymphadenectomy was performed. Postoperatively, plasma levels of PIVKA-II returned to within the normal range (29 mAU/ml). Microscopic examination revealed stomach adenocarcinoma showing various histological types, such as moderately to poorly differentiated mucinous adenocarcinoma, but hepatoid differentiation of gastric adenocarcinoma was not detected. Localization of PIVKA-II and AFP within tumor cells was demonstrated by immunohistochemical staining using monoclonal antibodies. These results indicate that tumor cells from gastric cancer may produce PIVKA-II. Some cases of PIVKA-II- and AFP-producing advanced gastric cancer with liver metastasis have been reported, but this is the first report of gastric cancer without liver metastasis producing PIVKA-II alone.

  11. Preoperative chemoradiotherapy for locally advanced gastric cancer

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    Pepek Joseph M

    2013-01-01

    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  12. Novel therapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Yue; Zhang; Shenhong; Wu

    2015-01-01

    Gastric cancer(GC) is a common lethal malignancy.Gastroesophageal junction and gastric cardia tumors are the fastest rising malignancies due to increasing prevalence of obesity and acid reflex in the United States.Traditional chemotherapy remains the main treatment with trastuzumab targeting human epidermal growth factor receptor 2 positive disease.The median overall survival(OS) is less than one year for advanced GC patients; thus,there is an urgent unmet need to develop novel therapy for GC.Although multiple targeted agents were studied,only the vascular endothelial growth factor receptor inhibitor ramucirumab was approved recently by the United States Food and Drug Administration because of its 1.4 mo OS benefit(5.2 mo vs 3.8 mo,P = 0.047) as a single agent; 2.2 mo improvement of survival(9.6 mo vs 7.4 mo,P = 0.017) when combined with paclitaxel in previously treated advanced GC patients.It is the first single agent approved for previously treated GC and the second biologic agent after trastuzumab.Even with limited success,targeted therapy may be improved by developing new biomarkers.Immune therapy is changing the paradigm of cancer treatment and is presently under active investigation for GC in clinical trials.More evidence supports GC stem cells existence and early stage studies are looking for its potential therapeutic possibilities.

  13. Ifosfamide in advanced adenocarcinoma of the oesophagus or oesophageal-gastric junction area

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    T.C. Kok (Tjebbe); A. van der Gaast (Ate); T.A.W. Splinter (Ted); H.W. Tilanus (Hugo)

    1991-01-01

    markdownabstractAbstract 25 previously untreated patients with inoperable or metastatic adenocarcinoma of the oesophagus or oesophageal-gastric junction area were treated with ifosfamide 6 g/m2 over 48 hours, combined with mesna 6 g/m2. 1 complete response and 1 partial response were seen among 23

  14. Advanced endoscopic imaging in gastric neoplasia and preneoplasia

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    Lee, Jonathan W J; Lim, Lee Guan; Yeoh, Khay Guan

    2017-01-01

    Conventional white light endoscopy remains the current standard in routine clinical practice for early detection of gastric cancer. However, it may not accurately diagnose preneoplastic gastric lesions. The technological advancements in the field of endoscopic imaging for gastric lesions are fast growing. This article reviews currently available advanced endoscopic imaging modalities, in particular chromoendoscopy, narrow band imaging and confocal laser endomicroscopy, and their corresponding evidence shown to improve diagnosis of preneoplastic gastric lesions. Raman spectrometry and polarimetry are also introduced as promising emerging technologies. PMID:28176895

  15. Synchronous advanced gastric adenocarcinoma and advanced esophageal squamous cell carcinoma

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    Fernando Augusto Mardiros Herbella

    2002-01-01

    Full Text Available CONTEXT: Synchronous associations of esophageal and gastric cancers are not a common finding, especially with differing histological types and both tumors in advanced forms. A case with such an association is presented, in which an unusual therapy was proposed: palliative gastrectomy and esophageal intubation. CASE REPORT: A 75-year-old white man was referred to our service complaining of malaise and weight loss for one year and dysphagia and vomiting for 2 months. The patient had sought out medical consultation as a result of the latter two complaints.

  16. New Perspectives in the Treatment of Advanced Gastric Cancer

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    Mahlberg, Rolf; Lorenzen, Sylvie; Thuss-Patience, Peter

    2017-01-01

    available in non-Asia countries until recently. In Japan, S-1 in combination with cisplatin is the recommended first-line treatment in patients with gastric cancer. In Europe, the first trials with S-1 were disappointing due to high unacceptable incidences of adverse events. Pharmacokinetic studies showed...... differences in Asian and Caucasian patients; therefore, a new non-Asian study program was initiated, which led to the pivotal phase 3 trial First-Line Advanced Gastric Cancer Study (FLAGS). In FLAGS, 1,053 patients with advanced gastric cancer from 24 non-Asian countries were enrolled. S-1 plus cisplatin...... safety profile. This led to the approval of S-1 in combination with cisplatin in gastric cancer in Europe in 2011. This article reviews the mode of action of S-1, pivotal study results from an EU point of view, and future perspectives....

  17. Borrmann Type 4 Advanced Gastric Cancer: Focus on the Development of Scirrhous Gastric Cancer

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    Jung, Kyoungwon; Park, Moo In; Kim, Sung Eun; Park, Seun Ja

    2016-01-01

    Early diagnosis of Borrmann type 4 advanced gastric cancer (AGC) is very important for improving the prognosis of AGC patients. Because there is no definite mass in most cases of Borrmann type 4 AGC, its accurate diagnosis via endoscopy requires an understanding of its pathogenesis and developmental process. Moreover, many people confuse linitis plastica (LP) type gastric cancer (GC), scirrhous GC, and Borrmann type 4 AGC. To distinguish each of these cancers, knowledge of their endoscopic an...

  18. A p53 genetic polymorphism of gastric cancer: Difference between early gastric cancer and advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Sun Young Yi; Woon Jung Lee

    2006-01-01

    AIM: To investigate the role of the polymorphism of p53 codon 72 in early gastric cancer (EGC) and advanced gastric cancer (AGC) in Korean patients.METHODS:DNA was extracted from blood samples of gastric cancer patients (n = 291) and controls (n=216).tn the p53 codon 72 genotypes were determined by PCR-RFLP.RESULTS: Patients with gastric cancer had a significantly higher frequency of the homozygous proline (Pro) allele than the control (P=0.032). Patients with AGC had a significantly higher frequency of the Arg/Arg (arginine)allele (P=0.038) than EGC and a similar Pro/Pro allele.The signet ring cell type had a higher frequency of the Pro/Pro allele than other types (P=0.031). The Pro/Pro genotype carries a 3.9-fold increased risk of developing gastric cancer (95% CI,1.3-15.4,P=0.039)when compared to Arg/Arg and Arg/Pro genotypes and to develop EGC is a 5.25 fold increased risk (95% CI,1.8-19.6,P=0.021).CONCLUSION: The Pro/Pro genotype of the p53 codon 72 polymorphism carries a higher risk for gastric cancer in general and is also associated with a much higher risk for EGC than AGC.

  19. Concomitant cetuximab and radiation therapy: A possible promising strategy for locally advanced inoperable non-melanoma skin carcinomas

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    DELLA VITTORIA SCARPATI, GIUSEPPINA; PERRI, FRANCESCO; PISCONTI, SALVATORE; COSTA, GIUSEPPE; RICCIARDIELLO, FILIPPO; DEL PRETE, SALVATORE; NAPOLITANO, ALBERTO; CARRATURO, MARCO; MAZZONE, SALVATORE; ADDEO, RAFFAELE

    2016-01-01

    Non-melanoma skin cancers (NMSCs) include a heterogeneous group of malignancies arising from the epidermis, comprising squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Merkel cell carcinoma and more rare entities, including malignant pilomatrixoma and sebaceous gland tumours. The treatment of early disease depends primarily on surgery. In addition, certain patients present with extensive local invasion or metastasis, which renders these tumours surgically unresectable. Improving the outcome of radiotherapy through the use of concurrent systemic therapy has been demonstrated in several locally advanced cancer-treatment paradigms. Recently, agents targeting the human epidermal growth factor receptor (EGFR) have exhibited a consolidated activity in phase II clinical trials and case series reports. Cetuximab is a monoclonal antibody that binds to and completely inhibits the EGFR, which has been revealed to be up-regulated in a variety of SCCs, including NMSCs. The present review aimed to summarize the role of anti-EGFR agents in the predominant types of NMSC, including SCC and BCC, and focuses on the cetuximab-based studies, highlighting the biological rationale of this therapeutic option. In addition, the importance of the association between cetuximab and radiotherapy for locally advanced NMSC is discussed. PMID:27073643

  20. Preoperative treatment with radiochemotherapy for locally advanced gastroesophageal junction cancer and unresectable locally advanced gastric cancer

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    Ratosa Ivica

    2015-06-01

    Full Text Available Background. To purpose of the study was to analyze the results of preoperative radiochemotherapy in patients with unresectable gastric or locoregionally advanced gastroesophageal junction (GEJ cancer treated at a single institution.

  1. Exome sequencing identifies early gastric carcinoma as an early stage of advanced gastric cancer.

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    Kang, Guhyun; Hwang, Woo Cheol; Do, In-Gu; Wang, Kai; Kang, So Young; Lee, Jeeyun; Park, Se Hoon; Park, Joon Oh; Kang, Won Ki; Jang, Jiryeon; Choi, Min-Gew; Lee, Jun Ho; Sohn, Tae Sung; Bae, Jae Moon; Kim, Sung; Kim, Min Ji; Kim, Seonwoo; Park, Cheol Keun; Kim, Kyoung-Mee

    2013-01-01

    Gastric carcinoma is one of the major causes of cancer-related mortality worldwide. Early detection and treatment leads to an excellent prognosis in patients with early gastric cancer (EGC), whereas the prognosis of patients with advanced gastric cancer (AGC) remains poor. It is unclear whether EGCs and AGCs are distinct entities or whether EGCs are the beginning stages of AGCs. We performed whole exome sequencing of four samples from patients with EGC and compared the results with those from AGCs. In both EGCs and AGCs, a total of 268 genes were commonly mutated and independent mutations were additionally found in EGCs (516 genes) and AGCs (3104 genes). A higher frequency of C>G transitions was observed in intestinal-type compared to diffuse-type carcinomas (P = 0.010). The DYRK3, GPR116, MCM10, PCDH17, PCDHB1, RDH5 and UNC5C genes are recurrently mutated in EGCs and may be involved in early carcinogenesis.

  2. Postoperative chemoradiotherapy in high risk locally advanced gastric cancer

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    Song, Sang Hyuk; Chie, Eui Kyu; Kim, Kyu Bo; Lee, Hyuk Joon; Yang, Han Kwang; Han, Sae Won; Oh, Do Youn; Im, Seok Ah; Bang, Yung Jue; Ha, Sung W. [Seoul National University College of Medicine, Seoul(Korea, Republic of)

    2012-12-15

    To evaluate treatment outcome of patients with high risk locally advanced gastric cancer after postoperative chemoradiotherapy. Between May 2003 and May 2012, thirteen patients who underwent postoperative chemoradiotherapy for gastric cancer with resection margin involvement or adjacent structure invasion were retrospectively analyzed. Concurrent chemotherapy was administered in 10 patients. Median dose of radiation was 50.4 Gy (range, 45 to 55.8 Gy). The median follow-up duration for surviving patients was 48 months (range, 5 to 108 months). The 5-year overall survival rate was 42% and the 5-year disease-free survival rate was 28%. Major pattern of failure was peritoneal seeding with 46%. Loco-regional recurrence was reported in only one patient. Grade 2 or higher gastrointestinal toxicity occurred in 54% of the patients. However, there was only one patient with higher than grade 3 toxicity. Despite reported suggested role of adjuvant radiotherapy with combination chemotherapy in gastric cancer, only very small portion of the patients underwent the treatment. Results from this study show that postoperative chemoradiotherapy provided excellent locoregional control with acceptable and manageable treatment related toxicity in patients with high risk locally advanced gastric cancer. Thus, postoperative chemoradiotherapy may improve treatment result in terms of locoregional control in these high risk patients. However, as these findings are based on small series, validation with larger cohort is suggested.

  3. Requirement for a standardised definition of advanced gastric cancer.

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    DE Sol, Angelo; Trastulli, Stefano; Grassi, Veronica; Corsi, Alessia; Barillaro, Ivan; Boccolini, Andrea; DI Patrizi, Micol Sole; DI Rocco, Giorgio; Santoro, Alberto; Cirocchi, Roberto; Boselli, Carlo; Redler, Adriano; Noya, Giuseppe; Kong, Seong-Ho

    2014-01-01

    Each year, ~988,000 new cases of stomach cancer are reported worldwide. Uniformity for the definition of advanced gastric cancer (AGC) is required to ensure the improved management of patients. Various classifications do actually exist for gastric cancer, but the classification determined by lesion depth is extremely important, as it has been shown to correlate with patient prognosis; for example, early gastric cancer (EGC) has a favourable prognosis when compared with AGC. In the literature, the definition of EGC is clear, however, there is heterogeneity in the definition of AGC. In the current study, all parameters of the TNM classification for AGC reported in each previous study were individually analysed. It was necessary to perform a comprehensive systematic literature search of all previous studies that have reported a definition of ACG to guarantee homogeneity in the assessment of surgical outcome. It must be understood that the term 'advanced gastric cancer' may implicate a number of stages of disease, and studies must highlight the exact clinical TNM stages used for evaluation of the study.

  4. Targeting chemotherapy via arterial infusion for advanced gastric cancer

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    Zhi-yu CAO

    2011-10-01

    Full Text Available Objective To evaluate the clinical effects of chemotherapy via arterial infusion in treatment of advanced gastric cancer.Methods Forty-seven patients with advanced gastric cancer were given chemotherapy via arterial infusion.Chemotherapy plan was as follows: 5-Fluorouracil(Fu 500mg/m2,cyclophosphamide(MMX 10mg/m2,Hydroxycamptothecin(HPT 20mg/m2,once per week,2 weeks as a course,a total of 2-3 courses.Results After chemotherapy via arterial infusion,complete remission(CR was achieved in 1 case,partial remission(PR in 28 cases,stabilization of disease(SD in 16 cases,progression of disease(PD was found in 2 cases,and rate with response(CR+PR was 61.7%.Four of 28 PR patients underwent tumorectomy,the pathology revealed the presence of cancer cells around the vascular vessels,manifesting karyopyknosis,karyorrhexis,coagulation and necrosis of cytoplasm,intercellular edema,hyperplasia of fibroblasts,inflammatory cell infiltration,thickening of endothelium,and thrombosis.One,two and three-year survival rates were 70.2%,14.9% and 2.1%,respectively.The average survival period was 17.2 months.Conclusion Targeting chemotherapy via arterial infusion,as a part of the combined treatment,is beneficial to the patients with unresectable advanced gastric cancer.

  5. Control study of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Bin Liu

    2016-01-01

    Objective: To analyze the differences in effect of arterial interventional chemotherapy before radical gastrectomy for gastric cancer and simple radical gastrectomy for gastric cancer in treatment of advanced gastric cancer.Methods:A total of 86 cases of patients with advanced gastric cancer treated in our hospital were selected as research subjects and randomly divided into two groups, observation group received arterial interventional chemotherapy combined with radical gastrectomy for gastric cancer, control group received simple radical gastrectomy for gastric cancer, and then differences in prognosis-associated factors, MMP and Leptin contents as well as tumor marker and telomerase activity levels of two groups were compared.Results:Serum HER-2/neu ECD level of observation group was lower than that of control group, and serum DKK-1, TS and TP levels were higher than those of control group; at each point in time after treatment, serum CA72-4 and CA50 contents of observation group were lower than those of control group; intraoperative MMP-2, MMP-7, MMP-9 and Leptin levels in gastric cancer tissue of observation group were lower than those of control group; telomerase activity value in gastric cancer tissue of observation group after treatment was lower than that of control group, and both PGⅠ positive expression rate and PGⅠ/ PGⅡ ratio were higher than those of control group.Conclusion: Arterial interventional chemotherapy before radical gastrectomy for gastric cancer can lower tumor malignancy, promote the curative effect of radical gastrectomy for gastric cancer and improve long-term prognosis.

  6. SUVmax/THKmax as a biomarker for distinguishing advanced gastric carcinoma from primary gastric lymphoma.

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    Liping Fu

    Full Text Available BACKGROUND: Gastric carcinoma and primary gastric lymphoma (PGL are the two most common malignancies in stomach. The purpose of this study was to screen and validate a biomarker of (18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F-FDG PET/CT for distinguishing advanced gastric carcinoma (AGC from PGL for clinical applications. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed PET/CT scans collected from January 2008 to April 2012 of 69 AGC and 38 PGL (14 low-grade mucosa-associated lymphoid tissue [MALT], 24 non-MALT aggressive non-Hodgkin lymphoma [ANHL] with a focus on FDG intensity (maximum standardized uptake value [SUVmax] of primary lesions and its CT-detected abnormalities, including maximal gastrointestinal wall thickness (THKmax and mucosal ulcerations. Gastric FDG uptake was found in 69 (100% patients with AGC and 36 (95%, 12 MALT vs. 24 ANHLwith PGL. The presence of CT-detected abnormalities of AGC and PGL were 97% (67/69 and 89% (12 MALT vs. 22 ANHL, respectively. After controlling for THKmax, SUVmax was higher with ANHL than AGC (17.10 ± 8.08 vs. 9.65 ± 5.24, p0.05. Cross-validation analysis showed that for distinguishing ANHL from AGC, the classifier with SUVmax as a feature achieved a correct classification rate of 81% with thresholds 13.40 ± 1.12 and the classifier with SUVmax/THKmax as a feature achieved a correct classification rate of 83% with thresholds 7.51 ± 0.63. CONCLUSIONS/SIGNIFICANCE: SUVmax/THKmax may be as a promising biomarker of FDG-PET/CT for distinguishing ANHL from AGC. Structural CT abnormalities alone may not be reliable but can help with PET assessment of gastric malignancies. (18F-FDG PET/CT have potential for distinguishing AGC from PGL at the individual level.

  7. Exome sequencing identifies early gastric carcinoma as an early stage of advanced gastric cancer.

    Directory of Open Access Journals (Sweden)

    Guhyun Kang

    Full Text Available Gastric carcinoma is one of the major causes of cancer-related mortality worldwide. Early detection and treatment leads to an excellent prognosis in patients with early gastric cancer (EGC, whereas the prognosis of patients with advanced gastric cancer (AGC remains poor. It is unclear whether EGCs and AGCs are distinct entities or whether EGCs are the beginning stages of AGCs. We performed whole exome sequencing of four samples from patients with EGC and compared the results with those from AGCs. In both EGCs and AGCs, a total of 268 genes were commonly mutated and independent mutations were additionally found in EGCs (516 genes and AGCs (3104 genes. A higher frequency of C>G transitions was observed in intestinal-type compared to diffuse-type carcinomas (P = 0.010. The DYRK3, GPR116, MCM10, PCDH17, PCDHB1, RDH5 and UNC5C genes are recurrently mutated in EGCs and may be involved in early carcinogenesis.

  8. Targeted therapy in advanced gastric carcinoma: the future is beginning.

    Science.gov (United States)

    Schinzari, G; Cassano, A; Orlandi, A; Basso, M; Barone, C

    2014-01-01

    Gastric cancer represents one of the most common cancer worldwide. Unfortunately, the majority of patients present in advanced stage and outcome still remains poor with high mortality rate despite decreasing incidence and new diagnostic and therapeutic strategies. Although utility of classical chemotherapy agents has been widely explored, advances have been slow and the efficacy of these agents has reached a plateau of median overall survival not higher than 12 months. Therefore, researchers focused their attention on better understanding molecular biology of carcinogenesis and deeper knowledge of the cancer cell phenotype, as well on development of rationally designed drugs that would target specific molecular aberrancies in signal transduction pathways. These targets include cell surface receptors, circulating growth and angiogenic factors and other molecules involved in downstream intracellular signaling pathways, including receptor tyrosine kinases. However, therapeutic advances in gastric cancer are not so encouraging when compared to other solid organ malignancies such as breast and colorectal cancer. This article reviews the role of targeted agents in gastric cancer as single-agent therapy or in combination regimens, including their rational and emerging mechanism of action, current and emerging data. We focused our attention mainly on published phase III studies, therefore cornerstone clinical trials with trastuzumab and bevacizumab have been largely discussed. Phase III studies presented in important international meetings are also reviewed as well phase II published studies and promising new therapies investigated in preclinical or phase I studies. Today, in first-line treatment only trastuzumab has shown significantly increased survival in combination with chemotherapy, whereas ramucirumab as single agent resulted effective in progressing patients, but - despite several disappointing results - these are the proof of principle that targeting the proper

  9. Prevalence of Helicobacter pylori infection in advanced gastric carcinoma

    Directory of Open Access Journals (Sweden)

    Irami Araújo-Filho

    2006-12-01

    Full Text Available BACKGROUD: There is substantial evidence that infection with Helicobacter pylori plays a role in the development of gastric cancer and that it is rarely found in gastric biopsy of atrophic gastritis and gastric cancer. On advanced gastric tumors, the bacteria can be lost from the stomach. AIMS: To analyze the hypothesis that the prevalence of H.pylori in operated advanced gastric carcinomas and adjacent non-tumor tissues is high, comparing intestinal and diffuse tumors according to Lauren's classification METHODS: A prospective controlled study enrolled 56 patients from "Hospital Universitário", Federal University of Rio Grande do Norte, Natal, RN, Brazil, with advanced gastric cancer, treated from February 2000 to March 2003. Immediately after partial gastrectomy, the resected stomach was opened and several mucosal biopsy samples were taken from the gastric tumor and from the adjacent mucosa within 4 cm distance from the tumor margin. Tissue sections were stained with hematoxylin and eosin. Lauren's classification for gastric cancer was used, to analyse the prevalence of H. pylori in intestinal or diffuse carcinomas assessed by the urease rapid test, IgG by ELISA and Giemsa staining. H. pylori infected patients were treated with omeprazole, clarithromycin and amoxicillin for 7 days. Follow-up endoscopy and serology were performed 6 months after treatment to determine successful eradication of H. pylori in non-tumor tissue. Thereafter, follow-up endoscopies were scheduled annually. Chi-square and MacNemar tests with 0.05 significance were used. RESULTS: Thirty-four tumors (60.7% were intestinal-type and 22 (39.3% diffuse type carcinomas. In adjacent non-tumor gastric mucosa, chronic gastritis were found in 53 cases (94.6% and atrophic mucosa in 36 patients (64.3%. All the patients with atrophic mucosa were H. pylori positive. When examined by Giemsa and urease test, H. pylori positive rate in tumor tissue of intestinal type carcinomas was

  10. Localization of thymidine phosphorylase in advanced gastric and colorectal cancer.

    Science.gov (United States)

    Kobayashi, Michiya; Okamoto, Ken; Akimori, Toyokazu; Tochika, Naoshige; Yoshimoto, Tadashi; Okabayashi, Takehiro; Sugimoto, Takeki; Araki, Keijiro

    2004-01-01

    Thymidine phosphorylase (TP) is known to be more concentrated in human cancer tissues than in adjacent normal tissue based on findings using enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry. However, the ultrastructural localization of TP in cancer tissues has not previously been demonstrated. We investigated the localization of TP in gastric cancer and colorectal cancer tissue by ELISA, immunohistochemistry, and immunoelectron microscopy. Between April 1997 and May 2000, we obtained surgically resected specimens from 42, 46, and 36 cases of advanced gastric, colon, and rectal cancer, respectively. ELISA demonstrated that the TP level was higher in cancer tissues than in adjacent normal tissue. Immunohistochemically, cancer cells were positive for the enzyme in some cases. However, in a number of cases immunopositive inflammatory cells were also present in cancerous tissues. At the electron microscope level, TP was diffusely distributed in the cytoplasm of cancer cells and in the mitochondria of the neutrophil in gastric cancer tissue. In rectal cancer tissues, cytoplasmic granules in macrophages in cancer tissues were immunoreactive for the TP. These findings suggest that TP is produced by macrophages and exists in neutrophils and cancer cells.

  11. A multicentre, randomised phase III trial comparing protracted venous infusion (PVI) 5-fluorouracil (5-FU) with PVI 5-FU plus mitomycin C in patients with inoperable oesophago-gastric cancer.

    Science.gov (United States)

    Tebbutt, N C; Norman, A; Cunningham, D; Iveson, T; Seymour, M; Hickish, T; Harper, P; Maisey, N; Mochlinski, K; Prior, Y; Hill, M

    2002-10-01

    This randomised study compared protracted venous infusion (PVI) fluorouracil (5-FU) with PVI 5-FU plus mitomycin C (MMC) in patients with advanced oesophago-gastric cancer. Two hundred and fifty-four patients with adenocarcinoma, squamous cell carcinoma or undifferentiated carcinoma involving the oesophagus, oesophago-gastric junction or the stomach were randomised. The major end points were tumour response, survival, toxicity and quality of life. The median age of patients treated was 72 years and the two arms were well-balanced for baseline demographic factors. The overall response rate was 16.1% [95% confidence interval (CI) 9.5% to 22.7%] in patients treated with PVI 5-FU alone compared with 19.1% (95% CI 12.0% to 26.0%) for those treated with PVI 5-FU plus MMC (P = 0.555). Median time to treatment failure was 3.9 months for PVI 5-FU and 3.8 months for PVI 5-FU plus MMC (P = 0.195). Median survival was 6.3 months for PVI 5-FU and 5.3 months for PVI 5-FU plus MMC (P = 1.0). Toxicity was mild for both treatments. Symptomatic benefit measured by improvement in pain control, weight loss, dysphagia and oesophageal reflux was observed in over 64% of patients in each arm. Quality of life scores were comparable in each arm. PVI 5-FU is a safe, effective form of palliation for patients with advanced oesophago-gastric cancer although the addition of MMC adds little extra benefit.

  12. Clinical benefit of palliative radiation therapy in advanced gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Michelle M.; Rana, Vishal; Janjan, Nora A. (Dept. of Radiation Oncology, Univ. of Texas M.D. Anderson Cancer Center, Houston, Texas (US)) (and others)

    2008-03-15

    Background. Local progression of advanced gastric cancer often manifests as bleeding, dysphagia/obstruction, or pain. We evaluated the magnitude and durability of palliation with radiotherapy (RT). Material and methods. From 1996 to 2004, 37 gastric cancer patients were treated with palliative RT (median dose 35Gy in 14 fractions). Nearly two-thirds of all patients received concurrent chemoradiation therapy (CRT). Index pre-treatment symptoms were gastric bleeding, dysphagia/obstruction, and pain in 54%, 43%, and 19% of patients, respectively. Results. The rates of control for bleeding, dysphagia/obstruction, and pain were 70% (14/20), 81% (13/16), and 86% (6/7), respectively. These symptoms were controlled without additional interventions for a median of 70%, 81%, and 49% of the patient's remaining life, respectively. Patients receiving CRT had a trend towards better median overall survival than those receiving RT alone (6.7 vs. 2.4 months, p=0.08). Lower (<41 Gy) biologically effective dose (BED, assuming an alpha/beta ratio of 10 for early responding tissues) predicted for poorer local control (6-month local control 70% vs. 100%, p=0.05) while T4 tumors had a trend towards inferior local control (6-month LC 56% vs. 100%, p=0.06). Discussion. Palliative RT controls symptoms for most of the remaining life in the majority of gastric cancer patients. The role of a higher dose of RT (BED >= 41 Gy), especially in patients with T4 tumors, remains to be established. In order to accurately define the role for radiotherapy in palliation of these symptoms, prospective randomized studies need to be conducted.

  13. Molecular-targeted first-line therapy for advanced gastric cancer.

    Science.gov (United States)

    Song, Huan; Zhu, Jianwei; Lu, DongHao

    2016-07-19

    Gastric cancer is the fifth most common cancer and third leading cause of cancer-related deaths worldwide. Complete resection of the whole tumor remains the only approach to treat this malignant disease. Since gastric cancer is usually asymptomatic in its early stages, many people are diagnosed at an advanced stage when the tumor is inoperable. In addition, because other conventional treatments (radiotherapy and chemotherapy) have only modest efficacy for those with advanced/metastatic gastric cancer, the prognosis in such cases is poor. Recently, trials have provided some promising results regarding molecular-targeted therapy, raising the possibility that the development of these agents could be a fruitful approach. However, the benefit of molecular-targeted therapy for advanced gastric cancer remains inconclusive. To evaluate the efficacy and safety of molecular-targeted therapy , either alone or in combination with chemotherapy, in people with advanced gastric cancer. We searched the following databases (from inception to December 2015): the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. In addition, we searched the reference lists of included trials and contacted experts in the field. We searched for randomized controlled trials (RCTs) in adults (aged 18 years or older) with histologically-confirmed advanced adenocarcinoma of the stomach/gastro-esophageal junction. Trials of participants with esophageal adenocarcinoma were also considered to be eligible. The eligible trials should aim to evaluate the effects of molecular-targeted agents on participants' prognosis. Two review authors independently performed selection of eligible trials, assessment of trial quality, and data extraction. We used methods of survival analysis and expressed the intervention effect as a hazard ratio (HR) when pooling time-to-event data, and calculated the odds ratio (OR) for dichotomous data and mean differences (MDs) for continuous data, with

  14. Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement

    Institute of Scientific and Technical Information of China (English)

    Xin-Bao Wang; Li-Tao Yang; Ze-Wei Zhang; Jian-Min Guo; Xiang-Dong Cheng

    2008-01-01

    AIM:To characterize the factors of the improved survival following combined pancreaticoduodenectomy (PD) and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement. METHODS:From 1995 to 2004,53 patients with primary gastric cancer were diagnosed with synchronous (n=44) or metachronous (n=9) pancreaticoduodenal region involvement.Of these,17 patients (32%) underwent total gastrectomy (TG) or distal subtotal gastrectomy (SG) combined with PD simultaneously.The preoperative demographic,clinical information,clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison. RESULTS:The actual 1-and 3-year survival rates of these 17 patients after resection were 77% and 34%, respectively,and three patients survived for more than 5 years after surgery.The tumor-free resection margin (P=0.0174) and a well-differentiated histologic type (P=0.0011) were significant prognostic factors on univariate analysis.No mortality occurred within one mo after operation,postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications.There were 9(53%) cases of recurrence in 5-48 mo after operation.The survival rate in the palliative and explorative group was significantly (P=0.0064) lower than in the combined PD group. CONCLUSION:Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreaticoduodenal region involvement.Well-differentiated histology and negative resection margin are the most important predictors of long survival.

  15. MRI for advanced gastric cancer; Especially for scirrhous cancer of the stomach

    Energy Technology Data Exchange (ETDEWEB)

    Homma, Hisato; Masuko, Eiichi; Saito, Tadanori; Ikeda, Shigeyuki (National Sapporo Hospital (Japan)); Mezawa, Synichi; Betsuyaku, Takashi; Niitsu, Yoshiro

    1993-01-01

    We conducted MRI examinations in 92 patients with advanced gastric cancer and evaluated the clinical potential of MRI for diagnosis of scirrhous cancer of the stomach. The feature of scirrhous cancer of stomach by MRI are: (1) thickened gastric wall, (2) shortening of T1 and T2 values; and (3) clear contrast between the gastric mucosae and cancer areas found in the T1 and T2 weighted images (preservation of the mucosae). MRI for scirrhous cancer of the stomach is thought a useful image diagnosis as an adjunct method to gastric X-ray and gastric endoscopy. (author).

  16. A STUDY OF ENDOSCOPIC TREATMENT OF ADVANCED ESOPHAGEAL AND GASTRIC CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    Zhang Jichang; Zhang Lijian; Wang Yanmeng; Li Wei

    1998-01-01

    Objective: To investigate the effect of endoscopic treatment on advanced esophageal and gastric carcinoma.Methods: Twenty advanced gastric cancer patients and 25advanced esophageal cancer patients, who had recurrence after operation and radiotherapy were managed by endoscopic treatment. Results: 10 cases were treated to stop bleeding only, 35 cases were treated by microwave,dilation and local chemotherapy. The successful rate of hemostasis was about 67%, the remission rate of digestive obstruction was about 100% after dilation, 83% of the recurrence lesions were relieved by endoscopic chemotherapy. Conclusion: Endoscope treatment has certain therapeutic efficiency for the recurrence of advanced esophageal and gastric cancer.

  17. Surgical palliation of gastric outlet obstruction in advanced malignancy

    Science.gov (United States)

    Potz, Brittany A; Miner, Thomas J

    2016-01-01

    Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity. PMID:27648158

  18. Palliative treatment of patients with inoperable locally advanced, recurrent or metastatic head and neck squamous cell cancer, using a low-dose and personalized chemotherapeutic regimen

    Science.gov (United States)

    Bishnoi, Rohit; Bennett, Jeffery; Reisman, David N.

    2017-01-01

    Inoperable or metastatic head and neck squamous cell cancer (HNSCC) is known to be associated with a poor patient prognosis. First line therapies include a Taxol, platinum-based antineoplastic and fluorouracil (FU) treatment regimen (TPF) or a platinum-based antineoplastic, FU and EGFR inhibitor treatment regimen (PFE). The toxicity of these regimens is one of the major limiting factors, particularly for palliative treatment. The present study is a retrospective study of 15 patients with HNSCC, where the treatment goal was palliative. Of the 15 patients, 8 received a TPF, while 7 received a PFE. A total of 129 treatment cycles were administered with a median of 9 cycles (range, 3–14). Chemotherapy began with low doses and was subsequently titrated up based on tolerance and response. Positive responses were noted with the lower doses compared with the conventional doses, and maximal doses were not required. The median dose of cisplatin, paclitaxel and 5-FU administered was 40 mg/m2, 80 mg/m2 and 360 mg/m2/day for 5 days, respectively. Cetuximab was used at a standard dose. At the initial follow-up (mean, 64 days; 3 cycles), a 100% disease control rate (DCR) and 80% overall response rate (ORR) was achieved. A positive response, 60% DCR and 60% ORR, was maintained until the late stages of the study (mean, 217 days; 9 cycles). Following termination of chemotherapy after >9 cycles, 4 patients remained disease free for ~1 year. A total of 3 patients exhibited a pathologic complete response despite radiologically exhibiting residual disease. The median progression-free survival time was 10.03 months and the overall survival time was 15.77 months. The only grade 3 hematologic toxicity noted was neutropenia in 3 (20%) patients. Grade 3 vomiting was noted in 1 (6.67%) patient and grade 3 stomatitis was noted in 1 (6.67%) patient. Due to low toxicity patients exhibited improved tolerance to this approach, particularly in terms of palliative care. Furthermore, these results

  19. Recent advances in molecular biology of gastric carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    萧树东; 冉志华

    2003-01-01

    Gastric cancer is a major health care problem and the second most common fatal cancer worldwide. In the last decade, better insight has been gained into the molecular basis underlying the neoplasitc transformation of stomach. The dramatic variation in the incidence of gastric cancer in different geographical areas and from one generation to the next have led to the hypothesis that the incidence of gastric cancer is determined largely by environmental rather than genetic factors.

  20. Neoadjuvant chemotherapy for advanced gastric cancer:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To study the value of neoadjuvant chemotherapy (NAC) for advanced gastric cancer by performing a meta-analysis of the published studies.METHODS:All published controlled trials of NAC for advanced gastric cancer vs no therapy before surgery were searched.Studies that included patients with metastases at enrollment were excluded.Databases included Cochrane Library of Clinical Comparative Trials,MEDLINE,Embase,and American Society of Clinical Oncology meeting abstracts from 1978 to 2010.The censor date was...

  1. [Utility of the WallFlexTM duodenal stent for unresectable advanced gastric cancer related to gastric outlet obstruction].

    Science.gov (United States)

    Aoki, Taro; Hyuga, Satoshi; Kato, Aya; Chono, Teruhiro; Watanabe, Risa; Komori, Takamichi; Matsumoto, Takashi; Takachi, Kou; Nishioka, Kiyonori; Uemura, Yoshio; Kobayashi, Kenji

    2012-11-01

    Duodenal stenting for malignant disease related to gastric outlet obstruction(GOO) has been covered by health insurance in Japan since April 2010. We inserted WallFlexTM duodenal stents(WDS) in 4 patients with GOO caused by unresectable gastric cancer. WDS insertion was successful in all 4 cases. Duodenal perforation occurred in 1 case. One case each of stent obstruction and stent migration occurred. All patients could eat a soft-food diet for 3-6 months (median, 5.3 months). Survival time ranged between 5 and 14 months (median, 6 months). Three patients underwent S-1 combination chemotherapy. Duodenal stenting is expected to be effective for advanced gastric cancer related to GOO.

  2. MLN0264 in Previously Treated Asian Participants With Advanced Gastrointestinal Carcinoma or Metastatic or Recurrent Gastric or Gastroesophageal Junction Adenocarcinoma Expressing Guanylyl Cyclase C

    Science.gov (United States)

    2017-02-08

    Advanced Gastrointestinal Carcinoma; Gastroesophageal Junction Adenocarcinoma; Recurrent Gastric Adenocarcinoma; Recurrent Gastroesophageal Junction Adenocarcinoma; Metastatic Gastric Adenocarcinoma; Metastatic Gastroesophageal Junction Adenocarcinoma; Recurrent Gastrointestinal Carcinoma

  3. Advanced endoscopic imaging for gastric cancer assessment: new insights with new optics?

    Science.gov (United States)

    Serrano, M; Kikuste, I; Dinis-Ribeiro, M

    2014-12-01

    The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa - detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.

  4. Role of Helicobacter pylori in gastric cancer: advances and controversies.

    Science.gov (United States)

    Meng, Wenbo; Bai, Bing; Sheng, Liang; Li, Yan; Yue, Ping; Li, Xun; Qiao, Liang

    2015-11-01

    Gastric cancer is one of the most common cancers of digestive system globally and Helicobacter pylori (HP) infection is believed to be a major risk factor. HP can be classified into different types based on the presence and expression level of CagA and VacA, and, when exposed to adverse environment, HP changes its phenotype from helical type to coccoid type, with each having different pathogenicity. The mechanisms of HP-induced gastric carcinogenesis and progression are complicated, including DNA nitration and oxidation induced by mutagenic factors, HP-induced epigenetic modifications, HP-induced disruption of the balance between cell proliferation and apoptosis, and HP-induced cancer cell invasion and metastasis. HP may also affect the biological function of cancer stem cells and induction of cell autophagy. The lipopolysaccharide produced by HP can act through toll-like receptor-4 (TLR-4) to induce gastric mucosal inflammation and is thereby linked to the development of gastric cancer.

  5. Recent advances in mass spectrometry-based proteomics of gastric cancer

    Science.gov (United States)

    Kang, Changwon; Lee, Yejin; Lee, J Eugene

    2016-01-01

    The last decade has witnessed remarkable technological advances in mass spectrometry-based proteomics. The development of proteomics techniques has enabled the reliable analysis of complex proteomes, leading to the identification and quantification of thousands of proteins in gastric cancer cells, tissues, and sera. This quantitative information has been used to profile the anomalies in gastric cancer and provide insights into the pathogenic mechanism of the disease. In this review, we mainly focus on the advances in mass spectrometry and quantitative proteomics that were achieved in the last five years and how these up-and-coming technologies are employed to track biochemical changes in gastric cancer cells. We conclude by presenting a perspective on quantitative proteomics and its future applications in the clinic and translational gastric cancer research. PMID:27729735

  6. Relationship between clinicopathological features and mucin phenotypes of advanced gastric adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Fumiaki; Toki; Atsushi; Takahashi; Ryusuke; Aihara; Kyoichi; Ogata; Hiroyuki; Ando; Tetsuro; Ohno; Erito; Mochiki; Hiroyuki; Kuwano

    2010-01-01

    AIM: To investigate a relationship between the clinicopathological features and mucin phenotypes in advanced gastric adenocarcinoma (AGA). METHODS: Immunohistochemical staining was performed to determine the mucin phenotypes in 38 patients with differentiated adenocarcinomas (DACs), 9 with signet-ring cell carcinomas (SIGs), and 48 with other diffuse-type adenocarcinomas (non-SIGs) of AGA. The mucin phenotypes were classified into 4 types: gastric (G), gastrointestinal (GI), intestinal, and unclassified. RE...

  7. Clinical significance of preoperative regional intra-arterial infusion chemotherapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Cheng-Wu Zhang; Shou-Chun Zou; Dun Shi; Da-Jian Zhao

    2004-01-01

    AIM: Preoperative intra-arterial infusion chemotherapy could increase the radical resection rate of advanced gastric cancer, but its effect on the long-term survival has not been assessed. This study was designed to evaluate the clinical significance of preoperative intra-arterial infusion chemotherapy for advanced gastric cancer.METHODS: Clinicopathological data of 91 patients who underwent curative resection for advanced gastric cancer were collected. Among them, 37 patients undertaken preoperative intra-arterial infusion chemotherapy were used as the interventional chemotherapy group, and the remaining 54 patients as the control group. Eleven factors including clinicopathological variables, treatment procedures and molecular biological makers that might contribute to the long-term survival rate were analyzed using Cox multivariate regression analysis.RESULTS: The 5-year survival rate was 52.5% and 39.8%,respectively, for the interventional group and the control group (P<0.05). Cox multivariate regression analysis revealed that the TNM stage (P<0.001), preoperative intraarterial infusion chemotherapy (P = 0.029) and growth pattern (P = 0.042) were the independent factors for the long-term survival of patients with advanced gastric cancer.CONCLUSION: Preoperative intra-arterial infusion chemotherapy plays an important role in improving the prognosis of advanced gastric cancer.

  8. Advances in Understanding How Heavy Metal Pollution Triggers Gastric Cancer

    Science.gov (United States)

    Yuan, Wenzhen; Yang, Ning

    2016-01-01

    With the development of industrialization and urbanization, heavy metals contamination has become a major environmental problem. Numerous investigations have revealed an association between heavy metal exposure and the incidence and mortality of gastric cancer. The mechanisms of heavy metals (lead, cadmium, mercury, chromium, and arsenic) contamination leading to gastric cancer are concluded in this review. There are four main potential mechanisms: (1) Heavy metals disrupt the gastric mucosal barrier by decreasing mucosal thickness, mucus content, and basal acid output, thereby affecting the function of E-cadherin and inducing reactive oxygen species (ROS) damage. (2) Heavy metals directly or indirectly induce ROS generation and cause gastric mucosal and DNA lesions, which subsequently alter gene regulation, signal transduction, and cell growth, ultimately leading to carcinogenesis. Exposure to heavy metals also enhances gastric cancer cell invasion and metastasis. (3) Heavy metals inhibit DNA damage repair or cause inefficient lesion repair. (4) Heavy metals may induce other gene abnormalities. In addition, heavy metals can induce the expression of proinflammatory chemokine interleukin-8 (IL-8) and microRNAs, which promotes tumorigenesis. The present review is an effort to underline the human health problem caused by heavy metal with recent development in order to garner a broader perspective.

  9. Advances in Understanding How Heavy Metal Pollution Triggers Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Wenzhen Yuan

    2016-01-01

    Full Text Available With the development of industrialization and urbanization, heavy metals contamination has become a major environmental problem. Numerous investigations have revealed an association between heavy metal exposure and the incidence and mortality of gastric cancer. The mechanisms of heavy metals (lead, cadmium, mercury, chromium, and arsenic contamination leading to gastric cancer are concluded in this review. There are four main potential mechanisms: (1 Heavy metals disrupt the gastric mucosal barrier by decreasing mucosal thickness, mucus content, and basal acid output, thereby affecting the function of E-cadherin and inducing reactive oxygen species (ROS damage. (2 Heavy metals directly or indirectly induce ROS generation and cause gastric mucosal and DNA lesions, which subsequently alter gene regulation, signal transduction, and cell growth, ultimately leading to carcinogenesis. Exposure to heavy metals also enhances gastric cancer cell invasion and metastasis. (3 Heavy metals inhibit DNA damage repair or cause inefficient lesion repair. (4 Heavy metals may induce other gene abnormalities. In addition, heavy metals can induce the expression of proinflammatory chemokine interleukin-8 (IL-8 and microRNAs, which promotes tumorigenesis. The present review is an effort to underline the human health problem caused by heavy metal with recent development in order to garner a broader perspective.

  10. Evaluation of inoperable pancreatic carcinoma based on tumor metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Miura, Yasuhiko; Ueda, Michio; Kubota, Toru; Endo, Itaru; Sekido, Hitoshi; Togo, Shinji; Shimada, Hiroshi [Yokohama City Univ. (Japan). School of Medicine

    2002-05-01

    Many pancreatic cancers are detected only after they are far advanced, and thus show a poor prognosis. We evaluated the survival of patients with inoperable pancreatic carcinoma, and strategy treatment. Subjects were 72 persons with advanced inoperable pancreatic carcinoma selected from among 144 examined at our department from May 1992 to March 2001. Patient factors (age, gender, and nutrition), tumor factors (hepatic metastasis, peritoneal dissemination, and distant metastasis), and treatment (radiotherapy, systemic chemotherapy, and hepatic arterial infusion therapy (HAI)) were studied and survival evaluated statistically. Overall mean survival was 175 days and the 1-year survival ratio was 13.5%. With multivariate analysis, prognostic factors were hepatic metastasis and radiotherapy. We therefore re-evaluated 56 patients treated with radiotherapy. In the group with no hepatic metastasis whose mean survival was 247 days, the prognostic factor was systemic chemotherapy. In the group with hepatic metastasis, mean survival was 140 days and the prognostic factor was the prognostic nutritional index (PNI) on admission. HAI was also a significant factor, which prolonged survival time with univariate analysis. Radiotherapy will be conducted for all inoperable pancreatic carcinomas. For the group with no hepatic metastasis, systemic chemotherapy is effective and for the group with hepatic metastasis. HAI will be selected. (author)

  11. [Morbidity and mortality related to gastroenteroanastomosis in advanced gastric cancer].

    Science.gov (United States)

    Berrospi, F; Ruiz, E; Morante, C; Celis, J; Montalbelti, J A

    1995-01-01

    Determination of the postoperative morbidity and mortality after gastroenterostomy in patients with unresectable gastric cancer. Retrospective review of clinical records of all patients with obstructive distal gastric cancer who underwent gastroenterostomy at the Instituto de Enfermedades Neoplásicas between 1980 and 1993. The following factors were analyzed: age, sex, hemoglobin, albumin, preoperative risk, ascites, extent of disease, operative time, hospital stay, morbidity and mortality. 198 gastroenterostomy were done with a morbidity and mortality rates of 20% and 10%, respectively. Pneumonia was the principal cause of postoperative morbidity and mortality. High operative risk, adjacent organ invasion by the tumor and peritoneal metastasis were factors associated with increased postoperative morbidity (p > 0.05). High operative risk was the only prognostic factor for postoperative mortality (p < 0.01). Because of high postoperative morbidity and mortality, gastroenterostomy should not be done in patients with unresectable gastric cancer and high preoperative risk.

  12. Fulminant amoebic colitis during chemotherapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Noboru Hanaoka; Katsuhiko Higuchi; Satoshi Tanabe; Tohru Sasaki; Kenji Ishido; Takako Ae; Wasaburo Koizumi; Katsunori Saigenji

    2009-01-01

    A 52-year-old man had bloody stools during chemotherapy for gastric cancer. A colonoscopy revealed necrotizing ulcer-like changes. A biopsy confirmed the presence of amoebic trophozoites. Subsequently,peritonitis with intestinal perforation developed, and emergency peritoneal lavage and colostomy were performed. After surgery, endotoxin adsorption therapy was performed and metronidazole was given. Symptoms of peritonitis and colonitis resolved.with the progression of gastric cancer. The patient died 50 d after surgery. Fulminant amoebic colitis is very rarely associated with chemotherapy. Amoebic colitis should be considered in the differential diagnosis of patients who have bloody stools during chemotherapy.

  13. High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Hendrik Andreas; Bosch, Jan; Hennies, Steffen; Hess, Clemens F.; Christiansen, Hans [Dept. of Radiotherapy and Radiooncology, Univ. Medicine Goettingen (Germany); Jung, Klaus [Dept. of Medical Statistics, Univ. Medicine Goettingen (Germany); Overbeck, Tobias [Dept. of Haematology and Oncology, Univ. Medicine Goettingen (Germany); Matthias, Christoph; Roedel, Ralph M. [Dept. of Otorhinolaryngology, Univ. Medicine Goettingen (Germany)

    2010-05-15

    Purpose: to test for a possible correlation between high-grade acute organ toxicity during primary radio(chemo)therapy and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Patients and methods: from 05/1994 to 01/2009, 216 HNSCC patients were treated with radio(chemo)therapy in primary approach. They received normofractionated (2 Gy/fraction) irradiation including associated nodal drainage sites to a cumulative dose of 70 Gy. 151 patients received additional concomitant chemotherapy (111 patients 5-fluorouracil/mitomycin C, 40 patients cisplatin-based). Toxicity during treatment was monitored weekly according to the Common Toxicity Criteria (CTC), and any toxicity grade CTC {>=} 3 of mucositis, dysphagia or skin reaction was assessed as high-grade acute organ toxicity for later analysis. Results: a statistically significant coherency between high-grade acute organ toxicity and overall survival as well as locoregional control was found: patients with CTC {>=} 3 acute organ toxicity had a 5-year overall survival rate of 4% compared to 8% in patients without (p < 0.01). Thereby, multivariate analyses revealed that the correlation was independent of other possible prognostic factors or factors that may influence treatment toxicity, especially concomitant chemotherapy and radiotherapy technique or treatment-planning procedure. Conclusion: these data indicate that normal tissue and tumor tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during radio(chemo)therapy showed to be an independent prognostic marker in the own patient population. However, the authors are aware of the fact that a multivariate analysis in a retrospective study generally has statistical limitations. Therefore, their hypothesis should be further analyzed on biomolecular and clinical levels and other tumor entities in prospective trials. (orig.)

  14. Cancer of the esophagus and gastric cardia: recent advances

    NARCIS (Netherlands)

    Tytgat, G.N.; Bartelink, H.; Bernards, R.A.; Giacone, G.; Lanschot, J.J. van; Offerhaus, G.J.; Peters, G.J.

    2004-01-01

    Esophageal cancer and cancer of the gastric cardia, in particular adenocarcinomas, have shown a rapid and largely unexplained increase in incidence in many developed countries around the world. These diseases have a poor prognosis and current therapies have a modest impact on survival. This review p

  15. Cancer of the esophagus and gastric cardia: recent advances.

    NARCIS (Netherlands)

    Tytgat, GN; Bartelink, H.; Bernards, R; Giaccone, G.; Lanschot, van JJ; Offerhaus, GJ; Peters, G.J.

    2004-01-01

    Esophageal cancer and cancer of the gastric cardia, in particular adenocarcinomas, have shown a rapid and largely unexplained increase in incidence in many developed countries around the world. These diseases have a poor prognosis and current therapies have a modest impact on survival. This review p

  16. Polymorphisms of interleukin-10 promoter are not associated with prognosis of advanced gastric cancer

    Science.gov (United States)

    Liu, Jie; Song, Bao; Wang, Jia-Lin; Li, Zeng-Jun; Li, Wan-Hu; Wang, Zhe-Hai

    2011-01-01

    AIM: To evaluate the association between of the interleukin-10 (IL-10) promoter polymorphisms and survival of advanced gastric cancer (GC) patients. METHODS: The IL-10 (-1082, rs1800896; -819, rs1800871; and-592, rs1800896) genotypes in 234 patients with advanced gastric cancer and in 243 healthy controls were determined by polymerase chain reaction-restriction fragment length polymorphism assay. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by unconditional logistic regression for the associations between IL-10 genotypes and the risk of GC. The Kaplan-Meier method with log-rank testing was used to evaluate the association between genotype and survival of the patients. RESULTS: The IL-10 -1082 G allele and GCC (-1082, -819 and -592) haplotype were associated with increased gastric cancer risks (OR 1.2, 95% CI 0.6-3.2, P = 0.007, for -1082 G allele, OR = 2.3, 95% CI, 1.2-4.1, P = 0.005, for GCC haplotype, respectively). However, none of the three IL-10 gene polymorphisms (-1082, -819 and -592) was correlated with gastric cancer survival (P > 0.05), and none of the genotypes of the three IL-10 sites was found as independent prognostic risk factors in the multivariate test. CONCLUSION: IL-10 gene promoter polymorphisms may not be associated with the prognosis of advanced gastric cancer. PMID:21455338

  17. Polymorphisms of interleukin-10 promoter are not associated with prognosis of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jie Liu; Bao Song; Jia-Lin Wang; Zeng-Jun Li; Wan-Hu Li; Zhe-Hai Wang

    2011-01-01

    AIM: To evaluate the association between of the interleukin- 10 (IL-10) promoter polymorphisms and survival of advanced gastric cancer (GC) patients. METHODS: The IL-10 (-1082, rs1800896; -819, rs1800871; and-592, rs1800896) genotypes in 234 patients with advanced gastric cancer and in 243 healthy controls were determined by polymerase chain reactionrestriction fragment length polymorphism assay. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by unconditional logistic regression for the associations between IL-10 genotypes and the risk of GC. The Kaplan-Meier method with log-rank testing was used to evaluate the association between genotype and survival of the patients. RESULTS: The IL-10 -1082 G allele and GCC (-1082, -819 and -592) haplotype were associated with increased gastric cancer risks (OR 1.2, 95% CI 0.6-3.2, P = 0.007, for -1082 G allele, OR = 2.3, 95% CI, 1.2-4.1, P = 0.005, for GCC haplotype, respectively). However, none of the three IL-10 gene polymorphisms (-1082, -819 and -592) was correlated with gastric cancer survival (P > 0.05), and none of the genotypes of the three IL-10 sites was found as independent prognostic risk factors in the multivariate test. CONCLUSION: IL-10 gene promoter polymorphisms may not be associated with the prognosis of advanced gastric cancer.

  18. Correlation of primary tumor FDG uptake with histopathologic features of advanced gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Won; Won, Kyoung Sook; Song, Bong Il; Kang, Yu Na [Keimyung University Dongsan Medical Center, Daegu (Korea, Republic of)

    2015-06-15

    Histopathologic features could affect the FDG uptake of primary gastric cancer and detection rate on FDG PET/CT. The aim of this study was to evaluate the FDG uptake of primary gastric cancer by correlating it with the histopathologic features of the tumors. Fifty patients with locally advanced gastric adenocarcinoma who were referred for preoperative FDG-PET/CT scans were enrolled in this study. The detection rate of PET/CT and maximum standardized uptake values (SUV{sub max}) of the primary tumor were compared using the WHO, Lauren, Ming and Borrmann classifications and tumor size and location. In 45 of the 50 patients (90 %), the primary gastric tumors were detected by FDG PET/CT. On comparison using the WHO classification, the detection rate and SUV{sub max} of the tubular type were significantly higher than those of the poorly cohesive type. On comparison using the Lauren and Ming classifications, the SUV{sub maxs} of the intestinal type and expanding type were significantly higher than those of the diffuse and infiltrative type, respectively. On comparison using the Borrmann classification and tumor size and location, there was no significant difference in the detection rate and SUV{sub max} of primary gastric tumors. This study demonstrates that the poorly cohesive type according to the WHO classification, diffuse type according to the Lauren classification and infiltrative type according to the Ming classification have low FDG uptake in patients with locally advanced gastric carcinoma. Understanding the relationship between primary tumor FDG uptake and histopathologic features would be helpful in detecting the primary tumor by FDG PET/CT in patients with gastric cancer.

  19. Phase II Study of Oxaliplatin, Irinotecan, and Capecitabine in Advanced Gastric/Gastroesophageal Junction Carcinoma

    Science.gov (United States)

    2015-04-15

    Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Gastric Cancer; Stage IIIA Gastric Cancer; Stage IIIB Gastric Cancer; Stage IIIC Gastric Cancer; Stage IV Gastric Cancer

  20. Targeted therapy for advanced gastric cancer: A review of current status and future prospects

    Institute of Scientific and Technical Information of China (English)

    Ozkan; Kanat; Bert; O’Neil; Safi; Shahda

    2015-01-01

    In the West in particular, the vast majority of gastric cancer(GC) patients present with advanced-stage disease. Although combination chemotherapy is stillthe most important component of treatment for these patients, it confers a modest survival advantage. Recently, increased knowledge of the key molecular signaling pathways involved in gastric carcinogenesis has led to the discovery of specific molecular-targeted therapeutic agents. Some of these agents such as trastuzumab and ramucirumab have changed the treatment paradigm for this disease. In this paper, we will summarize the current clinical status of targeted drug therapy in the management of GC.

  1. Advanced Gastric Neuroendocrine Carcinoma with an Adenocarcinoma Component

    Directory of Open Access Journals (Sweden)

    Masashi Miguchi

    2012-01-01

    Full Text Available In the present study, we observed that the adenocarcinoma component in the mucosa was continuous with neuroendocrine carcinoma (NEC in the deeper layers; this suggests the normal course of NEC carcinogenesis at the histological level. A 72-year-old man was admitted to our hospital with a chief complaint of tarry stools. Endoscopic examination of the upper gastrointestinal tract revealed a 2-cm tumor, with a deep central depression, surrounded by a smooth elevated area, in the middle of the stomach body. A biopsy showed that the tumor was a moderately differentiated gastric adenocarcinoma. The patient underwent total gastrectomy and standard lymph node dissection. The resected tumor was a 3.5 × 2.5 cm type 2 lesion. It comprised two elements at the histological level: (i a moderately differentiated adenocarcinoma in the superficial portion of the mucous membrane layer, and (ii NEC-like cells with dark, round nuclei and scant cytoplasm, presenting a solid and trabecular pattern, in the submucosal and muscularis propria layers. Immunohistochemical findings showed that the NEC-like cells were diffusely positive for chromogranin A, synaptophysin, neural cell adhesion molecule, and neuron-specific enolase, but were negative for carcinoembryonic antigen. The Ki-67 labeling index was 95%. The final pathological diagnosis was gastric NEC with an adenocarcinoma component and a high cellular proliferative potential.

  2. Prognostic impact of splenectomy on advanced proximal gastric cancer with No.10 lymph node metastasis

    Institute of Scientific and Technical Information of China (English)

    HUANG Chang-ming; WANG Jia-bin; LU Hui-shan; ZHENG Chao-hui; LI Ping; XIE Jian-wei; ZHANG Xiang-fu

    2009-01-01

    Background This study evaluated the prognostic impact of D2 lymphadenectomy combined with splenectomy in patients with advanced proximal gastric cancer and lymph node metastasis at the splenic hilum (No. 10 lymph nodes).Methods The clinical records of 216 patients with advanced proximal gastric cancer and No.10 lymph node metastasis who underwent D2 curative resection were retrospectively analyzed. Seventy-three patients underwent simultaneous splenectomy (splenectomy group), while 143 patients did not (spleen-preserving group). Five-year survival rates, mean numbers of dissected No.10 lymph nodes and metastatic No.10 lymph nodes, and operative morbidity and mortality were calculated and compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analysis.Results The 5-year survival rate was 30.0% for the splenectomy group and 19.7% for the spleen-preserving group (X~2=14.73, P 0.05).Conclusions Splenectomy is beneficial for No.10 lymph node dissection in patients with advanced proximal gastric cancer. To improve patient prognosis, total gastrectomy with splenectomy is recommended for patients with T3 proximal gastric cancer who have No. 10 lymph node metastasis.

  3. The Relationship between RUNX3 Expression, Nursing Strategies and Nutritional Status in Elderly Patients with Advanced Gastric Cancer.

    Science.gov (United States)

    Song, Wen; Teng, Wenhui; Shi, Xinyan; Liu, Xiaozhen; Cui, Zheng; Tian, Zibin

    2017-06-01

    The aim of this study was to explore the relationship between nutritional status and expression of RUNX3 in gastric cancer cells and to investigate the effects of nursing strategies on the nutritional status of elderly patients with advanced gastric cancer. Forty-eight elderly patients admitted at Affiliated Hospital of Qingdao University with advanced gastric cancer and 30 healthy controls were selected as subjects from 2014-15. The correlation between RNX3 gene expression and nutritional status of the gastric cancer patients was investigated. The patients with advanced gastric cancer who had low expression of RUNX3 gene were treated with holistic nursing while routine nursing was taken for those patients who had normal or high expression of RUNX3 gene. The nutritional statuses of these patients were evaluated after 3 months of nursing. After a follow-up of 1 year, the influence of different nursing methods on the survival time was evaluated. Compared with normal gastric tissue, the expression of RUNX3 gene and protein in tissues of advanced gastric cancer were significantly decreased (Pnutritional statuses of advanced gastric cancer patients with low expressions of RUNX3 were lower (Pnutritional statuses of patients with low expressions of RUNX3 were notably improved after holistic nursing, becoming equivalent to those with normal or high expression of RUNX3 who received routine nursing (P>0.05). The survival time of patients with low expression of RUNX3 who received holistic nursing were similar to patients with normal or high expression of RUNX3 who received routine nursing (P>0.05). RUNX3 is correlated with the occurrence and development of advanced gastric cancer. The low nutritional status of elderly advanced gastric cancer patients with low expressions of RUNX3 can be significantly enhanced by holistic nursing, thereby prolonging survival time.

  4. Differentiation of early gastric cancer with ulceration and resectable advanced gastric cancer using multiphasic dynamic multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Tsurumaru, Daisuke; Miyasaka, Mitsutoshi; Nishimuta, Yusuke; Asayama, Yoshiki; Nishie, Akihiro; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Kawanami, Satoshi [Kyushu University, Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Fukuoka (Japan); Oki, Eiji [Kyushu University, Department of Surgery and Sciences, Graduate School of Medical Sciences, Fukuoka (Japan); Hirahashi, Minako [Kyushu University, Department of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Fukuoka (Japan)

    2016-05-15

    Early gastric cancer with ulceration (EGC-U) mimics advanced gastric cancer (AGC), as EGC-Us and ACGs often have similar endoscopic appearance to ulceration. The purpose of this retrospective study was to determine whether multiphasic dynamic multidetector CT (MDCT) can help differentiate EGC-Us from AGCs. Patients with EGC-Us with ulcer stages Ul-III or IV and AGCs with tumour stages T2 to T4a were enrolled. MDCT images were obtained 40 s (arterial phase), 70 s (portal phase) and 240 s (delayed phase) after injection of non-ionic contrast material. Two readers independently measured the attenuation values of the lesions by placing regions of interest. We compared the EGC-Us and AGCs using the mean attenuation values in each phase and peak enhancement phase. We analysed the diagnostic performance of CT for differentiating EGC-Us from AGCs. Forty cases (16 EGC-Us and 24 AGCs) were analysed. The mean attenuation values of the EGC-Us were significantly lower than those of the AGCs in both the arterial and portal phases (all p < 0.0001 for each reader). The peak enhancement was significantly different between the EGC-Us and AGCs for both readers (Reader 1, p = 0.0131; Reader 2, p = 0.0006). Multiphasic dynamic contrast-enhanced MDCT can help differentiate EGC-Us from AGCs. (orig.)

  5. Life expectancy with perioperative chemotherapy and chemoradiotherapy for locally advanced gastric adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Sadighi S

    2008-12-01

    Full Text Available "nBackground: Although postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach, curative surgery occurs in less than 50% of nonmetastatic gastric cancers. A regimen of docetaxel, cisplatin and infusional fluorouracil improves survival of patients with incurable locally-advanced gastric adenocarcinoma. So we assessed the perioperative regimen of docetaxel, cisplatin and infusions 5FU (TCF and postoperative chemoradiotherapy to improve outcomes in patients with potentially resectable gastric adenocarcinoma. "nMethods: Between March 2005 and March 2008, we 100 enrolled patients with stage II to IV (M0 adenocarcinoma of the stomach who had not been treated previously. Treatment consisted of three preoperative and one postoperative cycles of TCF followed by chemoradiotherapy. The primary end point was overall survival. The secondary end points were progression-free survival and toxicity of treatment. "nResults: A total of 100 patients participated, 83 of whom received neoadjuvant and 17 received adjuvant chemotherapy. Seventy-five patients underwent at least D0 gastrectomy. After chemotherapy, tumor stages were significantly lower than before beginning the protocol. Out of 100 patients, 44 had stage IV before chemotherapy versus 15 after the treatment. Three patients showed complete pathologic response. The median survival time was 25 months. "nConclusion: Docetaxel, cisplatin and 5FU combination chemotherapy is an active preoperative treatment in locally advanced gastric cancer. Perioperative chemoradio-therapy should be considered as an option to lengthen patient survival.

  6. A phase II study of the vitamin D analogue Seocalcitol in patients with inoperable hepatocellular carcinoma

    DEFF Research Database (Denmark)

    Dalhoff, K; Dancey, J; Astrup, L

    2003-01-01

    growth in cancer cell lines and in vivo. The vitamin D receptor is expressed in hepatocytes and more abundantly in HCC cells. In total, 56 patients with inoperable advanced HCC were included in an uncontrolled study of oral Seocalcitol treatment for up to 1 year (with possible extension for responders......Hepatocellular carcinoma (HCC) is a common malignant tumour, which has a poor prognosis. Surgical resection can be curative but most patients are inoperable and most chemotherapy agents have minimal activity in this disease. Seocalcitol, a vitamin D analogue, induces differentiation and inhibits...

  7. OUR EXPERIENCE OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR PATIENTS WITH ADVANCED GASTRIC CANCER

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available Purpose. Improvement of the results of treatment of patients with locally advanced and metastatic gastric cancer. Material and methods. From the 2010–2014 we performed 30 surgeries using techniques HICT. Among patients there were 17 men and 13 women. The median of age was 50 years. Locally advanced gastric cancer (T4a-T4b was observed in 22 cases, including 4 patients in the emergency immunocytochemical study with peritoneal lavage detected cancer-free (Cyt + cells in the abdominal cavity. The group of patients with metastatic gastric cancer accounted for 8 patients. Narrow carcinomatosis (P1 was 4 cases, carcinomatosis (P2-P3 — 4. Adjuvant systemic chemotherapy in the study group was not carried out. In the control group No 1 (n = 51 performed surgery alone, without additional anticancer therapy. In the control group No 2 (n = 66, a combined treatment (surgery + chemotherapy. Results. Follow-up median was 25 months. Overall 1-year survival rate for all three groups was 55%, 39% and 52%, respectively. Median survival in the intervention group versus 21.4 months in the 8 and 12 months, respectively. The most effective HICT is shown for patients with locally advanced gastric cancer. In the study group, median overall survival was 29 months. The survival rate of 1-, 2-, 3-year-old was equal to 68%, 61% and 42%. In the first control group, 1-year survival of 45%. None of the patients did not survive 2 years. In the second control group, one-year survival rate was 60%, 2-year survival is not. Results of treatment of metastatic gastric cancer proved to be more modest. In the main group the median survival was 10 months, compared with 6 and 7 months of the two control groups. There were no statistically significant differences. Conclusions. 1. Availability of limited dissemination, free cancer cells in the abdominal cavity, as well as a massive defeat of serous membrane of the stomach can be seen as indications for HICT in gastric cancer. 2. In

  8. Catheterization-associated complications of intraperitoneal chemotherapy in advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Meng Ye; Hong-Ming Pan; Hai-Yun Wang; Fang Lou; Wei Jin; Yu Zheng; Jin-Ming Wu

    2004-01-01

    AIM: To assess the catheterization-associated complications during intraperitoneal chemotherapy (IPCT) for advanced gastric cancer.METHODS: From 1998 to 2002, 80 patients with advanced gastric cancer received a total of 320 courses of IPCT using a large bore central venous catheter and associated complications were analyzed.RESULTS: Catheterization-associated complications occurred in 11 of the 80 patients (13.8%), including abdominal pain caused by catheter in 2 cases (0.63%), insertion failure in 2 cases (0.63%), bowel perforation in 1 case (0.31%)and abdominal pain during chernotherapy in 6 cases (1.88%).No serious complications required surgical intervention.CONCLUSION: IPCT using central venous catheters can be performed safely and simply without severe associated complications.

  9. Krukenberg tumors diagnosed during pregnancy simultaneously with advanced gastric cancer; A case report

    Energy Technology Data Exchange (ETDEWEB)

    You, Myung Won; Jung, Yoon Young; Shin, Jung Hwan; Hong, Young Ok [Eulji Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Krukenberg tumors recognized during pregnancy are rarely reported. The preoperative diagnosis can be challenging because of the confusing morphological features and symptoms during pregnancy. Here, we report a case of a 29-year-old pregnant woman at 29 weeks gestation presenting with bilateral solid ovarian masses, which were later diagnosed as metastatic ovarian cancer originating from advanced gastric cancer. This case suggests that Krukenberg tumors should be considered when bilateral ovarian solid masses are encountered regardless of pregnancy.

  10. Eight-year survival after advanced gastric cancer treated with S-1 followed by surgery

    Institute of Scientific and Technical Information of China (English)

    Susumu; Hijioka; Keisho; Chin; Yasuyuki; Seto; Noriko; Yamamoto; Kiyohiko; Hatake

    2010-01-01

    We report a case of advanced gastric cancer, with cervical, axillary, and abdominal paraaortic lymph node metastases, that was successfully treated with chemotherapy and surgery. The disease was initially considered unresectable, and the patient was treated with orally administered S-1. Chemotherapy was effective, and all lymph node metastases disappeared after 6 courses. After 27 mo of chemotherapy, the patient underwent curative surgery, with subtotal gastrectomy and lymph node dissection. Histopathologic...

  11. Effect of lymphadenectomy extent on advanced gastric cancer located in the cardia and fundus

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To analyze the prognostic impact of lymphade- nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS: Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes (iNs) dissected and survival was analyzed among different clinical stage subgroups. RESULTS: The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected (P<0.0001; or number of negative LNs examined, P<0.0001), number of positive INs (P < 0.0001), T category (P < 0.0001) and tumor size (P=0.015). The greatest survival differences were observed at cutoff values of 20 INs resected for stage II (P = 0.0136), 25 for stage III (P < 0.0001), 30 for stage IV (P = 0.0002), and 15 for all patients (P = 0.0024). Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative INs for patients of stages III (P = 0.013) and IV (P = 0.035). CONCLUSION: To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 INs for stage II, 25 INs for stage III, and 30 INs for stage 1V patients during D2 radical dissection is recommended.

  12. A Case of Advanced Gastric Cancer with Poor Performance Status Which Improved by Chemotherapy

    Directory of Open Access Journals (Sweden)

    Kohei Shitara

    2010-07-01

    Full Text Available Introduction: The prognosis of advanced gastric cancer patients, especially those with poor performance status (PS, is generally dismally poor. Patients with PS 3–4 are usually ineligible for participation in clinical studies and are managed with only best supportive care. Case Report: A 63-year-old male with advanced gastric cancer was admitted to our hospital. His PS was markedly impaired (Eastern Cooperative Oncology Group PS 4, with dyspnea secondary to lymphangitis, pleuritis and pericarditis. He also had bilateral leg paralysis due to multiple bone metastases. He was treated with chemotherapy using 5-fluorouracil and leucovorin for 14 days with pericardial drainage followed by intrapericardial infusion of cisplatin. He was also treated with radiotherapy for bone metastasis. The patient required 5 l/min oxygen therapy at the start of chemotherapy, but his dyspnea was improved by day 14 and he no longer required supplemental oxygen therapy. His leg paralysis also improved with the radiation therapy. His PS was significantly improved with this multimodal treatment modality, and he was ultimately discharged with chemotherapy with oral fluoropyrimidine. Conclusion: This case suggests that multimodal therapy including chemotherapy may be beneficial in advanced gastric cancer patients even in the setting of poor PS. Further study might be required to confirm the benefit of chemotherapy in this patient population.

  13. Chemo-Immunotherapy Using Lentinan for the Treatment of Gastric Cancer with Liver Metastases

    Directory of Open Access Journals (Sweden)

    Kenji Ina

    2016-04-01

    Full Text Available Gastric cancer is the third leading cause of cancer-related mortality worldwide. Systemic chemotherapy is the main treatment option for advanced gastric cancer when the tumor is inoperable. Despite recent advances in chemotherapeutic agents, the prognosis of unresectable or recurrent gastric cancer remains extremely poor. In Japan, combination therapy including S-1 and cisplatin is the standard first-line treatment for advanced gastric cancer; however, the five-year survival rate remains very low. Lentinan, the backbone of beta-(1,3-glucan with beta-(1,6 branches, an active ingredient purified from Shiitake mushrooms, has been approved as a biological response modifier for the treatment of gastric cancer. This agent has been used in combination with oral fluoropyrimidines to improve the overall survival of gastric cancer patients. A retrospective chart review on 138 metastatic gastric cancer patients receiving chemotherapy was performed in Nagoya Memorial Hospital from 1 September 2010 to 31 August 2015. 12 patients with liver metastases were treated by lentinan in combination with S-1-based chemotherapy. The rate of objective response was 42% (5/12 and the disease control rate was 83% (10/12 in response to chemo-immunotherapy using lentinan, with a median overall survival of 407 days (95% CI: 207–700 days.

  14. [A case of early gastric cancer completely responding to adjuvant chemotherapy for advanced colon cancer].

    Science.gov (United States)

    Tanaka, Ryo; Kameyama, Hitoshi; Nakano, Mae; Ichikawa, Hiroshi; Hanyu, Takaaki; Nakano, Masato; Ishikawa, Takashi; Shimada, Yoshifumi; Sakata, Jun; Kobayashi, Takashi; Kosugi, Shinichi; Minagawa, Masahiro; Koyama, Yu; Wakai, Toshifumi

    2014-11-01

    A 70-year-old man was referred to our hospital with ascending colon cancer (cT3N1M0, Stage IIIa), which was found during examinations following a positive fecal occult blood test. The patient was also diagnosed with early gastric cancer (cT1a, N0, M0, Stage IA)during a preoperative gastroscopy examination. A laparoscopically assisted right colectomy and D3 lymphadenectomy was performed for the ascending colon cancer. The postoperative pathological diagnosis was Stage IIIb (pT3N2), he was administered in combination with capecitabine plus oxaliplatin (CapeOX) as adjuvant chemotherapy before the treatment for the colon cancer. After 6 months of adjuvant chemotherapy, we were unable to detect any gastric lesions at the same location using gastroscopy, and so diagnosed a clinical complete response. A follow-up gastroscopy 6 months later showed the same findings. The patient has had no recurrence of gastric cancer for 18 months after the initial operation. He will continue to be followed up closely using gastroscopy. In this case, CapeOX as adjuvant chemotherapy for advanced colon cancer was also effective for early gastric cancer.

  15. Literature Analysis of TCM Syndrome Types of Gastric Cancer and Advanced Gastric Cancer%进展期胃癌中医证型的文献分析

    Institute of Scientific and Technical Information of China (English)

    王晓妍; 曹志群; 相宏杰; 王慧娟

    2013-01-01

    Objective: Study of gastric cancer and advanced gastric cancer syndromes distribution was made to determine the main TCM syndrome types. Methods: The domestic public reports of gastric cancer and advanced gastric cancer syndrome differentiation of TCM in nearly 30 years were analyzed, in order to summarize and analyze the syndrome type of traditional Chinese medicine constitution ratio. Results: Common syndrome types of traditional Chinese medicine about gastric cancer are deficiency of the spleen and stomach type,stasis toxin resistance type,liver stomach disharmony,Qi and blood deficiency type,phlegm coagulation type,stomach yin deficiency type,Common syndrome types of traditional Chinese medicine about advanced gastric cancer are deficiency of the spleen and stomach type, stasis toxin resistance type, Qi and blood deficiency type, liver stomach disharmony, stomach yin deficiency type, Deficiency of the spleen and stomach is the most basic pathogenesis of gastric carcinoma. Conclusion: The statistical results of TCM syndrome type of gastric cancer and advanced gastric cancer have important guiding significance on the establishment of the clinical syndrome differentiation standard.%目的:运用循证医学方法,探讨进展期胃癌的证型分布规律,明确其主要证型.方法:统计近30余年国内公开报道的进展期胃癌辨证分型文献,总结、分析其中中医证型的构成比.结果:进展期胃癌常见中医证型是:脾胃虚损型、瘀毒内阻型、气血两亏型、肝胃不和型、胃热伤阴型.脾胃虚损是胃癌的最基本病机.结论:进展期胃癌证型统计结果对确立临床辨证分型标准具有重要指导意义.

  16. Current Molecular Targeted Therapy in Advanced Gastric Cancer: A Comprehensive Review of Therapeutic Mechanism, Clinical Trials, and Practical Application

    Directory of Open Access Journals (Sweden)

    Kaichun Li

    2016-01-01

    Full Text Available Despite the great progress in the treatment of gastric cancer, it is still the third leading cause of cancer death worldwide. Patients often miss the opportunity for a surgical cure, because the cancer has already developed into advanced cancer when identified. Compared to best supportive care, chemotherapy can improve quality of life and prolong survival time, but the overall survival is often short. Due to the molecular study of gastric cancer, new molecular targeted drugs have entered the clinical use. Trastuzumab, an antibody targeting human epidermal growth factor receptor 2 (HER2, can significantly improve survival in advanced gastric cancer patients with HER2 overexpression. Second-line treatment of advanced gastric cancer with ramucirumab, an antibody targeting VEGFR-2, alone or in combination with paclitaxel, has been proved to provide a beneficial effect. The VEGFR-2 tyrosine kinase inhibitor, apatinib, can improve the survival of advanced gastric cancer patients after second-line chemotherapy failure. Unfortunately, none of the EGFR targeting antibodies (cetuximab or panitumumab, VEGF targeting monoclonal antibodies (bevacizumab, mTOR inhibitor (everolimus, or HGF/MET pathway targeting drugs has a significant survival benefit. Many other clinical trials based on molecular markers are underway. This review will summarize targeted therapies for advanced gastric cancer.

  17. Intraperitoneal Paclitaxel Is Useful as Adjuvant Chemotherapy for Advanced Gastric Cancer with Serosal Exposure

    Directory of Open Access Journals (Sweden)

    Joji Kitayama

    2014-01-01

    Full Text Available Background: Intraperitoneal administration of paclitaxel (PTX can elicit a marked clinical response in peritoneal metastases of gastric cancer. Methods: In this study, we retrospectively analyzed the clinical outcome of 17 patients who underwent R0 resection with D2 dissection for advanced gastric cancer with macroscopic serosal exposure and received intraperitoneal PTX as adjuvant therapy. Results: A pathological study revealed that the depth of invasion of the primary tumor was pT4a or pT4b in 10 cases, and that the pN stage was more than pN2 in 8 cases. Genetic analysis of peritoneal lavage fluid was performed in 14 cases, all of which were positive for carcinoembryonic antigen mRNA. In these patients, PTX was intraperitoneally administered at 20-60 mg/m2 with oral S-1 for 3-36 months after surgery. In a median follow-up period of 66 months, recurrence occurred in the liver and peritoneum in 2 (11.7% and 1 (5.9% patients, respectively, and no nodal recurrence was observed. Five-year overall survival and disease-free survival were 88.2 and 82.3%, respectively. Conclusion: Since these patients are considered to be a high-risk group for peritoneal recurrence, this result strongly suggests that adjuvant chemotherapy including intraperitoneal PTX is a promising protocol to improve the outcome of patients with advanced gastric cancer with serosal exposure.

  18. Pharmacokinetics of paclitaxel in a hemodialysis patient with advanced gastric cancer: A case report

    Institute of Scientific and Technical Information of China (English)

    Susumu Kawate; Izumi Takeyoshi; Yasuo Morishita

    2006-01-01

    We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced,nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treated with chemotherapy using paclitaxel. Paclitaxel was administered at a dose of 60 mg/m2 as a 1 h iv infusion in 250 mL of saline. Hemodialysis was started 1 h after the completion of the paclitaxel infusion and was performed for 3 h. Paclitaxel was administered weekly on d 1, 8, and 15 on a 28-d cycle. The maximum plasma concentration of paclitaxel was 1390 μg/L. The Grade 2 leukopenia was encountered during the first cycle. The plasma concentrations of paclitaxel from 6to over 24 h after the infusion were 0.01 to 0.1 μmol/L in our patient, and these concentrations have been shown to be effective on inhibiting the growth of gastric cancer cells without producing adverse side effects in the patient. The plasma concentration of paclitaxel was not influenced by hemodialysis. We conclude that the pharmacokinetics of paclitaxel is not altered in a patient with renal failure, and that weekly paclitaxel is a suitable treatment regimen for hemodialysis patients with advanced gastric cancer.

  19. Advanced Gastric Cancer and Perfusion Imaging Using a Multidetector Row Computed Tomography: Correlation with Prognostic Determinants

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    Zhang, Huan; Pan, Zilai; Du, Lianjun; Yan, Chao; Ding, Bei; Song, Qi; Ling, Huawei; Chen, Kemin [Jiaotong University, Jiaotong (China)

    2008-04-15

    Objective : To investigate the relationship between the perfusion CT features and the clinicopathologically determined prognostic factors in advanced gastric cancer cases. Materials and Methods : A perfusion CT was performed on 31 patients with gastric cancer one week before surgery using a 16-channel multi-detector CT (MDCT) instrument. The data were analyzed with commercially available software to calculate tumor blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS). The microvessel density (MVD), was evaluated by immunohistochemical staining of the surgical specimens with anti-CD34. All of the findings were analyzed prospectively and correlated with the clinicopathological findings, which included histological grading, presence of lymph node metastasis, serosal involvement, distant metastasis, tumor, node, metastasis (TNM) staging, and MVD. The statistical analyses used included the Student's t-test and the Spearman rank correlation were performed in SPSS 11.5. Result : The mean perfusion values and MVD for tumors were as follows: BF (48.14+/-16.46 ml/100 g/min), BV (6.70+/-2.95 ml/100 g), MTT (11.75+/-4.02 s), PS (14.17+/-5.23 ml/100 g/min) and MVD (41.7+/-11.53). Moreover, a significant difference in the PS values was found between patients with or without lymphatic involvement (p = 0.038), as well as with different histological grades (p 0.04) and TNM stagings (p = 0.026). However, BF, BV, MTT, and MVD of gastric cancer revealed no significant relationship with the clinicopathological findings described above (p > 0.05). Conclusion : The perfusion CT values of the permeable surface could serve as a useful prognostic indicator in patients with advanced gastric cancer.

  20. Percutaneous cryotherapy for inoperable lung malignancy

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    Park, Eun Hae; Jin, Gong Yong; Han, Young Min; Lee, Yong Chul; Kwon, Keun Sang [Chonbuk National Univ. Medical School and Hospital, Jeonju, (Korea, Republic of)

    2012-05-15

    To evaluate the therapeutic efficacy of percutaneous cryotherapy for inoperable patients with malignant pulmonary nodules. We enrolled 14 patients (7 males, 7 females, average age 68.8 years) who had inoperable lung malignancy in this study from August 2006 through July 2009. We evaluated the therapeutic efficacy of cryotherapy for complete or incomplete ablation by follow up chest CT. Using Kaplan Meier statistical methods, we estimated the survival of patients who had undergone cryotherapy and we investigated post cryotherapy complications. Five of the 14 patients underwent complete ablation (35.7%), while 9 of 14 patients underwent incomplete ablation (64.3%). The change in mean size before procedure and at last follow up CT in the complete and incomplete ablation were as follows: 13.2 {+-} 7.6 mm {yields} 3.8 {+-} 2.7 mm, and 18.1 {+-} 6.2 mm {yields} 33.7 {+-} 17.9 mm, respectively. The median survival of patients in the complete and the incomplete groups were 51.5 months and 24 months, respectively. One patient developed a small pneumothorax, which resolved spontaneously. Two patients developed hemoptysis after the procedure, which was controlled within a day. Percutaneous cryotherapy may be an effective and safe therapeutic method for inoperable patients with malignant pulmonary nodules.

  1. [A case report-highly advanced gastric cancer leading to perforation during neoadjuvant chemotherapy with docetaxel, cisplatin and S-1].

    Science.gov (United States)

    Mihara, Koki; Egawa, Tomohisa; Kemmochi, Takeshi; Irino, Tomoyuki; Okamura, Akihiko; Inaba, Yusaku; Eto, Eiichi; Segami, Kenki; Ito, Yasuhiro; Hayashi, Shinobu; Nagashima, Atsushi

    2011-11-01

    A 70-year-old man was found to have advanced gastric cancer with a deep ulcer and multiple lymph-node metastases. Although the tumor was resectable, we predicted that the patient would have a poor outcome. We therefore administered neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1 to improve the prognosis before curative resection. On day 15 of chemotherapy, sudden abdominal pain occurred, and we performed an emergency surgery for a diagnosis of panperitonitis due to gastric cancer perforation. The defect in the gastric wall was about 2 cm in diameter and was located in the anterior wall of the antrum, consistent with the center of the tumor. The operative findings suggested that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. We saved the patient's life, but intensive care with high-dose catecholamine therapy was needed for several days after the surgery. Gastric cancer perforation induced by neoadjuvant chemotherapy appeared to be more severe than perforation caused by other factors. The adverse effects of chemotherapy apparently increased the severity. Our findings suggest that the risk of gastric cancer perforation should be borne in mind when we administer neoadjuvant chemotherapy to patients who have advanced gastric cancer with a deep ulcer.

  2. [The third report from Sapporo Tsukisamu Hospital--chemotherapy for patients with advanced gastric cancer (peritoneal dissemination, peritonitis carcinomatosa)].

    Science.gov (United States)

    Yamamitsu, Susumu; Kimura, Hiromichi; Yamada, Yoshiyuki; Inui, Noriaki; Hiyama, Shigemi; Hirata, Koichi; Kimura, Yasutoshi; Yamaguchi, Kouji; Shirasaka, Tetsuhiko

    2007-09-01

    Recently, it became possible to reduce the size of tumors in patients with advanced or relapsed gastric cancer by chemotherapy with the combination of several kinds of anti-cancer drugs which are all effective and allowed for use with gastric cancer patients. However, chemotherapy alone can not cure patients with advanced gastric cancer that was shown to improve median survival time (MST), compared with patients provided with the best supportive care (BSC). According to reports from Europe, US and Japan,the MST of patients with advanced gastric cancer and those with peritoneal expansion treated by chemotherapy is almost 7-12 months and 5-6 months,respectively, both of which are short and unsatisfactory. From March 2002, we started to treat patients with advanced gastric cancer (stage IV) with a new regimen; intermittent dosage of 5-FU (-->S-1), CDDP and paclitaxel utilizing the difference of cell cycle between normal and cancer cells (intermittent FP . weekly PTX). In the present study, therefore, we analyzed advanced gastric cancer patients with peritoneal expansion (9 cases, 4 with cancerous peritonitis) treated with this regimen. The results were as follows. The one-and 2-year survival rate was 55.6% and 27.8%, respectively, and the MST was 14 months. Four patients (44.4%) had hematological toxicities over grade 3. All of them had anemia (3 cases) and neutropenia (3 cases). Toxicities of thrombocytopenia were all under grade 1 and nonhematological toxicities were all under grade 2, which were clinically manageable. These results, although the sample was small, suggested that this may contribute to the extension of survival time of patients with stage IV advanced gastric cancer with peritoneal expansion.

  3. Endoscopic Ultrasound-Guided Drainage of Intra-Abdominal Abscess after Gastric Perforation in a Patient Receiving Ramucirumab and Paclitaxel for Advanced Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Koichiro Mandai

    2017-01-01

    Full Text Available Gastrointestinal perforation is a serious adverse event that occurs in approximately 1% of patients receiving ramucirumab and paclitaxel. A 67-year-old man with unresectable advanced gastric cancer was admitted to our hospital and treated with ramucirumab and paclitaxel. Gastric perforation occurred during the second cycle of chemotherapy. Although the patient’s condition improved without surgery, an abscess developed in the intra-abdominal fluid collection resulting from the perforation. We performed endoscopic ultrasound-guided abscess drainage. The patient improved and was discharged in satisfactory condition. Endoscopic ultrasound-guided drainage is a treatment option for patients with intra-abdominal abscess following gastric perforation due to ramucirumab.

  4. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer

    OpenAIRE

    Palmela, Carolina; Velho, S?nia; Agostinho, Lisa; Branco,Francisco; Santos, Marta; Santos, Maria Pia Costa; Oliveira, Maria Helena; Strecht, Jo?o; Maio, Rui; Cravo, Mar?lia; Baracos, Vickie E

    2017-01-01

    Purpose Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity...

  5. Critical evaluation of ramucirumab in the treatment of advanced gastric and gastroesophageal cancers.

    Science.gov (United States)

    ElHalawani, Hesham; Abdel-Rahman, Omar

    2015-01-01

    Gastric (GC) and gastroesophageal junction (GEJ) cancers are two global health problems with a relatively high mortality, particularly in the advanced stage. Inhibition of angiogenesis is now contemplated as a classic treatment preference for myriad tumor types encompassing renal cell carcinoma, non-small cell lung cancer, colorectal cancer, glioblastoma, and ovarian cancer, among others. Bevacizumab and ramucirumab have been widely investigated in GC and GEJ cancer, with some controversy about their therapeutic role. Ramucirumab is a monoclonal antibody for vascular endothelial growth factor receptor-2, with demonstrated activity both as a monotherapy and as a part of combination strategy in the management of advanced GC/GEJ cancer. In this review article, we present a critical evaluation of the preclinical and clinical data underlying the use of this drug in this indication. Moreover, we provide a spotlight on the future perspectives in systemic therapy for advanced GC/GEJ cancer.

  6. Advanced gastric cancer: Is there enough evidence to call second-line therapy standard?

    Institute of Scientific and Technical Information of China (English)

    Hendrik-Tobias Arkenau; Matilde Saggese; Charlotte Lemech

    2012-01-01

    Gastric cancer and cancer of the gastro-oesophageal junction (GOJ) are the 4th most common cancer diagnoses worldwide with regional differences in incidence rates.The treatment of gastric and GOJ cancers is complex and requires multimodality treatment including chemotherapy treatment,surgery,and radiotherapy.During the past decade considerable improvements were achieved by advanced surgical techniques,tailored chemotherapies/radiotherapy and technical innovations in clinical diagnostics.In patients with advanced or metastatic gastric/GOJ cancer systemic chemotherapy with fluoropyrimidine/platinum-based regimens (+/-human epidermal growth factor receptor-2 antibody) is the mainstay of treatment.Despite these improvements,the clinical outcome for patients with advanced or metastatic disease is generally poor with 5-year survival rates ranging between 5%-15%.These poor survival rates may to some extent be related that standard therapies beyond first-line therapies have never been defined.Considering that this patient population is often not fit enough to receive further treatments there is an increasing body of evidence from phase-2 studies that in fact second-line therapies may have a positive impact in terms of overall survival.Moreover two recently published phase-3 studies support the use of second-line chemotherapy.A South Korean study compared either,irinotecan or docetaxel with best supportive care and a German study compared irinotecan with best supportive care-both studies met their primary endpoint overall survival.In this "Field of Vision" article,we review these recently published phase-3 studies and put them into the context of clinical prognostic factors helping to guide treatment decisions in patients who most likely benefit.

  7. Impact of Neoadjuvant Chemotherapy Among Patients with Pancreatic Fistula After Gastrectomy for Advanced Gastric Cancer.

    Science.gov (United States)

    Kosaka, Takashi; Akiyama, Hirotoshi; Makino, Hirochika; Kimura, Jun; Takagawa, Ryo; Ono, Hidetaka A; Kunisaki, Chikara; Endo, Itaru

    2016-04-01

    Neoadjuvant chemotherapy (NAC) has been widely adopted for patients with advanced gastric cancer; however, the safety of gastrectomy with D2 lymphadenectomy followed by NAC has not yet been evaluated. We retrospectively analyzed the influence of NAC on morbidity and mortality after gastrectomy in patients with advanced gastric cancer. A series of 364 patients with advanced gastric cancer who underwent gastrectomy without pancreatectomy between January 2008 and December 2010 at eight hospitals registered to the Yokohama Clinical Oncology Group were studied retrospectively. There were 330 patients who underwent surgical treatment immediately after diagnosis (surgery alone group) and 34 patients (NAC group) who first received NAC and then underwent surgical resection. Although there were no significant differences in the morbidity rate between the two groups, postoperative pancreatic fistula was more often observed in NAC patients than in patients of the group treated with surgery alone [5 cases (14.7%) vs. 11 cases (3.3%); p=0.011]. In the univariate analysis, NAC (p=0.029), bursectomy (pfistula, and NAC [odds ratio (OR)=4.901, 95% confidence interval (CI)=1.455-16.67; p=0.010] and bursectomy (OR=11.2, 95% CI=3.460-37.04; pfistula by multivariate analysis. The incidence of postoperative pancreatic fistula was 40.0% among patients who underwent gastrectomy with bursectomy followed by NAC. The incidence of pancreatic fistula in patients treated with NAC and bursectomy was significantly higher than that in other patients. Bursectomy may be discouraged for the prevention of pancreatic fistula from gastrectomy following NAC. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  8. Critical evaluation of ramucirumab in the treatment of advanced gastric and gastroesophageal cancers

    Directory of Open Access Journals (Sweden)

    ElHalawani H

    2015-07-01

    Full Text Available Hesham ElHalawani, Omar Abdel-Rahman Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt Abstract: Gastric (GC and gastroesophageal junction (GEJ cancers are two global health problems with a relatively high mortality, particularly in the advanced stage. Inhibition of angiogenesis is now contemplated as a classic treatment preference for myriad tumor types encompassing renal cell carcinoma, non-small cell lung cancer, colorectal cancer, glioblastoma, and ovarian cancer, among others. Bevacizumab and ramucirumab have been widely investigated in GC and GEJ cancer, with some controversy about their therapeutic role. Ramucirumab is a monoclonal antibody for vascular endothelial growth factor receptor-2, with demonstrated activity both as a monotherapy and as a part of combination strategy in the management of advanced GC/GEJ cancer. In this review article, we present a critical evaluation of the preclinical and clinical data underlying the use of this drug in this indication. Moreover, we provide a spotlight on the future perspectives in systemic therapy for advanced GC/GEJ cancer. Keywords: ramucirumab, gastric cancer, gastroesophageal cancer

  9. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly.

    Science.gov (United States)

    Qiu, Jiang-Feng; Yang, Bing; Fang, Lei; Li, Yi-Ping; Shi, Yi-Jiu; Yu, Xiu-Chong; Zhang, Mou-Cheng

    2014-01-01

    To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.

  10. Evaluation of two preoparative chemotherapy regimens for complete operability of advanced gastric adenocarcinoma: a clinical trial

    Directory of Open Access Journals (Sweden)

    S. Sedighi

    2006-08-01

    Full Text Available Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1 Cisplatin and continuous infusion of 5FU and Epirubicin (ECF, and 2 Cisplatin and continuous infusion of 5FU with Docetaxel (TCF. Reduction in tumor mass, overall survival (OS, time to progression (TTP, and safety were measured outcome. Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002 and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0 resection had done in two of ECF and six of TCF tumors (p=0.015. Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups. Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

  11. Role of salvage radiotherapy for regional lymph node recurrence after radical surgery in advanced gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byoung Hyuck; Eom, Keun Yong; Kim, Jae Sung; Kim, Hyung Ho; Park, Do Jong [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2013-09-15

    To evaluate the role of salvage radiotherapy (RT) for the treatment of regional lymph node recurrence (RLNR) after radical surgery in advanced gastric cancer. We retrospectively analyzed medical records of 26 patients who underwent salvage treatment after diagnosis of RLNR between 2006 and 2011. Patients with peritoneal seeding or distant metastasis were excluded. Eighteen patients received RT with or without chemotherapy and the other 8 did chemotherapy only without RT. A three-dimensional conformal RT was performed with median dose of 56 Gy (range, 44 to 60 Gy). Sixteen patients had fluoropyrimidine-based chemotherapy, 5 did taxane-based chemotherapy, and irinotecan was applied in 4. With a median follow-up of 20 months (range, 5 to 57 months), median overall survival (OS) and progression-free survival (PFS) after diagnosis of RLNR were 29 months and 12 months in the entire patients, respectively. Radiotherapy (p = 0.007) and disease-free interval (p = 0.033) were statistically significant factors for OS in multivariate analysis. Median OS was 36 months in patients who received RT and 16 months in those who did not. Furthermore, delivery of RT (p < 0.001), complete remission after salvage treatment (p = 0.040) and performance status (p 0.023) were associated with a significantly better PFS. Gastrointestinal toxicities from RT were mild in most patients. Salvage RT combined with systemic chemotherapy may be an effective treatment managing RLNR from advanced gastric cancer.

  12. Role of symptoms in diagnosis and outcome of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Gastric cancer is one of the most common cancers and the second most common cause of cancer deaths worldwide. Apart from Japan, where screening programmes have resulted in early diagnosis in asymptomatic patients, in most countries the diagnosis of gastric cancers is invariably made on account on dyspeptic and alarm symptoms, which may also be of prognostic significance when reported by the patient at diagnosis. However, their use as selection criteria for endoscopy seems to be inconsistent since alarm symptoms are not sufficiently sensitive to detect malignancies. In fact, the overall prevalence of these symptoms in dyspeptic patients is high, while the prevalence of gastro-intestinal cancer is very low. Moreover, symptoms of early stage cancer may be indistinguishable from those of benign dyspepsia, while the presence of alarm symptoms may imply an advanced and often inoperable disease. The features of dyspeptic and alarm symptoms may reflect the pathology of the tumour and be of prognostic value in suggesting site, stage and aggressiveness of cancer. Alarm symptoms in gastric cancer are independently related to survival and an increased number, as well as specific alarm symptoms, are closely correlated to the risk of death. Dysphagia, weight loss and a palpable abdominal mass appear to be major independent prognostic factors in gastric cancer, while gastro-intestinal bleeding, vomiting and also duration of symptoms, do not seem to have a relevant prognostic impact on survival in gastric cancer.

  13. Genetic variation in PSCA and risk of gastric advanced preneoplastic lesions and cancer in relation to Helicobacter pylori infection.

    Directory of Open Access Journals (Sweden)

    Cosmeri Rizzato

    Full Text Available SNPs in the Prostate Stem Cell Antigen (PSCA gene have been found associated with gastric cancer (GC risk in a genome-wide association study. This association has been replicated in several populations. In this study we assessed the impact of PSCA genotype on the risk of advanced gastric precancerous lesions and GC. We used baseline gastric histopathology data and DNA from frozen gastric biopsies of 2045 subjects enrolled in a chemoprevention trial for gastric precancerous lesions in Venezuela, and 180 cases of GC from the same area. We analyzed 3 SNPs in the PSCA gene (rs2294008, rs9297976 and rs12155758 which were previously found to be associated with GC risk in Europeans. The T allele of rs2294008 was found to be associated with a higher prevalence of atrophic gastritis (OR = 1.44; 95% CI 1.03-2.01 for the dominant model and intestinal metaplasia (OR = 1.50; 95% CI 1.13-1.98 for the dominant model. We also confirmed the association with higher risk of gastric cancer (OR = 2.34; 95% CI 1.36-4.01 for the allele carriers. SNP rs12155758 was not associated with risk of gastric preneoplastic lesions, but we confirmed its association with higher GC risk (OR 1.95; 95% CI 1.29-2.97 for dominant model. We tested the relevance of the presence of the Helicobacter pylori cagA gene, which is known to increase the risk of more severe gastric lesions, but we did not find any clearcut interaction with PSCA SNPs in defining risk of gastric precancerous lesions or cancer.

  14. Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer.

    Science.gov (United States)

    Lam, Simon W; Wai, Maya; Lau, Jessica E; McNamara, Michael; Earl, Marc; Udeh, Belinda

    2017-01-01

    Gastric cancer is the fifth most common malignancy and second leading cause of cancer-related mortality. Chemotherapy options for patients who fail first-line treatment are limited. Thus the objective of this study was to assess the cost-effectiveness of second-line treatment options for patients with advanced or metastatic gastric cancer. Cost-effectiveness analysis using a Markov model to compare the cost-effectiveness of six possible second-line treatment options for patients with advanced gastric cancer who have failed previous chemotherapy: irinotecan, docetaxel, paclitaxel, ramucirumab, paclitaxel plus ramucirumab, and palliative care. The model was performed from a third-party payer's perspective to compare lifetime costs and health benefits associated with studied second-line therapies. Costs included only relevant direct medical costs. The model assumed chemotherapy cycle lengths of 30 days and a maximum number of 24 cycles. Systematic review of literature was performed to identify clinical data sources and utility and cost data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. The primary outcome measure for this analysis was the ICER between different therapies, where the incremental cost was divided by the number of QALYs saved. The ICER was compared with a willingness-to-pay (WTP) threshold that was set at $50,000/QALY gained, and an exploratory analysis using $160,000/QALY gained was also used. The model's robustness was tested by using 1-way sensitivity analyses and a 10,000 Monte Carlo simulation probabilistic sensitivity analysis (PSA). Irinotecan had the lowest lifetime cost and was associated with a QALY gain of 0.35 year. Docetaxel, ramucirumab alone, and palliative care were dominated strategies. Paclitaxel and the combination of paclitaxel plus ramucirumab led to higher QALYs gained, at an incremental cost of $86,815 and $1,056,125 per QALY gained, respectively. Based on our prespecified

  15. Evaluation of Outcome and Tolerability of Combination Chemotherapy with Capecitabine and Oxaliplatin as First Line Therapy in Advanced Gastric Cancer

    Science.gov (United States)

    Mashhadi, Mohammad Ali; Sepehri, Zahra; Bakhshipour, Ali Reza; Zivari, Ali; Danesh, Hossein Ali; Metanat, Hasan Ali; Karimkoshteh, Azra; Hashemi, Seyed Mehdi; Rahimi, Hossein; Kiani, Zohre

    2016-01-01

    Background: Combination chemotherapy is accepted as a high efficacy treatment for gastric cancer, whereas choice of standard treatment is unclear. Multiple chemotherapeutic regimens have been used to achieve higher efficacy and lower toxicity. This study was designed to evaluate the treatment results of advanced gastric cancer with Capecitabine and Oxaliplatin regimen. Subjects and Methods : All cases with documented gastric adenocarcinoma and advanced disease were candidates for receiving Xelox regimen (Capecitabine – 750 mg/m2/twice daily/ 1-14 days and Oxaliplatin 125 mg/m2 in 1st day). Results: Twenty five cases with advanced gastric cancer entered in study while 24 cases continued treatment protocol and were evaluated. Mean age was 59.5 ± 12.1 years (range: 20-75), male and female cases were 66.7% and 33.3%, respectively. All cases received at least four cycles of Xelox regimen. Overall response rate was 74.99% with 29.16% complete response. Overall survival rate was 13 ± 0.53 months and DFS (disease-free survival) was 6 ± 1.09 months. Extremities neuropathy (62.5%), headache (45.8%) and muscle cramps (29.2%) were the most common complains. Haematological changes were rare and 16.7% of cases had mild cytopenia. Treatment related death was not observed. Conclusion: Xelox regimen is a safe and highly effective first line treatment for gastric cancer; however, considering it as first line therapy needs larger studies. PMID:27928475

  16. [Systemic treatment of inoperable metastasized malignant melanoma].

    Science.gov (United States)

    Gutzmer, R; Rauschenberg, R; Meier, F

    2016-07-01

    The medical therapy of inoperable malignant melanoma has changed dramatically over the last few years. The purpose of this article is to summarize the current state of systemic medical treatment of malignant melanoma. Clinical studies and guidelines in the therapy of malignant melanoma are reviewed. Medical therapy of inoperable melanoma changed due to developments in immunotherapies (checkpoint inhibitors) and molecular-targeted therapies (BRAF and MEK inhibitors). Checkpoint inhibitors are antibodies administered as infusions every 2-3 weeks, blocking the checkpoints PD-1 or CTLA-4, thus, preventing downregulation of the immune system. BRAF and MEK inhibitors are small molecules, they are given orally and block a certain signaling pathway in tumor cells. The activation of this pathway has to be demonstrated by molecular analysis of tumor tissue first. This strategy is currently registered for 40-50 % of melanomas harboring a BRAF V600 mutation, while the combination of a BRAF plus MEK inhibitor has been proven more efficient than a BRAF inhibitor alone. A fascinating development has started in the melanoma field due to immunotherapeutic and molecular-targeted treatment strategies. The continuation of this development needs further clinical and translational studies. This includes particular clinical studies with the new substances in the adjuvant situation, and sequences and combinations in the metastatic setting. Translational studies are needed to develop biomarkers for response and side effects.

  17. [OPERABILITY AND RESECTABILITY OF GASTRIC CANCER:ANALYSIS OF 2280 CASES IN 15 YEARS

    Science.gov (United States)

    Ruiz, Eloy; Berrospi, Francisco; Morante, Carlos; Payet, Eduardo; Celis, Juan; Montalbetti, Juan Antonio

    1997-01-01

    OBJECTIVES: To determine which are the operability and resectability tendencies of gastric cancer in Peru.BACKGROUND: In Peru, gastric cancer is the first cause of death in men and the third one in women. Most of the patients with gastric cancer receive treatment al the Instituto Nacional de Enfermedades Neoplásicas of Lima (INEN).PATIENTS AND METHODS: Every patient with untreated histologically verified gastric adenocarcinoma, who was admitted to the INEN between January 1980, and December 1994, was included.We determined the actual trends of operability and resectability. These rates were calculated and compared with rates of the 1952-1977 period.The 1980-1994 period was divided in lustrums to evaluate a more complete preoperative staging act upon operability and resectability.The causes of inoperability and irresectability were also determined.RESULTS: Between 1980 and 1994 a total of 2280 new gastric cancer patients were admitted to the INEN. The operability and resectability rates of the 1980-1994 period (56,8% and 58,5% respectively) differ significantly from rates of the 1952-1977 period (43,8% and 49,2% respectively). A more complete preoperative staging produces a decrease of operability and an increase of resectability.The main causes of inoperability were poor physical condition associated to a locally advanced tumor 34%, and peritoneal metastases 26%. The main causes of irresectability were peritoneal metastases 50,3%, and invasion to adjacent organs 26,7%.CONCLUSIONS: Even when there is an increase of operability and resectability rates, gastric cancer is still diagnosed al a late stage in Peru. It is vital to stage pathology precisely to avoid unnecessary laparotomies.

  18. Successful treatment of primary advanced gastric plasmacytoma using a combination of surgical resection and chemotherapy with bortezomib: A case report

    Directory of Open Access Journals (Sweden)

    Sotaro Fukuhara

    2016-01-01

    Conclusions: This is the first reported case of advanced gastric plasmacytoma using adjuvant chemotherapy involving bortezomib and auto-PBSCT after the resection, and the patient has maintained a good course over a year. This protocol could be a new way to treat these tumors.

  19. 16例局部晚期胃癌同步放化疗的疗效分析%The efficacy of concurrent chemoradiotheray for local advanced gastric cancer patients

    Institute of Scientific and Technical Information of China (English)

    轩菡; 李超; 王年飞; 陈振东

    2012-01-01

    Objective: To evaluate the efficacy and adverse effect of chemoradiotheray for inoperable patients or who did not want to be operated local advanced gastric cancer. Methods: Sixteen inoperable or who did not want to be operated local advanced gastric cancer patients were selected. All patients received two cycles of DLF chemotheray. The irradiation target was local - reginoal focus and lymph nodes surrounding stamoch. The radiation dose ranged form 40 to 50.4Gy in daily 1. 8 - 2.0Gy fractions,5 times weekly. We evaluted adverse effection during treatment, and treatment efficacy at a month after completing treatment. Results .-All patients were completed treatment. ORR was 75%.The remission rate of dysphagia/obstruction, bleeding and pain were 80.0% ( 12/15) ,83. 3% (5/6)and 100% (1/1). The median progression was 6 months. The median survival was 7 months. The survival ranged from 3 — 18 months. Conclusion: The treatment efficacy of DLF chemotherapy plus radiotherapy for local gastric carcinoma was good. The major adverse effects were tolerable.%目的:探讨不能手术或不愿手术的局部进展期胃癌行同步放化疗的疗效、不良反应.方法:选择不能手术或不愿手术的局部进展期胃癌患者16例,给予DLF方案化疗2周期,同步行病灶以及胃周淋巴结区域放疗DT 45 - 50.4Gy/1.8 - 2.0Gy.治疗期间评价不良反应,治疗结束后1个月开始评价疗效,每两个月随访一次.结果:16例患者全部完成治疗,客观缓解率为75%;患者梗阻、疼痛、出血的症状缓解率分别为:80.0% (12/15),83.3% (5/6),100%(1/1).中位进展时间为6个月,中位生存期为7个月,生存期范围:5 -18个月.不良反应主要为Ⅰ- Ⅱ级血液学和消化道反应.结论:局部进展期胃癌选用DLF方案同步放疗疗效较好,不良反应可以耐受,值得进一步推广.

  20. Updates on surgical management of advanced gastric cancer: new evidence and trends. Insights from the First International Course on Upper Gastrointestinal Surgery--Varese (Italy), December 2, 2011.

    Science.gov (United States)

    Rausei, Stefano; Dionigi, Gianlorenzo; Sano, Takeshi; Sasako, Mitsuru; Biondi, Alberto; Morgagni, Paolo; Garofalo, Alfredo; Boni, Luigi; Frattini, Francesco; D'Ugo, Domenico; Preston, Shaun; Marrelli, Daniele; Degiuli, Maurizio; Capella, Carlo; Sacco, Rosario; Ruspi, Laura; De Manzoni, Giovanni; Roviello, Franco; Pinotti, Graziella; Rovera, Francesca; Noh, Sung Hoon; Coit, Daniel; Dionigi, Renzo

    2013-11-01

    Between the Ninth International Gastric Cancer Congress (IGCC) in South-Korea (Seoul, 2011) and the Tenth IGCC in Italy (Verona, 2013), the Insubria University organized the First International Course on Upper Gastrointestinal Surgery (Varese, December 2, 2011), with the patronage of Italian Research Group for Gastric Cancer (IRGGC) and the International Gastric Cancer Association (IGCA). The Course was intended to be a comprehensive update and review on advanced gastric cancer (GC) staging and treatment from well-known international experts. Clinical, research, and educational aspects of the surgeon's role in the era of stage-adapted therapy were discussed. As highlighted in the meeting, in this final document we summarize and thoroughly analyze (with references only for well-acquired randomized control trials) the new and old open problems in surgical management of advanced GC. Between the Ninth (Seoul, 2011) and the Tenth (Verona,2013) International Gastric Cancer Congress, the First International Course on Upper Gastrointestinal Surgery (Varese, December 2, 2011) was organized by the University of Insubria. This congress received the patronage of the International Gastric Cancer Association and the Italian Research Group for Gastric Cancer. The aim was to discuss open issues in surgical management of advanced gastric malignancies. We considered the opinions of several recognized experts in the field from both the Eastern and Western world, focused on definition problems and oncological and technical issues to define the current principles of advanced gastric cancer (GC) surgery.

  1. COMBINATION OF 5-FU AND EPIRUBICIN IN THE TREATMENT OF ADVANCED GASTRIC CANCER

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    Ardeshir Ghavamzadeh

    1993-06-01

    Full Text Available This study was undertaken to assess the effectiveness of 5-FU plus epirubicin in the treatment of the advanced gastric cancer. For this purpose, 22 patients with no previous treatment were studied. All of the patients were unoperable or metastatic. Follow up checking continued for 24 months. Our selected therapeutic regimen consisted of a combination of 500 mg/m2 5-FU dialy for five days, and 75 mg/m2 epirubicin for one day. The response rate in this study was 47.4% and the mean survival rate was 9.7 months. By far, the most common complication was gastrointestinal disturbances and no carditoxicity was seen. Having presented the results of this study and comparing it with the other therapeutic regimens like FAM combination, this selected two drug combination seems to be a useful therapeutic protocol.

  2. Collagen-based biological glue after Appleby operation for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Gianluca Baiocchi; Nazario Portolani; Federico Gheza; Stefano M Giulini

    2011-01-01

    Pancreatic fistula is a common complication of distal pancreatectomy; although various surgical procedures have been proposed, no clear advantage is evident for a single technique. We herein report the case of a 38-year-old patient affected by an advanced gastric carcinoma infiltrating the pancreas body, with extensive nodal metastases involving the celiac trunk, who underwent total gastrectomy with lymphadenectomy, distal pancreatectomy and resection en bloc of the celiac trunk (Appleby operation). At the end of the demolitive phase, thepancreaticstumpandtheaortahe pancreatic stump and the aorta at the level of the celiac ligature were covered with a layer of Tachosil(R), ahorsecollagenspongemadewitha horse collagen sponge made with human coagulation factors (fibrinogen and thrombin). Presenting this case, we wish to highlight the possible sealing effect of this product and hypothesize a role in preventing pancreatic fistula and postoperative lymphorrhagia from extensive nodal dissection.

  3. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To investigate the prognostic impact of the metastatic lymph node ratio (MLR) in advanced gastric cancer from the cardia and fundus. METHODS: Two hundred and thirty-six patients with gastric cancer from the cardia and fundus who underwent D2 curative resection were analyzed ret- rospectively. The correlations between MLR and the total lymph nodes, positive nodes and the total lymph nodes were analyzed respectively. The influence of MLR on the survival time of patients was determined with univariate Kaplan-Meier survival analysis and mul- tivariate Cox proportional hazard model analysis. And the multiple linear regression was used to identify the relation between MLR and the 5-year survival rate of the patients. RESULTS: The MLR did not correlate with the total lymph nodes resected (r = -0.093, P = 0.057). The 5-year overall survival rate of the whole cohort was 37.5%. Kaplan-Meier survival analysis identified that the following eight factors influenced the survival time of the patients postoperatively: gender (X2 = 4.26, P = 0.0389), tumor size (X2 = 18.48, P < 0.001), Borrmann type (X2 = 7.41, P = 0.0065), histological grade (X2 =5.07, P = 0.0243), pT category (X2 = 49.42, P < 0.001), pN category (X2 = 87.7, P < 0.001), total number of re- trieved lymph nodes (X2 = 8.22, P = 0.0042) and MLR (X2 = 34.3, P < 0.001). Cox proportional hazard model showed that tumor size (X2 = 7.985, P = 0.018), pT category (X2 = 30.82, P < 0.001) and MLR (X2 = 69.39, P < 0.001) independently influenced the prognosis. A linear correlation between MLR and the 5-year survival was statistically significant based on the multiple lin- ear regression (β = -0.63, P < 0.001). Hypothetically, the 5-year survival would surpass 50% when MLR was lower than 10%. CONCLUSION: The MLR is an independent prognostic factor for patients with advanced gastric cancer from the cardia and fundus. The decrease of MLR due to adequate number of total resected lymph nodes can improve the survival.

  4. Sequence-dependence of cisplatin and 5-fluorouracil in advanced and recurrent gastric cancer.

    Science.gov (United States)

    Koizumi, Wasaburo; Kurihara, Minoru; Hasegawa, Koichi; Chonan, Akimichi; Kubo, Yasuhiko; Maekawa, Ryuichiro; Iwasaki, Ryozo; Sasai, Tadashi; Fukuyama, Yoshio; Ishikawa, Kunitsugu; Miyoshi, Kazuo; Yasutake, Koichi; Hayakawa, Makoto

    2004-09-01

    This randomized controlled clinical trial was designed to compare the safety and effectiveness of different sequences of treatment with cisplatin (CDDP) and 5-fluorouracil (5-FU) in patients with unresectable advanced and post-operative recurrent gastric cancer. Patients with unresectable advanced or post-operative recurrent gastric cancer were randomly assigned by a registration center to group A or B. Group A received CDDP (80 mg/m(2)) as a continuous 2-h intravenous infusion on day 1 and 5-FU (700 mg/m(2)) as a continuous intravenous infusion on days 2-5. Group B was given 5-FU (700 mg/m(2)) as a continuous intravenous infusion on days 1-4, followed by CDDP (80 mg/m(2)) as a continuous 2-h intravenous infusion on day 5. Each course of chemotherapy was repeated every 28 days. A total of 74 patients were enrolled. One patient died accidentally, and 5 could not be evaluated. Response was assessable in 68 patients. The response rate was 31.3% (10/32) in group A as compared with 13.9% (5/36) in group B. Although the response rate was higher in Group A, the difference was not significant (p=0.085). The response rate in patients with diffuse type tumors was significantly lower in group B. There was no difference between the groups in response among patients with intestinal type tumors. The median overall survival was 239 and 174 days and time to progression was 175 and 140 days in group A and group B, respectively. Although there were trends toward longer survival and time to progression in group A, the differences between the groups were not statistically significant. There was also no difference in the type or incidence of adverse reactions. The results of this controlled study indicate that the overall response rate was slightly but not significantly higher in patients who received CDDP before 5-FU. Among patients with diffuse type tumors, the response rate was significantly lower when 5-FU was administered before CDDP. Our results suggest that CDDP should be given

  5. Advances in TCM Treatment of Gastric Cancer and Studies on the Apoptosis

    Institute of Scientific and Technical Information of China (English)

    吴敏; 姚保泰

    2002-01-01

    @@ The significance of apoptosis in gastric cancer is now widely recognized, and the induction of apoptosis as a new approach to treat gastric cancer has aroused great interest. In recent years, studies on certain TCM drugs for treating gastric cancer and for inducing apoptosis have brought about great attention both at home and abroad. The following is a summary made in this aspect.

  6. A complete response to S-1 plus cis-diamminedichloroplatinum in advanced-stage esophageal and gastric adenocarcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Matsuno Yoritaka

    2012-07-01

    Full Text Available Abstract Background Complete remission from advanced-stage synchronous double primary (SDP esophageal and gastric adenocarcinoma by chemotherapy alone is rare. We report a case of advanced-stage SDP esophageal and gastric adenocarcinoma in which a complete response to treatment was obtained with S-1 and cis-diamminedichloroplatinum (CDDP. Case presentation The patient was a 74-year-old man referred to our hospital complaining of dysphagia. Gastrointestinal endoscopy was performed and advanced-stage SDP esophageal and gastric adenocarcinoma diagnosed. Computed tomography revealed multiple regional lymph node metastases in the mediastinum. Neoadjuvant chemotherapy with S-1 and CDDP for advanced esophageal and gastric cancer was planned. An endoscopy following two courses of chemotherapy revealed that the esophageal cancer had been replaced with a normal mucosal lesion and the gastric tumor with a scar lesion; the results of biopsies of both were negative for cancer. Computed tomography revealed that the multiple lymph node metastases had disappeared. We diagnosed a complete response to S-1 and CDDP in advanced-stage SDP esophageal and gastric cancer. The patient is still alive with no signs of recurrence 22 months after the disappearance of the original tumor and metastatic lesions without surgical treatment. Conclusion These results suggest that complete remission from advanced-stage esophageal and gastric cancer can be obtained with chemotherapy with S-1 plus CDDP.

  7. Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis

    Directory of Open Access Journals (Sweden)

    L. Casaretto

    2006-04-01

    Full Text Available The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1 randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2 stomach neoplasm and drug therapy, 3 clinical trial and multi-modality therapy, 4 stomach neoplasm and drug therapy or quality of life, 5 double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53% receiving chemotherapy, 182 (47% receiving support care treatment and 6 losses (1.6%. The 1-year survival rate was 8% for support care and 20% for chemotherapy (RR = 2.14, 95% CI = 1.00-4.57, P = 0.05; 30% of the patients in the chemotherapy group and 12% in the support care group attained a 6-month symptom-free period (RR = 2.33, 95% CI = 1.41-3.87, P < 0.01. Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34%; RR = 2.07, 95% CI = 1.31-3.28, P < 0.01 with tumor mass reduction (RR = 3.32, 95% CI = 0.77-14.24, P = 0.1. Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life.

  8. Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis.

    Science.gov (United States)

    Kim, H S; Kim, H J; Kim, S Y; Kim, T Y; Lee, K W; Baek, S K; Kim, T Y; Ryu, M H; Nam, B H; Zang, D Y

    2013-11-01

    Many patients with refractory or relapsed gastric cancer after first-line chemotherapy have received salvage chemotherapy in routine clinical practice. However, there was no evidence to support this treatment until recent phase III trials demonstrated substantial prolongation of overall survival. Therefore, we conducted a meta-analysis of these trials and investigated whether second-line chemotherapy was more effective than best supportive care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2013), MEDLINE (1950 to March week 4, 2013) and EMBASE (1980-2013, week 13). In addition, we searched all abstracts and virtual meeting presentations from the American Society of Clinical Oncology (ASCO) conferences held between 2004 and 2013. The search process yielded 578 studies, two of which were randomized phase III trials that compared chemotherapy with supportive care. From the abstracts and virtual meeting presentations of ASCO held between 2004 and 2013, 127 abstracts were identified that evaluated second-line chemotherapy; only one relevant abstract was included in the meta-analysis. A total of 410 patients were eligible for analysis, of whom 150 received docetaxel chemotherapy, and 81 received irinotecan chemotherapy. A significant reduction in the risk of death [HR = 0.64, 95% confidence interval (CI) 0.52-0.79, P HR was 0.55 (95% CI 0.40-0.77, P = 0.0004) for irinotecan and 0.71 (95% CI 0.56-0.90, P = 0.004) for docetaxel. This meta-analysis demonstrated evidence to support second-line chemotherapy in advanced gastric cancer.

  9. Epidermal growth factor receptor as a predictor of tumor response to preoperative chemoradiation in locally advanced gastric carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sirak, I.; Petera, J.; Vosmik, M.; Melichar, B.; Dvorak, J.; Zoul, Z. [Dept. of Oncology and Radiotherapy, Charles Univ. Medical School and Univ. Hospital, Hradec Kralove (Czech Republic); Hatlova, J.; Tycova, V. [Dept. of Pathology, Charles Univ. Medical School and Univ. Hospital, Hradec Kralove (Czech Republic); Lesko, M. [Dept. of Surgery, Charles Univ. Medical School and Univ. Hospital, Hradec Kralove (Czech Republic); Hajduch, M. [Lab. of Molecular Pathology, Inst. of Pathology, Palacky Univ., Olomouc (Czech Republic)

    2008-11-15

    Purpose: the purpose of our study was a retrospective evaluation whether the intensity of epidermal growth factor receptor (EGFR) expression predicts tumor response to preoperative chemoradiotherapy in patients with locally advanced gastric carcinoma. Patients and methods: thirty-six patients with gastric adenocarcinoma (cT2-4 or N+) were studied. Preoperative treatment consisted of 30-45 Gy of gastric irradiation with continuous 5-fluorouracil and weekly cisplatin. Surgical resection was performed 4-6 weeks later. EGFR expression in pretreatment tumor biopsies was assessed by immunohistochemistry. Level of EGFR expression was determined from the intensity and extent of staining. Tumor response was defined as a reduction of at least one T-stage level and/or finding of intense tumor regression in histopathologic examination. Results: seventeen patients responded to preoperative chemoradiation - 8 patients (22%) had pathologic complete response, 9 patients (25%) were downstaged. Positive EGFR expression was found in 8 tumors (22%), and represented a significant predictive marker of poor tumor response in multivariate logistic regression analysis (p = 0.015). Response to chemoradiotherapy was found in 60% (16/28) of EGFR negative patients and in 13% (1/8) of EGFR positive patients (p = 0.044). None of the eight EGFR positive patients achieved pathologic complete response in comparison with 8/28 (29%) of patients with EGFR negative staining (p = 0.16). Conclusion: EGFR may represent a molecular marker predictive for poor response to preoperative chemoradiotherapy in locally advanced gastric carcinoma. (orig.)

  10. Gastric cancer: a primer on the epidemiology and biology of the disease and an overview of the medical management of advanced disease.

    Science.gov (United States)

    Shah, Manish A; Kelsen, David P

    2010-04-01

    Gastric cancer is a cause of significant morbidity and cancer-related mortality worldwide. Despite recent advances in targeted therapy and understanding of the biology and development of the malignancy, progress in the treatment of gastric cancer has been limited. Most newly diagnosed patients will present with incurable disease, and have a median survival of less than 1 year. Although the disease has widespread ethnic and epidemiologic differences, medical management of gastric cancer does not distinguish among the various disease subtypes. The recent report of the ToGA phase III study has validated Her2 as a molecular target in this disease, supporting the concept that a greater understanding of the biology of gastric cancer subsets may improve treatment selection and overall outcome of individual patients. This article summarizes the epidemiology and ethnic variation of this disease to crystalize subtypes of gastric cancer in the context of current and future medical management of advanced disease.

  11. [A case of advanced gastric cancer showing high serum CYFRA21-1 level responding to chemotherapy with S-1].

    Science.gov (United States)

    Hara, Akihito; Watanabe, Hiroaki

    2008-12-01

    The patient was a 75-year-old man whose complaint was back pain and appetite loss. He was diagnosed with unresectable advanced gastric cancer due to multiple liver metastases and direct invasion of pancreas and spleen. He underwent gastrostomy because of esophageal stenosis, and we administered S-1 80 mg/body(4 weeks administration and 2 weeks rest)to the patient through a gastrostogavage tube. On blood examination, the serum level of CYFRA21- 1 was significantly high, while those of CEA and CA19-9 were within normal ranges. After the first course of this chemotherapy, the serum CYFRA21-1 level significantly decreased with reduction of the cancer. After the second course, it sensitively increased before image views detected the progression of the cancer. This case shows that CYFRA21- 1 could be a useful tumor marker of advanced gastric cancer.

  12. Clinical and psychometric validation of the quality of life assessment system for advanced gastric cancer based on traditional Chinese medicine.

    Science.gov (United States)

    Quan, Peng; Zheng, Pei-Yong; You, Sheng-Fu; Hua, Yong-Qiang; Song, Yi; Liu, Tao; Wan, Chong-Hua; Lu, Jin-Gen

    2016-08-01

    To establish questionnaire scaling and reliability and examine the clinical and psychometric validity of the quality of life assessment based on Traditional Chinese Medicine for advanced gastric cancer (QLASTCM-Ga). The QLASTCM-Ga was developed based on programmed decision procedures with multiple nominal and focus group discussions, in-depth interview, pretesting and quantitative statistical procedures. The questionnaire was administered to 240 patients diagnosed with advanced gastric cancer before and after treatment. Structured group methods were employed to establish a general and a specifific module respectively. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness. The three identified scales of the QLASTCM-Ga and the total score demonstrated good psychometric properties. Test-retest reliability of the total scale and all domains ranged from 0.90 to 0.94, and internal consistency ranged from 0.86 to 0.93. Correlation and factor analysis demonstrated good construct validity. Signifificant difference in the subscales and the total score were found among groups differing in traditional Chinese medicine syndrome, supporting the clinical sensitivity of the QLASTCM-Ga. Statistically signifificant changes were found for each scale and the total score. Responsiveness was also good. The QLASTCM-Ga demonstrates good psychometric and clinical validity to assess quality of life in patients with advanced gastric cancer undergoing traditional Chinese medicine therapy. This study is an important fifirst step for future research in this area.

  13. Shenqifuzheng injection combined with chemotherapy in the treatment of advanced gastric cancer: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Kunhou Yao

    2014-01-01

    Full Text Available Objective: The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of Shenqifuzheng (SQFZ injection combined with chemotherapy in the treatment of advanced gastric cancer. Materials and Methods: We conducted an electronic search by using PubMed, EMBASE, ASCO, ESMO and Chinese National Knowledge Infratructure (CNKI, databases. The randomized controlled trials about Shenqifuzheng injection combined with chemotherapy versus chemotherapy alone in the treatment of advanced gastric cancer were reviewed and collected. Pooled odds ratio (OR for the response rate and KPS improvement were calculated using the software MetaAnalyst 3.1. Results: Fifteen trials met our inclusion criteria and finally included in this meta-analysis. The objective response rate (ORR in patients treated with Shenqifuzheng injection combined with chemotherapy was much higher than that of chemotherapy only (OR = 1.66, 95% CI: 1.20-2.29 with statistical significance (P < 0.05. The pooled data showed the combined treatment can significant increase the Karnofsky score (KPS compared with the chemotherapy only (OR = 3.74, 95% CI: 2.66-5.27 (P < 0.05. Conclusion: SQFZ injection combined with chemotherapy treatment regimen can improve the clinical efficacy and performance status in patients with advanced gastric cancer compared with chemotherapy alone.

  14. Prognostic significance of performing universal HER2 testing in cases of advanced gastric cancer.

    Science.gov (United States)

    Jiménez-Fonseca, Paula; Carmona-Bayonas, Alberto; Sánchez Lorenzo, Maria Luisa; Plazas, Javier Gallego; Custodio, Ana; Hernández, Raquel; Garrido, Marcelo; García, Teresa; Echavarría, Isabel; Cano, Juana María; Rodríguez Palomo, Alberto; Mangas, Monserrat; Macías Declara, Ismael; Ramchandani, Avinash; Visa, Laura; Viudez, Antonio; Buxó, Elvira; Díaz-Serrano, Asunción; López, Carlos; Azkarate, Aitor; Longo, Federico; Castañón, Eduardo; Sánchez Bayona, Rodrigo; Pimentel, Paola; Limón, Maria Luisa; Cerdá, Paula; Álvarez Llosa, Renata; Serrano, Raquel; Lobera, Maria Pilar Felices; Alsina, María; Hurtado Nuño, Alicia; Gómez-Martin, Carlos

    2017-05-01

    Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC. This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression. The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001-1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2. Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.

  15. Advances in Gastric and Gastro-Esophageal Junction Surgery for Cancer

    NARCIS (Netherlands)

    Haverkamp, L.

    2015-01-01

    Chapter 1 – Introduction Gastric cancer is conventionally treated by means of open distal or total gastrectomy. The open surgical approach is associated with high morbity and long postoperative hospital stay. Minimally invasive surgery is upcoming for gastric cancer, since promosing results in the t

  16. Advances in Gastric and Gastro-Esophageal Junction Surgery for Cancer

    NARCIS (Netherlands)

    Haverkamp, L.

    2015-01-01

    Chapter 1 – Introduction Gastric cancer is conventionally treated by means of open distal or total gastrectomy. The open surgical approach is associated with high morbity and long postoperative hospital stay. Minimally invasive surgery is upcoming for gastric cancer, since promosing results in the

  17. Multidetector CT of Locally Invasive Advanced Gastric Cancer: Value of Oblique Coronal Reconstructed Images for the Assessment of Local Invasion

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Hee; Kim, Ah Yong; Kim, Hye Jin; Yook, Jeong Hwan; Yu, Eun Sil; Jang, Yoon Jin; Park, Seong Ho; Shin, Yong Moon; Ha, Hyun Kwon [Asan Medical Center, Seoul (Korea, Republic of)

    2010-01-15

    To evaluate the diagnostic value of oblique coronal reconstructed CT images to determine the local invasion of advanced gastric cancer (AGC). Thirty-four consecutive patients, who were suspected to have locally invasive advanced gastric cancer (more than T3 stage) on a preoperative MDCT scan and underwent a diagnostic or curative laparotomy, were enrolled in this study. Two reviewers performed an independent blind review of three series of MDCT images in random order; axial (AXI), conventional coronal (CCI), and oblique coronal (OCI) (parallel to long axis of gastric body and pancreas) images. In assessing the local invasion, the reader's confidence for the local invasion of AGC was graded using a five point scale (1 = definitely negative, 5 = definitely positive: T4). With surgical findings and histopathological proofs as reference standards, the diagnostic performance of the three different plans of CT images was employed for the verification of local invasion of AGC on a preoperative CT scan using the receiver operating characteristic (ROC) method. Agreements between the two reviewers were analyzed using weighted kappa statistics. Results: In 19 out of 34 patients, local invasion was confirmed surgically or histopathologically (13 pancreas invasion, 6 liver invasion, 4 major vascular invasion, 3 colon and mesocolon invasion, and 2 spleen invasion). The diagnostic performance of OCI was superior to AXI or CCI in the local invasion of AGC. The differences in the area under the curve of AXI (0.770 {+-} 0.087, 0.700 {+-} 0.094), CCI (0.884 {+-} 0.058, 0.958 {+-} 0.038), and OCI (0.954 {+-} 0.050, 0.956 {+-} 0.049), were statistically significant for both reviewers. Inter-observer agreement was excellent for OCI ({kappa}= .973), which was greater than CCI (({kappa}= .839), and AXI (({kappa}= .763). On a CT scan, OCI might be a useful imaging technique in evaluating locally invasive advanced gastric cancer.

  18. Efficacy and safety of target combined chemotherapy in advanced gastric cancer: a meta-analysis and system review.

    Science.gov (United States)

    Zou, Kun; Yang, Shuailong; Zheng, Liang; Yang, Chaogang; Xiong, Bin

    2016-09-15

    The aim of our meta-analysis is to assess the efficacy and safety of the target combined chemotherapy for the patients with unresectable advanced or recurrent gastric cancer. In accordance with the standard meta-analysis procedures, the patients included in our study were with unresectable advanced or recurrent gastric cancer and allocated randomly to receive target combined chemotherapy or the traditional chemotherapy. The search was applied to PubMed, EMBASE, Science Citation Index Expanded, Cocran's library (from inception to February 2016). All analyses were performed by STATA 12.0, with the odds ratio, hazard ratio, and 95 % confidence interval as the effect measures. Fourteen studies were included in this meta-analysis. A total of 5067 patients with advanced gastric cancer were divided into two arms: traditional chemotherapy arm and target combined chemotherapy arm. A significant improvement for overall survival (hazard ratio was 0.89, 95 % confidence interval: 0.83-0.95) and overall response rate (odds ratio was 1.44, 95 % confidence interval: 1.15-1.81) was observed, but no significant difference was found for progression-free survival (hazard ratio was 0.89, 95 % confidence interval: 0.77-1.00) in the target combined chemotherapy arm. In subgroup analysis, increasing benefits regarding overall survival and progression-free survival were found in anti epidermal growth factor receptor target drugs for selected patients subgroup and anti vascular endothelial growth factor receptor target drugs for unselected patients subgroup, but not in anti epidermal growth factor receptor target drugs for unselected patients subgroup. Besides, some adverse events were increased in the target combined chemotherapy arm. The target combined chemotherapy represented a better overall survival benefit and treatment efficiency and higher incidence of some grade 3-4 adverse events than the traditional chemotherapy for patients with unresectable advanced or recurrence gastric

  19. Effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ru-Juan Xu

    2016-01-01

    Objective:To study the effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer. Methods:A total of 134 patients who were diagnosed with advanced gastric cancer in our hospital from May 2012 to December 2014 were selected for study, received surgical resection after chemotherapy, and were divided into intravenous chemotherapy group and combined treatment group according to different chemotherapy regimens. After chemotherapy and before operation, serum tumor marker levels were detected;after operation, recurrence and metastasis-related molecule levels in tumor tissue were detected. Results:After chemotherapy and before operation, serum CEA, CA199, CA72-4, TSGF, ESM-1 and DKK-1 levels of combined treatment group were significantly lower than those of intravenous chemotherapy group;TET1, TET2, LATS1 and RUNX3 levels in tumor tissue of combined treatment group were higher than those of intravenous chemotherapy group while Sipa1, GOLPH3, AEP, MT2-MMP, OPN, Galectin-1, Galectin-3 and Galectin-9 levels were lower than those of intravenous chemotherapy group. Conclusions:Compared with systemic intravenous chemotherapy, preoperative S-1 combined with regional transcatheter arterial chemoembolization can more effectively kill gastric cancer cells and prevent tumor recurrence and metastasis at molecular level.

  20. Efficacy and safety assessment of short EOF program regional arterial infusion chemotherapy and conventional chemotherapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ming-Cai Shui; Lin Xiong

    2016-01-01

    Objective:To study the efficacy and safety of short EOF program regional arterial infusion chemotherapy and conventional chemotherapy for advanced gastric cancer.Methods: 66 cases of patients diagnosed of advanced gastric cancer in our hospital were enrolled for study, given preoperative short EOF program chemotherapy and randomly divided into two groups. Observation group received short EOF program regional arterial infusion chemotherapy and control group received short EOF program intravenous chemotherapy. Then number of apoptosis cells and contents of apoptosis genes in the tumor tissue, serum liver and kidney function indicators as well as cfDNA methylation degree of two groups were detected. Results:(1) indicators of efficacy: the number of apoptosis cells in gastric cancer tissue of observation group was more than that of control group, mRNA levels of Caspase-3, Caspase-9, Fas and FasL were higher than those of control group, and serum p16, RNF180, SFRP2, SOX17 and RUNX methylation ratios were lower than those of control group; (2) indicators of safety: serum RBP, CysC, ALT and AST contents of observation group were lower than those of control group.Conclusions:Short EOF program regional arterial infusion chemotherapy can more effectively kill cancer cells, reduce methylation degree of tumor-associated genes and decrease liver function and kidney function damage; both efficacy and safety of it are better than conventional chemotherapy.

  1. Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor

    Institute of Scientific and Technical Information of China (English)

    Daniel Kaemmerer; Vikas Prasad; Wolfgang Daffner; Dieter H(o)rsch; Günter Kl(o)ppel; Merten Hommann; Richard P Baum

    2009-01-01

    Pancreatic endocrine tumors are rare but are among the most common neuroendocrine neoplasms of the abdomen. At diagnosis many of them are already advanced and difficult to treat. We report on an initially inoperable malignant pancreatic endocrine tumor in a 33-year-old woman, who received neoadjuvant peptide receptor radionuclide therapy (PRRT) as first-line treatment. This resulted in a significant downstaging of the tumor and allowed its subsequent complete surgical removal. Follow-up for eighteen months revealed a complete remission. This is the first report on neoadjuvant PRRT in a neuroendocrine neoplasm with subsequent successful complete resection.

  2. Body Composition as a Prognostic Factor of Neoadjuvant Chemotherapy Toxicity and Outcome in Patients with Locally Advanced Gastric Cancer.

    Science.gov (United States)

    Palmela, Carolina; Velho, Sónia; Agostinho, Lisa; Branco, Francisco; Santos, Marta; Santos, Maria Pia Costa; Oliveira, Maria Helena; Strecht, João; Maio, Rui; Cravo, Marília; Baracos, Vickie E

    2017-03-01

    Neoadjuvant chemotherapy has been shown to improve survival in locally advanced gastric cancer, but it is associated with significant toxicity. Sarcopenia and sarcopenic obesity have been studied in several types of cancers and have been reported to be associated with higher chemotherapy toxicity and morbi-mortality. The aim of this study was to assess the prevalence of sarcopenia/sarcopenic obesity in patients with gastric cancer, as well as its association with chemotherapy toxicity and long-term outcomes. A retrospective analysis was performed using an academic cancer center patient cohort diagnosed with locally advanced gastric cancer between January 2012 and December 2014 and treated with neoadjuvant chemotherapy. We analyzed body composition (skeletal muscle and visceral fat index) in axial computed tomography images. A total of 48 patients met the inclusion criteria. The mean age was 68±10 years, and 33 patients (69%) were men. Dose-limiting toxicity was observed in 22 patients (46%), and treatment was terminated early owing to toxicity in 17 patients (35%). Median follow-up was 17 months. Sarcopenia and sarcopenic obesity were found at diagnosis in 23% and 10% of patients, respectively. We observed an association between termination of chemotherapy and both sarcopenia (P=0.069) and sarcopenic obesity (P=0.004). On multivariate analysis, the odds of treatment termination were higher in patients with sarcopenia (odds ratio=4.23; P=0.050). Patients with sarcopenic obesity showed lower overall survival (median survival of 6 months [95% confidence interval {CI}=3.9-8.5] vs. 25 months [95% CI=20.2-38.2]; log-rank test P=0.000). Sarcopenia and sarcopenic obesity were associated with early termination of neoadjuvant chemotherapy in patients with gastric cancer; additionally, sarcopenic obesity was associated with poor survival.

  3. Adjuvant chemoradiotherapy combined with cisplatin, 5-fluorouracil and folinic acid for locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Muharrem Kocar

    2016-04-01

    Conclusion: The addition of combination chemotherapy with cisplatin, infusional 5-fluorouracil and folinic acid before and after chemoradiotherapy was found to be safe and effective in patients with operated gastric cancer.

  4. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

    Directory of Open Access Journals (Sweden)

    Lin Jian-Xian

    2013-01-01

    Full Text Available Abstract Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Conclusion Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary.

  5. Optimal indications for second-line chemotherapy in advanced gastric cancer.

    Science.gov (United States)

    Hasegawa, Hiroko; Fujitani, Kazumasa; Nakazuru, Shoichi; Hirao, Motohiro; Mita, Eiji; Tsujinaka, Toshimasa

    2012-04-01

    As it remains uncertain whether patients with advanced gastric cancer who progress after first-line chemotherapy should receive second-line chemotherapy, we attempted to identify the optimal indications for second-line chemotherapy. In this retrospective study, 101 patients were included in univariate and multivariate analyses to identify clinicopathological variables independently associated with longer survival postprogression (SPP), defined as the time from recognition of disease progression on first-line chemotherapy to death from any cause or last follow-up. The median SPP was 340 days. On multivariate analysis, performance status 2 [hazard ratio (HR), 14.234; 95% confidence interval (CI), 2.766-73.258], serum albumin level less than 3.5 g/dl (HR, 2.088; 95% CI, 1.047-4.060) at initiation of second-line chemotherapy, and time to progression less than 170 days on first-line chemotherapy (HR, 2.497; 95% CI, 1.227-5.083) were identified as independent prognostic factors associated with shorter SPP. The median SPP was 496, 375, and 232 days in patients with 0, 1, and 2 of these 3 negative prognostic factors, respectively (P=0.0002). The present study suggests that second-line chemotherapy would not be beneficial in patients with two or more of the following three negative prognostic factors: performance status 2, serum albumin less than 3.5 g/dl at initiation of second-line chemotherapy and time to progression less than 170 days on first-line chemotherapy.

  6. Comparison of staging between the old (6th edition) and new (7th edition) TNM classifications in advanced gastric cancer.

    Science.gov (United States)

    Kikuchi, Shiro; Futawatari, Nobue; Sakuramoto, Shinichi; Katada, Natsuya; Yamashita, Keishi; Shibata, Tomotaka; Nemoto, Masayuki; Watanabe, Masahiko

    2011-06-01

    The aims of the present study were to compare staging between the old (6th edition) and new (7th edition) TNM classifications, and to evaluate the prognostic impact of extended lymph node dissection according to the new nodal staging in advanced gastric cancer. A total of 609 patients with advanced gastric cancer who had undergone curative gastric resection combined with extended lymph node dissection were enrolled in the present study. Survival curves were analyzed according to staging based on the TNM 6th and 7th editions and the Japanese Classification of Gastric Carcinoma (JCGC) 14th edition. The 5-year survival rates and the consecutive stage survival with no significant differences were: IB 88%; II 74%; IIIA 53%; IIIB 39%; and IV 18% (IIIA vs. IIIB, p=0.1307) by the TNM 6th edition; IB 94%; IIA 85%; IIB 71%; IIIA 68%; IIIB 48%; IIIC 23%; and IV 13%; (IIB vs. IIIA, p=0.7665; IIIC vs. IV, p=0.4156) by the TNM 7th and JCGC 14th editions; N0 85%; N1 70%; N2 46%; N3 18%; and M1 13%; (N3 vs. M1, p=0.8640) by the TNM 6th edition; and N0 85%; N1 80%; N2 61%; N3a 46%; N3b 18%; and M1 13%; (N0 vs. N1, p=0.2735; N2 vs. N3a, p=0.0663; N3b vs. M1, p=0.8640) by the TNM 7th and JCGC 14th editions. The new classification according to the TNM 7th and the JCGC 14th editions does not always seem to be superior to the TNM 6th edition for the prognostic stratification of stages in patients who undergo curative resection for advanced gastric cancer. An extended lymph node dissection may be effective for N0-N3a, but not for N3b and M1 stages classified according to the new TNM 7th and JCGC 14th editions.

  7. Gastric carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    Ismail Gomceli; Baris Demiriz; Mesut Tez

    2012-01-01

    Gastric cancer is the second most common cancer worldwide and the second most common cause of cancer-related deaths.Despite complete resection of gastric cancer and lymph node dissection,as well as improvements in chemotherapy and radiotherapy,there are still 700 000 gastric cancer-related deaths per year worldwide and more than 80% of patients with advanced gastric cancer die of the disease or recurrent disease within 1 year after diagnosis.None of the treatment modalities we have been applying today can influence the overall survival rates:at present,the overall 5-year relative survival rate for gastric cancer is about 28%.Cellular metaplasia due to chronic inflammation,injury and repair are the most documented processes for neoplasia.It appears that chronic inflammation stimulates tumor development and plays a critical role in initiating,sustaining and advancing tumor growth.It is also evident that not all inflammation is tumorigenic.Additional mutations can be acquired,and this leads to the cancer cell gaining a further growth advantage and acquiring a more malignant phenotype.Intestinalization of gastric units,which is called "intestinal metaplasia";phenotypic antralization of fundic units,which is called "spasmolytic polypeptide-expressing metaplasia"; and the development directly from the stem/progenitor cell zone are three pathways that have been described for gastric carcinogenesis.Also,an important factor for the development of gastrointestinal cancers is peritumoral stroma.However,the initiating cellular event in gastric metaplasia is still controversial.Understanding gastric carcinogenesis and its precursor lesions has been under intense investigation,and our paper attempts to high-light recent progress in this field of cancer research.

  8. Molecular targeted therapy of advanced gastric cancer%进展期胃癌分子靶向治疗

    Institute of Scientific and Technical Information of China (English)

    王润洁; 石晓燕; 黄薇; 刘超英

    2012-01-01

    Efficacy of chemotherapy for advanced gastric cancer is unsatisfactory. Molecular targeted therapies have emerged as a novel approach to the treatment of advanced gastric cancer in recent years.These therapeutic strategies include targeting EGFR signal transduction pathway,anti-angiogenesis therapy,multi-target molecular targeted drugs. Targeted drugs such as trastuzumab,cetuximab,bevacizumab,apatinib,sorafenib sunitinib,lapatinib and everolimus which are targeting HER2,EGFR,VEGF and mTOR pathway,are applied in the comprehensive treatment of advanced gastric cancer,and their therapeutic effects are encouraging.%进展期胃癌化疗效果不佳.分子靶向治疗是近年来进展期胃癌综合治疗的新手段.目前这些策略主要包括针对表皮生长因子受体(EGFR)通道的靶向治疗、针对血管内皮生长因子通道的靶向治疗、口服小分子靶向药物等.近期有关HER2、EGFR、VEGF、mTOR信号通路的靶向药物曲妥珠单抗、西妥昔单抗、贝伐单抗、阿帕替尼、索拉非尼、舒尼替尼、拉帕替尼、RAD001 (everolimus)等综合治疗进展期胃癌的报道结果令人鼓舞.

  9. [Gastrectomy for a patient with advanced gastric cancer with spleen metastases following induction chemotherapy with S-1 plus cisplatin].

    Science.gov (United States)

    Kano, Yosuke; Ueki, Kyo; Yajima, Kazuhito; Tada, Takashi; Ishizuka, Dai; Wakai, Toshifumi

    2014-02-01

    An asymptomatic 56-year-old woman, upon medical examination, was diagnosed with advanced adenocarcinoma of the upper third of the stomach. Computed tomography showed that the primary gastric tumor was directly invading the splenic hilum, and there were multiple metastases in the spleen; incurable gastric cancer was confirmed. S-1 plus cisplatin therapy was introduced as the induction regimen, and the main tumor and splenic metastases reduced significantly. Total gastrectomy with splenectomy and D2 lymphadenectomy was performed after 9 courses of chemotherapy. The surgery was completed with no residual tumor, and intraperitoneal washing cytology was negative. Histologically, the primary tumor was classified as Grade 2, reflecting the effect of chemotherapy, and viable metastatic tumors were confirmed in the spleen. S-1-based treatment was continued as adjuvant chemotherapy, and the patient was alive with no evidence of tumor recurrence 39 months after the initiation of chemotherapy. Although metastasis to the spleen from gastric adenocarcinoma has been reported as a rare metastatic pattern with poor prognosis, our patient had a long survival time after gastrectomy following induction chemotherapy.

  10. Expression of Inflammation-Related Genes Is Altered in Gastric Tissue of Patients with Advanced Stages of NAFLD

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    Rohini Mehta

    2013-01-01

    Full Text Available Obesity is associated with chronic low-grade inflammation perpetuated by visceral adipose. Other organs, particularly stomach and intestine, may also overproduce proinflammatory molecules. We examined the gene expression patterns in gastric tissue of morbidly obese patients with nonalcoholic fatty liver disease (NAFLD and compared the changes in gene expression in different histological forms of NAFLD. Stomach tissue samples from 20 morbidly obese NAFLD patients who were undergoing sleeve gastrectomy were profiled using qPCR for 84 genes encoding inflammatory cytokines, chemokines, their receptors, and other components of inflammatory cascades. Interleukin 8 receptor-beta (IL8RB gene overexpression in gastric tissue was correlated with the presence of hepatic steatosis, hepatic fibrosis, and histologic diagnosis of nonalcoholic steatohepatitis (NASH. Expression levels of soluble interleukin 1 receptor antagonist (IL1RN were correlated with the presence of NASH and hepatic fibrosis. mRNA levels of interleukin 8 (IL8, chemokine (C-C motif ligand 4 (CCL4, and its receptor chemokine (C-C motif receptor type 5 (CCR5 showed a significant increase in patients with advanced hepatic inflammation and were correlated with the severity of the hepatic inflammation. The results of our study suggest that changes in expression patterns for inflammatory molecule encoding genes within gastric tissue may contribute to the pathogenesis of obesity-related NAFLD.

  11. REFLECTIONS ON THE INOPERABILITY INPUT-OUTPUT MODEL

    NARCIS (Netherlands)

    Dietzenbacher, Erik; Miller, Ronald E.

    2015-01-01

    We argue that the inoperability input-output model is a straightforward - albeit potentially very relevant - application of the standard input-output model. In addition, we propose two less standard input-output approaches as alternatives to take into consideration when analyzing the effects of disa

  12. Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

    Directory of Open Access Journals (Sweden)

    Chen Qi-Yue

    2012-11-01

    Full Text Available Abstract Background The application of laparoscopic surgery for advanced gastric cancer (AGC remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG for advanced gastric cancer without serosal invasion. Methods From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05. The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859. The mean number of resected lymph nodes (LNS between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786. Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05. No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05 and the survival curve after surgery between the LAG group and OG group. Conclusion Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with

  13. Effect of laparoscope and open radical resection on immunological and stress levels in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Xia-Fei Sun; Zi-Rui He

    2016-01-01

    Objective:To explore the effect of laparoscope and open radical resection of gastric cancer on the immunological and stress levels in patients with advanced gastric cancer.Methods:A total of 80 patients with advanced gastric cancer who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into the laparoscope group and open group according to different treatment protocols. The morning fasting venous blood 1 d before operation, and 1 d, 3 d, and 5 d after operation in the two groups was collected, and centrifuged for the serum. The scatter turbidimetry was used to detect CRP. ELISA was used to detect IL-6. FCM was used to detect CD4+ and CD8+. CD4+/CD8+ were calculated.Results:The comparison of CRP and IL-6 levels before operation between the two groups was not statistically significant (P>0.05). CRP and IL-6 levels 1 d after operation were significantly elevated, and were gradually reduced 3 d and 5 d after operation. CRP and IL-6 levels 3 d and 5d after operation in the laparoscope group were significantly lower than those in the open group (P0.05). CD4+ 1 d after operation reached the peak, while CD8+ and CD4+/CD8+ were reduced to the lowest. CD4+, CD8+, and CD4+/CD8+ 3 d and 5 d after operation were gradually recovered, and the recovered degree of the above indicators in the laparoscope group were significantly superior to that in the open group (P<0.05).Conclusions:Due to the significant advantage of small effect on the stress reaction and immunosuppression, the laparoscopic radical gastrectomy should be preferred.

  14. Side Effects during Treatment of Advanced Gastric Carcinoma by Chemotherapy Combined with CIK-cell Transfusion in Elderly People

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    Jingting Jiang; Changping Wu; Liangrong Shi; Ning Xu; Haifeng Deng; Mingyang Lu; Mei Ji; Yibei Zhu; Xueguang Zhang

    2008-01-01

    OBJECTIVE To study the side effects and therapeutic results of autologous cytokine-induced killer (CIK) cell treatment in elderly patients with advanced gastric cancer.METHODS CIK cells were induced and cultured using biotechnics in vitro, and then the ceils were infused back into the patients. Sixty elderly gastric cancer patients treated by chemotherapy (FOLFOX4 protocol) were followed-up. Among them, 29 patients were treated with CIK cells during application of chemotherapy. Short-term curative effects and adverse events from the CIK transfusion and chemotherapy were observed.RESULTS Eight cases developed partial remission (PR), 9 cases moderate remission (MR), 7 cases stable disease(SD) and 5 cases progressive disease (PD). Out of a total of 29 patients who received chemotherapy combined with autologous CIK therapy,the total remission rate (PR + MR) was 58.6%. The total remission rate following chemotherapy alone was 45.2%, including 5 PR cases, 9 MR cases, 7 SD cases, and 10 PD cases. There was a relatively lower rate of severe chemotherapic toxicities in the CIK-cell transfusion group. Side effects of autologous CIK transfusion included chilis (13 cases), fever (9 cases), nausea and vomiting(1 case) and general malaise (3 cases). Side effects were treated with conventional therapy resulting in their amelioration. No patients developed shock, blood capillary leakage syndrome, or abnormalities in routine blood, urine, liver and renal function tests.CONCLUSION Adoptive immunotherapy with autologous CIK cells may decrease the clinical signs and symptoms of elderly patients who suffer from advanced gastric cancer. Adverse reactions of patients can be alleviated by conventional therapy.Autologous CIK-cell transfusion may improve endurance to chemotherapy.

  15. Lack of any prognostic relationship between adiponectin receptor (Adipo R1/R2) expression for early/advanced stage gastric cancer.

    Science.gov (United States)

    Ayyildiz, Talat; Dolar, Enver; Ugras, Nesrin; Dizdar, Oguzhan Sitki; Adim, Saduman Balaban; Yerci, Omer

    2014-01-01

    Adiponectin (ApN) is a complement C1q-related protein, mainly secreted from adipose tissue, that signals through ApN receptor 1 (Adipo-R1) and ApN receptor 2 (Adipo-R2). Low serum ApN concentrations are associated with obesity-related malignancies. However, there are very few studies on any prognostic role of ApN receptors in gastric cancer. The aim of this study is to investigate the relationship between AdipoR1/R2 expression and early/advanced stage gastric cancer in terms of clinicopathologic characteristics and survival. Eighteen patients with early and 39 with advanced stage gastric cancer who underwent surgical gastric resection were included in this study. Adipo-R1 expression was low in 2 of the 18 patients with early stage gastric cancer (11.1%), while 4 had low Adipo-R2 expression (22.2%). In those with advanced stage gastric cancer, 7 of 39 had low Adipo-R1 expression (17.9%) and 16 had low Adipo-R2 expression (41%). Adipo-R2 expression was significantly higher (p=0.011) in moderately differentiated tumors when compared to well-differentiated tumors. While there was nearly a statistically significant relationship between TNM stage (T, tumor size; N, regional lymph node; M, whether distant metastases exist) and Adipo-R2 expression (p=0.054), there was no relationship between Adipo-R1/-R2 expression with tumor stage and survival. Adipo-R1/-R2 expression has no prognostic significance of in early/advanced stage gastric cancer.

  16. Chemotherapy with or without irinotecan in patients with advanced or recurrent gastric cancer: a meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    Zeng Chao; Zhou Hang; Wei Yang; Wang Liyang; Xie Hua; Yao Wenxiu

    2014-01-01

    Background Studies have shown that irinotecan can improve survival in patients with advanced or recurrent gastric cancer,but the overall benefit of irinotecan in the treatment of advanced or recurrent gastric cancer remains controversial.The aim of this study was to evaluate the benefits and risks of irinotecan for survival in patients with advanced or recurrent gastric cancer.Method We searched PubMed,EmBase,the Cochrane Central Register of Controlled Trials,reference lists of articles,and proceedings of major conferences for relevant clinical trials.We included randomized controlled trials that reported on the efficacy and safety of irinotecan in patients with advanced or recurrent gastric cancer.Outcomes were analyzed by survival rate,objective response rate (ORR),and toxicity.Furthermore,the analysis was further stratified by factors that could affect the treatment effects.Results Eight trials recruiting 1 546 patients with advanced or recurrent gastric cancer were included in the analysis.Overall,irinotecan therapy was associated with a 6% improvement in survival rate,but this difference was not statistically significant (odds ratio (OR) 0.94; 95% confidence interval (95% CI) 0.70-1.27; P=-0.69).However,irinotecan therapy had more frequent ORR than irinotecan-free arm (OR 1.70; 95% CI 1.34-2.17; P <0.001).Furthermore,irinotecan therapy was associated with a clinically and statistically significant increase in the risk for declined hemoglobin,hyponatremia,and diarrhea,but it also protected against thrombocytopenia risk when compared with irinotecan-free therapy.Conclusions There is no evidence to support the use of irinotecan therapy in patients with advanced or recurrent gastric cancer; however,given the significant advantage in ORR irinotecan therapy using combination regimens may be considered for further evaluation in subsets of patients who may benefit from this treatment.

  17. Late-onset peritoneal recurrence of advanced gastric cancer 20 years after primary resection

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    Mohri Yasuhiko

    2010-11-01

    Full Text Available Abstract Late onset of peritoneal recurrence of gastric cancer more than 10 years after surgery is extremely rare, and only three cases have been reported. We present the case of a 61-year-old man who was diagnosed finally with peritoneal recurrence of gastric cancer 20 years after primary curative resection. As a result of small-bowel obstruction caused by peritoneal recurrence, diverting ileostomy with partial ileal resection was performed. The resected specimen revealed tubular adenocarcinoma that resembled the primary gastric cancer. The clinical course after the second operation was unfavorable and systemic chemotherapy had no effect. He died at 62 years of age, 21 years and 7 months after initial gastrectomy. Immunohistochemical analysis using antibodies against proliferating cell nuclear antigen (PCNA, Ki-67, and p53 was performed to investigate the phenotype of primary and recurrence cancer. Protein expression of proliferation markers such as PCNA and Ki-67 was down-regulated, but p53 was overexpressed at the site of recurrence. These data suggest that late peritoneal recurrence has a low proliferation rate and is resistant to chemoradiotherapy. In conclusion, we present late onset of peritoneal recurrence of gastric cancer more than 20 years after primary surgery, and speculate on the mechanism of late-onset recurrence in our case.

  18. The new credo: induction chemotherapy in locally advanced gastric cancer: consequences for surgical strategies.

    Science.gov (United States)

    Ott, Katja; Lordick, Florian; Herrmann, Ken; Krause, Bernd-Joachim; Schuhmacher, Christoph; Siewert, Jörg Rüdiger

    2008-01-01

    Perioperative chemotherapy in stage II and stage III gastric cancer is now accepted as a standard of care in the Western world. Two randomized phase III studies have shown improved survival for patients with induction chemotherapy followed by surgery compared with surgery alone. It is generally accepted that patients who respond to induction therapy have a significantly improved survival compared with that in nonresponding patients. Unfortunately no prospectively tested markers predicting response and/or prognosis are available for clinical practice. In adenocarcinomas of the esophagogastric junction (AEG), fluorodeoxyglucose-positron emission tomography (FDG-PET) prospectively was established as a surrogate predicting response and prognosis. The MUNICON (Metabolic response evalUatioN for Individualisation of neoadjuvant Chemotherapy in oesOphageal and oesophagogastric adeNocarcinoma) I study confirmed prospectively the usefulness of early metabolic response evaluation and showed the feasibility of a PET-guided treatment algorithm. These findings are an important step forward in the tailoring of multimodal treatment in accordance with tumor biology. In gastric cancer, we have analyzed FDG-PET in a prospective study. In gastric cancer the issue is more complicated, because about 30% of gastric cancers cannot be visualized with sufficient contrast for quantification. Insufficient FDG uptake is mostly associated with diffuse-type gastric cancer with signet ring cells and mucinous content. In FDG-avid patients, FDG-PET can be used for response evaluation, comparable to that in AEG. The prognosis of FDG-nonavid patients is similar to that in metabolic nonresponders. The addition of new tracers such as fluorothymidine may increase the sensitivity of PET in the future. Treatment concepts such as immediate resection after only 2 weeks of induction therapy with or without adjuvant treatment could be considered in metabolic nonresponders, or modified chemotherapy regimens

  19. Advanced gastric cancer (GC) and cancer of the gastro-oesophageal junction (GEJ): focus on targeted therapies.

    Science.gov (United States)

    Cappetta, Alessandro; Lonardi, Sara; Pastorelli, Davide; Bergamo, Francesca; Lombardi, Giuseppe; Zagonel, Vittorina

    2012-01-01

    Despite recent improvements in surgical techniques and chemotherapy treatments, locally advanced/metastatic gastroesophageal junction (GEJ) and gastric cancer (GC) are still associated with poor clinical outcome. However, increased understanding of molecular mechanisms underlying carcinogenesis and its implementation in the treatment of breast, colon, lung, and other cancers in recent years have spurred focus on the development and incorporation of targeted agents in current therapeutic options for this difficult-to-treat disease. Such agents have the ability to target a variety of cancer relevant targets, including epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) and its receptor. In this review, we describe the current status of targeted therapies in the treatment of advanced GC and GEJ cancer, focusing on pre-clinical and clinical data available on monoclonal antibodies and tyrosine kinase inhibitors acting in these pathways, including completed and ongoing phase III studies.

  20. Peripheral venous blood neutrophil-to-lymphocyte ratio predicts survival in patients with advanced gastric cancer treated with neoadjuvant chemotherapy

    Directory of Open Access Journals (Sweden)

    Chen L

    2017-05-01

    Full Text Available Li Chen,1 Yanjiao Zuo,1 Lihua Zhu,2 Yuxin Zhang,3 Sen Li,1 Fei Ma,4 Yu Han,5 Hongjiang Song,1 Yingwei Xue11Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, 2Department of Pathogen Biology, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei, 3Department of General Surgery, Mudanjiang First People’s Hospital, Mudanjiang, 4Department of Breast Surgery, 5Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, People’s Republic of ChinaBackground: Accurate and useful predictors of gastric carcinoma treated with neoadjuvant chemotherapy are lacking at present. We aim to explore the potential prognostic significance of the neutrophil-to-lymphocyte ratio (NLR in advanced gastric cancer receiving S-1 plus oxaliplatin (SOX or oxaliplatin and capecitabine (XELOX regimen.Methods: We enrolled 91 patients with advanced gastric cancer treated with neoadjuvant chemotherapy from August 2008 to September 2015. The peripheral venous blood samples were collected before neoadjuvant chemotherapy. The NLR was divided into two groups: low NLR <2.17 group and high NLR ≥2.17 group. Univariate analysis on disease-free survival (DFS and overall survival (OS were generated using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors were assessed by univariate analyses, and the independent prognostic factors were evaluated using multivariate analysis (Cox’s proportional-hazards regression model.Results: The univariate analysis showed that median DFS and median OS were worse for high NLR values than low NLR values before neoadjuvant chemotherapy (median DFS: 19.97 and 26.87 months, respectively, P=0.299; median OS: 25.83 and 29.73 months, respectively, P=0.405. Multivariate analysis showed that the NLR before neoadjuvant

  1. Inoperable esophageal carcinoma managed by combined chemotherapy (CBDCA, 5FU and VDS) and radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Morishima, Yuichi; Tashiro, Tsuguhiko; Yamamori, Hideo [Chiba Univ. (Japan). School of Medicine] [and others

    1997-06-01

    Eleven inoperable patients with advanced esophageal carcinoma were treated with chemotherapy (carboplatin, 5-FU, vindesine) and concomitant radiotherapy. Two patients (T2) received this treatment due to their poor general condition and refusal of operation, and 9 patients for infiltration of tumor into the adjacent organs (T4). Administration of carboplatin (30 mg/body) and 5-FU (250 mg/body) together with radiotherapy (1.8 Gy/d) for 5 days a week was performed. This chemoradiation therapy was carried out for 5 consecutive weeks. In addition, vindesine (1-3 mg/body) was administered in the 1st and 4th week. After evaluation, endoscopic balloon dilatation was performed in 6 patients with stenosis of the esophagus. The general response rate was 80%. CR was noted in 2 patients of T2 but 1 patient of T4 developed severe leucopenia and immunosuppression, and died of septic MOF. All but the MOF case could take enough food orally following the endoscopic dilatation. The 1-year survival rate in the T4 group (45%) was significantly better than the non-treatment group (0%). In conclusion, this treatment is beneficial for patients with inoperable esophageal carcinoma to obtain a satisfactory QOL and survival rate. (author)

  2. Comparison of efficacy of different route of administration of chemotherapy on unresectable, advanced gastric cancer

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    Zhang Caihua

    2012-08-01

    Full Text Available Abstract Background The aim of this study was to compare the efficacy of two neoadjuvant chemotherapies (FLEEOX and XELOX with different routes of administration for unresectable gastric cancer. Methods A total of 85 patients with unresectable gastric cancer hospitalized from January 2007 to December 2009 received neoadjuvant chemotherapy. The FLEEOX group (48 patients received the FLEEOX regimen(fluorouracil, leucovorin, http://epirubicin, epotoside, and oxaliplatin, which combined arterial with venous administration for one or two cycles, while the XELOX group (37 patients received XELOX (capecitabine plus oxaliplatin via venous administration for two to four cycles. The clinical response and overall survival of the two groups were compared. Results In the FLEEOX group, the clinical response rate (RR of chemotherapy was 85.4% (41 of 48 patients and the median survival time was 25 months. The 1-year and 2-year disease-free survival (DFS rates were 85.4% and 45.8%, respectively. In the XELOX group, the clinical RR was 59.5% and the median survival time was 9 months, while the 1-year and 2-year survival rates were 35.2% and 8.3%, respectively. The clinical RR, the R0 resection rate, the median survival time, and the 1-year and 2-year DFS rates were significantly better (P 0.05 in the FLEEOX group than in the XELOX group. In addition, there were no significant differences in the rates of toxic and adverse reactions or post-operative complications between the two groups. Conclusions For patients with a preoperative diagnosis of unresectable gastric cancer, the efficacy of the FLEEOX regimen, which combines arterial with venous administration, was better than that of the XELOX regimen, using venous administration only. This combination of arterial and venous administration could be useful for improving the efficacy of neoadjuvant chemotherapy for gastric cancer.

  3. Robotic surgery of locally advanced gastric cancer: a single-surgeon experience of 41 cases.

    Science.gov (United States)

    Vasilescu, C; Procopiuc, L

    2012-01-01

    The mainstay of curative gastric cancer treatment is open gastric resection with regional lymph node dissection. Minimally invasive surgery is yet to become an established technique with a well defined role. Robotic surgery has by-passed some of the limitations of conventional laparoscopy and has proven both safe and feasible. We present our initial experience with robotic surgery based on 41 gastric cancer patients. We especially wish to underline the advantages of the robotic system when performing the digestive tract anastomoses. We present the techniques of end-to-side eso-jejunoanastomoses (using a circular stapler or manual suture) and side-to-side eso-jejunoanastomoses. In our hands, the results with circular stapled anastomoses were good and we advocate against manual suturing when performing anastomoses in robotic surgery. Moreover, we recommend performing totally intracorporeal anastomoses which have a better post-operative outcome, especially in obese patients. We present three methods of realising the total intracorporeal eso-jejuno-anastomosis with a circular stapler: manual purse-string suture, using the OrVil and the double stapling technique. The eso-jejunoanastomosis is one of the most difficult steps in performing the total gastrectomy, but these techniques allow the surgeon to choose the best option for each case. We consider that surgeons who undertake total gastrectomies must have a special training in performing these anastomoses.

  4. Recent advances in photodynamic diagnosis of gastric cancer using 5-aminolevulinic acid.

    Science.gov (United States)

    Koizumi, Noriaki; Harada, Yoshinori; Minamikawa, Takeo; Tanaka, Hideo; Otsuji, Eigo; Takamatsu, Tetsuro

    2016-01-21

    Photodynamic diagnosis based on 5-aminolevulinic acid-induced protoporphyrin IX has been clinically applied in many fields based upon its evidenced efficacy and adequate safety. In order to establish a personalized medicine approach for treating gastric cancer patients, rapid intraoperative detection of malignant lesions has become important. Feasibility of photodynamic diagnosis using 5-aminolevulinic acid for gastric cancer patients has been investigated, especially for the detection of peritoneal dissemination and lymph node metastasis. This method enables intraoperative real-time fluorescence detection of peritoneal dissemination, exhibiting higher sensitivity than white light observation without histopathological examination. The method also enables detection of metastatic foci within excised lymph nodes, exhibiting a diagnostic accuracy comparable to that of a current molecular diagnostics technique. Although several complicating issues still need to be resolved, such as the effect of tissue autofluorescence and the insufficient depth penetration of excitation light, this simple and rapid method has the potential to become a useful diagnostic tool for gastric cancer, as well as urinary bladder cancer and glioma.

  5. Efficiency of the metabolic radiotherapy with {sup 177}Lu Octreotate in the case of gastric endocrine tumor with hepatic metastases; Efficacite de la radiotherapie metabolique au{sup 177}Lu Octreotate dans le cas d'une tumeur endocrine gastrique avec metastases hepatiques

    Energy Technology Data Exchange (ETDEWEB)

    Leghzali Moise, H.; Besse, H.; Stievenart, J.L [Medecine nucleaire, hopital Beaujon, AP-HP, (France); Scigliano, S. [service hospitalier Frederic-Joliot, Orsay, (France); Mortazavi Jehannod, N.; Lebtahid, R.; Le Guludec, D. [medecine nucleaire, hopital Bichat, AP-HP, (France); Ruszniewski, P. [pancreato-gastroenterologie, hopital Beaujon, AP-HP, (France)

    2009-05-15

    The therapy means of evolved, metastases or inoperable forms of digestive endocrine tumors are limited. we illustrate a case of treatment efficiency by {sup 177}Lu-Octreotate of a well differentiated gastric endocrine tumor with hepatic metastases. conclusions: the metabolic radiotherapy of endocrine tumors constitute a new alternative of conventional treatments, showing the achievement of objective tumor responses at advanced stages, and in failure of conventional treatments. it is necessary to identify the predictive factors of the therapy response in order to optimize the results and to limit the toxicity. (N.C.)

  6. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute.

    Science.gov (United States)

    Sun, Li-Bo; Zhao, Guo-Jie; Ding, Da-Yong; Song, Bin; Hou, Rui-Zhi; Li, Yong-Chao

    2014-09-08

    Gastric cancer is the third leading cause of cancer-related mortality in China, and the long-term survival for locally advanced gastric cancer is very poor. Simple surgery cannot yield an ideal result because of the high recurrence rate after tumor resection. Preoperative chemotherapy could help to reduce tumor volume, improve the R0 resection rate (no residual tumor after surgery), and decrease the risk of local tumor recurrence. The aim of this study was to evaluate the influence of pathological differentiation in the effect of preoperative chemotherapy for patients with locally advanced gastric cancer. Patients with locally advanced gastric cancer (n = 32) received preoperative chemotherapy under the XELOX (capecitabine plus oxaliplatin) regimen. According to pathological examination, patients' tumors were classified into better (well and moderate) and poorly differentiated (lower differentiated and undifferentiated) groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups of patients. Morphological changes and toxic reactions were monitored after chemotherapy. The results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% versus 25%, P = 0.000). The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% versus 25% P = 0.000). A significant shrinking of tumor and necrosis of tumor tissues caused by chemotherapy could be observed. In conclusion, the better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy under the XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for the better differentiated group.

  7. Effect of Yunpi Huoxue soup combined chemotherapy on T lymphocyte subsets and nutritional status in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Yi-Jiao Huang; Pei Xiang; Wei-Min Zhu

    2016-01-01

    Objective:To observe the effect of Yunpi Huoxue soup combined with chemotherapy on T lymphocyte subsets and nutritional status in patients with advanced gastric cancer.Methods:A total of 94 cases patients with advanced gastric cancer were randomly divided into the treatment group (49 cases) and the control group (45 cases) according to the results of the draw. The control group was given chemotherapy, the treatment group was given Yunpi Huoxue soup on the basis of the control group. Treated for 6 weeks, observed the changes of T cell subsets (CD3, CD4, CD8 and CD4/CD8) and nutrition indexes: total protein (TP), albumin (ALB), prealbumin (PA) and transferrin (TRF) in the two groups.Results:After treatment, CD3, CD4, CD8 and CD4/CD8 in the treatment group were (57.38±4.03), (31.63±4.26), (30.82±3.52) and (1.16±0.20 ) respectively, there were no significant differences compared with before treatment; After treatment, the levels of CD3, CD4, CD8 and CD4/CD8 in the control group were significantly lower than those before treatment, and the differences were statistically significant; After treatment, the levels of CD3, CD4, CD8 and CD4/CD8 in the treatment group were significant higher than those in the control group after treatment, and the differences were statistically significant. After treatment, TP, ALB, PA and TRF in the treatment group were(54.22±5.93) g/L, (32.47±4.97) g/L, (2.52±0.43) g/L and (1.66±0.40) g/L respectively, there were no significant differences compared with before treatment; After treatment, the levels of TP, ALB, PA and TRF in the control group were significantly lower than those before treatment; After treatment, the levels of TP, ALB, PA and TRF in the treatment group were significant higher than those in the control group after treatment, and the differences were statistically significant.Conclusion:When chemotherapy for patients with advanced gastric cancer, Yunpi Huoxue soup is helpful to maintain the immune function and

  8. [Effectiveness of chemoradiotherapy for a patient with local recurrence of advanced gastric cancer followed by curable gastrectomy].

    Science.gov (United States)

    Natsume, Soichiro; Iwasaki, Yoshiaki; Yajima, Kazuhito; Yuu, Ken; Oohinata, Ryouki; Ishiyama, Satoshi; Takahashi, Keiichi; Maeda, Yoshiharu

    2014-11-01

    We report here the effectiveness of chemoradiotherapy for a patient with local recurrence followed by curable gastrectomy. A 57-year-old man presented with a history of total gastrectomy with distal pancreatectomy and splenectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for advanced gastric cancer arising from the cardia. Esophageal intramural metastasis and lymph node metastasis around the right recurrent nerve were detected by chest-abdominal computed tomography and gastrointestinal endoscopy 27 months after the initial gastrectomy. Stable disease was achieved following 7 courses of chemotherapy using S-1 plus CDDP. Concurrent chemoradiotherapy including administration of S-1 and radiation of total 50 Gy (2 Gy/25 Fr) was selected for local tumor control. The patient was not able to eat solid food because of esophageal stenosis from regrowth of intramural metastasis of the esophagus 60 months after the chemotherapy. A WallFlex™ Duodenal Stent was placed to improve the dysphagia 67 months after chemotherapy. The patient died from recurrence of gastric cancer 69 months after completion of the initial chemotherapy and 2 months after the stent insertion.

  9. The Clinical Research in Advanced Stage Gastric Cancer Accompanying Hemorrhage with EHLF Chemotherapy and Thrombin to Take Orally

    Institute of Scientific and Technical Information of China (English)

    Chen Huoguo

    2003-01-01

    Purpose:Study therapeutic effectiveness about EHLF chemotherapy and thrombin to take orally in advanced stage gastriccancer accompanying hemorrhage.Methods:76 cases were divided into two groups at random,that were diagnosed by pathology andclinical. Research group included medicine:(etoposide)VP-16,100 mg intravenous drip,d1~3;(hydroxycamptothecin)HCPT, 10mg,ivtravenous drip,d1~5;(calciumfolinate)CF, 100 mg,intravenous drip,d1~5;(fluorouracil)5-Fu,0.5,intravenous drip,d1~5;thrombin,5oou,oral administration,three times in a day, d1~7.Matched control:normal regulation to medicine in gastric hemorrhye.Results:Effective rate in research group was 78.4%,obvious better than one in matched control 28.2%(P<0.01),bad reaction wasslight, life quantity was obvious exaltation.Conclusion:EHLF chemotherapy and thrombin to take orally was used as treatment project inadranced stage gastric cancer accompanying hemorrhage,good result in research group. It is worthy to deserve further reseach.

  10. Cardiac transplantation for pediatric patients. With inoperable congenital heart disease.

    OpenAIRE

    Shaffer, K M; Denfield, S W; Schowengerdt, K O; Towbin, J A; Radovancević, B; Frazier, O. H.; Price, J K; Gajarski, R J

    1998-01-01

    Recent studies have reported the expanding use of transplantation as the definitive option for pediatric patients with inoperable congenital heart disease. This study compares perioperative risk factors and outcomes in pediatric patients who received heart transplants for congenital heart disease with those in pediatric patients who received heart transplants for cardiomyopathy. Retrospective data collected on 40 consecutive pediatric patients undergoing cardiac transplantation from 1 January...

  11. The efficacy and safety of S-1-based regimens in the first-line treatment of advanced gastric cancer : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Ter Veer, Emil; Mohammad, Nadia Haj; Lodder, Paul; Ngai, Lok Lam; Samaan, Mary; van Oijen, Martijn G H; van Laarhoven, Hanneke W M

    2016-01-01

    BACKGROUND: S-1 is first-line therapy for advanced gastric cancer in Asia and is used with increased frequency in Western counties. We conducted a meta-analysis to investigate the efficacy and toxicity of S-1-based therapy compared with 5-fluorouracil (5-FU)/capecitabine-based therapy and S-1-based

  12. The expression of E-cadherin-catenin complex in patients with advanced gastric cancer: role in formation of metastasis.

    Directory of Open Access Journals (Sweden)

    Marek Ustymowicz

    2010-06-01

    Full Text Available The E-cadherin-catenin complex plays an important role in the process of cell adhesion. Its dysfunction is associated with a decrease in cell differentiation and with increased invasiveness and metastasis. Our aim was to evaluate the expression of E-cadherin and B-catenin in advanced gastric cancer in relation to selected clinico-pathomorphological parameters. Formalin-fixed, paraffin-embedded tissue specimens were immunohistochemically stained with monoclonal antibodies E-cadherin (NCL-E-Cad, Novocastra Laboratiries Ltd; dilution 1:50, beta-catenin (NCL-B-CAT, Novocastra Laboratories Ltd; dilution 1:100, alpha-catenin (alpha-E-caten, Santa Cruz Biotechnology; dilution 1:300 and gamma-catenin (gamma-catenin, Santa Cruz Biotechnology; dilution 1:100. The expressions of E-cadherin and alpha-, beta-, gamma-catenins in the main mass of tumor and lymph node metastasis were investigated in 91 patients with gastric cancer. No statistically significant correlation was observed between the expressions of E-cadherin, alpha-, beta-catenins and histological differentiation and between the expressions of E-cadherin, alpha-, gamma-catenins and location or depth of invasion. Moreover, the expression of alpha-, gamma-catenins in the main mass of tumor was not associated with lymph node metastasis. However, we found a relationship between the expression of beta-catenin in the main mass of tumor and lymph node metastasis and tumor location. The depth of invasion was correlated with positive expression of beta-catenin in the main mass of gastric cancer. A statistically significant association was observed between the expressions of E-cadherin and beta-catenin in the main mass of tumor and lymph node involvement. The expression of alpha-catenin in the main mass of tumor was also associated with histological differentiation and Lauren's classification. Statistical analysis showed an association between the expression of E-cadherin and postoperative survival time. No

  13. Benefits of intra-operative systemic chemotherapy during curative surgery in patients with locally advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-bin; YU Jian-chun; MA Zhi-qiang; KANG Wei-ming; ZHOU Li; YE Xin

    2013-01-01

    Background There is little information on the impact of intra-operative systemic chemotherapy on gastric cancer.The aim of this study was to identify prognostic factors in patients with locally advanced gastric cancer and undergoing curative resection,with a focus on evaluating survival benefits and tolerance of intra-operative systemic chemotherapy.Methods We retrospectively analyzed clinicopathological data for 264 consecutive patients who underwent curative resection for gastric cancer at Peking Union Medical College Hospital from January 2002 to January 2007.Survival curves were plotted using the Kaplan-Meier method and compared using log-rank tests.Univariate and multivariate analyses were performed with the Cox proportional hazard model.Results Patients who received intra-operative systemic chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P=0.019 and 0.010,respectively) than patients who did not receive intra-operative systemic chemotherapy.In the subgroup analysis,systemic intra-operative chemotherapy benefited the 5-year overall survival and disease-free survival rates for patients with cancer of stage pTNM ⅠB-ⅢB,but not stage pTNM ⅢC.Patients who received intra-operative systemic chemotherapy in combination with post-operative chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P=0.046 and 0.021,respectively) than patients who only received postoperative chemotherapy.However,the difference in these rates between patients who received only intra-operative systemic chemotherapy and patients who only received curative surgery was not statistically significant (P=0.150 and 0.170,respectively).Multivariate analyses showed that intra-operative systemic chemotherapy was a favorable prognostic factor for the overall survival and disease-free survival rates (P =0.048 and 0.023,respectively).No grade 4 toxicities related to intra-operative systemic chemotherapy were recorded within the

  14. Evaluation of the efficacy and toxicity of protocol cisplatin, 5-fluorouracil, leucovorin compared to protocol fluorouracil, doxorubicin and mitomycin C in locally advanced and metastatic gastric cancer

    Directory of Open Access Journals (Sweden)

    Andrić Zoran

    2012-01-01

    Full Text Available Introduction. Still there is no consensus on the choice of the most efficient and the least toxic chemotherapy regimen in the treatment of advanced gastric cancer. Nowadays few therapy protocols are available for treating this disease. Objective. Study was conducted to compare the efficacy and toxicity of FAM (flurouracil, doxorubicin, mitomycin C with CDDP and FU/FA (cisplatin, 5-fluorouracil, leucovorin protocols in patients with locally advanced and metastatic gastric cancer. Methods. This randomized study involved a group of 50 patients with locally advanced or metastatic gastric cancer, who had not previously undergone chemotherapy treatment. Progression free survival, overall survival and drug toxicity were evaluated. For statistical analysis chi-square test, Kaplan-Meier curve and the log rank test were used. Results. The overall response rate was 20% in the group treated with FAM and 24% in the group treated with CDDP, FU/FA (4% of patients from each group had complete response, but without significant statistical difference. Median survival was 10.9 months in the FAM group and 11.8 months in CDDP, FU/FA group, with no statistically significant difference. Non-haematological and haematological toxicities of CDDP, FU/FA were considerably less frequent than of FAM, and there was no treatment related deaths in any of the groups. Conclusion. Both investigated regimens demonstrated moderate efficacy. The study shows in favour of justified application of both protocols, while in regard to toxicity CDDP and FU/FA can be recommended as preferable treatment for locally advanced and metastatic gastric cancer. New strategies should be considered for better efficacy in the treatment of advanced gastric cancer. New strategies are necessary with the goal to achieve a better therapeutic effect.

  15. Efficacy and safety of neoadjuvant chemotherapy with modified FOLFOX7 regimen on the treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jun; CHEN Ren-xiong; ZHANG Jing; CAI Jun; MENG Hua; WU Guo-cong; ZHANG Zhong-tao; WANG Yu; WANG Kang-li

    2012-01-01

    Background Gastric cancer is one of the most common types of malignant tumors in China and East Asia and has the highest mortality rate of the malignant gastrointestinal tumors.Neoadjuvant chemotherapy is a systemic or local chemotherapy that is given prior to the local treatment of malignant tumors.Neoadjuvant therapy is currently showing some positive prospects; however,its clinical effects remain controversial.In this study,we used the modified FOLFO×7 (mFOLFO×7) regimen as a neoadjuvant chemotherapy regimen.Perioperative clinical and pathological efficacy,toxicity,effects of surgery,postoperative observation,and prognosis were studied to investigate its clinical efficacy and safety.Methods Eighty patients with advanced gastric cancer were treated in our surgery department from 2005 to 2009; 38 of these patients received mFOLFO×7 neoadjuvant chemotherapy,the other 42 patients assigned to the control group.The perioperative effects of mFOLFO×7 chemotherapy,including clinical effects and toxicity,were observed in each patient.Results After mFOLFO×7 chemotherapy,clinical and pathologic stages decreased in 21.1% and 36.8% of the patients,respectively,but the results were not statistically significant (P=0.129).The clinical response rate was 50% (19/38).Toxicity was mild; most adverse events were grade I or ll and involved no severe infections or deaths.Compared with the control group,the radical resection rate increased (92.1% vs.85.7%; P=0.437); surgical effects were completed without an increased incidence of perioperative complications.The 1-,2-,and 3-year survival rates were 78.70%,57.40%,and 51.66%,respectively,in the neoadjuvant chemotherapy group and 78.57%,56.87%,and 43.16%,respectively,in the control group.Conclusions The mFOLFO×7 regimen was very effective and well-tolerated as a neoadjuvant chemotherapy for advanced gastric cancer.However,the 1-,2-,and 3-year survival rates in the mFOLFO×7 group were not significantly

  16. Short-term outcomes of laparoscopic D2 lymphadenectomy with complete mesogastrium excision for advanced gastric cancer.

    Science.gov (United States)

    Xie, Daxing; Yu, Chaoran; Liu, Liang; Osaiweran, Hasan; Gao, Chun; Hu, Junbo; Gong, Jianping

    2016-11-01

    D2 lymphadenectomy has been widely accepted as a standard procedure of surgical treatment for local advanced gastric cancer [1, 2]. However, neither the dissection boundary nor the extent of the excision for perigastric soft tissues has been described [3-7]. Our previous researches demonstrate the existence of disseminated cancer cells in the mesogastrium [8, 9] and present an understandable mesogastrium model for gastrectomy [10]. Hence, the D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) is firstly proposed in this study, aiming to assess the safety, feasibility and corresponding short-term surgical outcomes. All of these patients underwent laparoscopy assisted D2 + CME radical gastrectomy with a curative R0 resection, and all the operations were performed by Prof. Jianping Gong, chief of GI surgery of Tongji Hospital, Huazhong University of Science and Technology. All participants provided informed written consent to participate in the study. This study was approved by the Tongji Hospital Ethics Committee. The standard surgical procedures in the video are described as follows. Dissect along the gastrocolic ligament and then toward the left colic flexture with special made gauze. Bluntly separate the adipose tissues to find fascia plane. Expose along the plane toward the splenic inferior polar area. Precede to the origins of left gastroepiploic vessels (LGEVs), clip and cut. All the mobilized adipose tissues in this area are defined as left gastroepiploic mesentery (LGEM) [10]. Next, turn to infra-pyloric area. Dissect the fascia plane between right gastroepiploic mesentery (RGEM) and transverse mesocolon. Turn to the pancreas head, remove the covering adipose tissues, identify the superior mesentery vein and expose the origins of right gastroepiploic vessels (RGEVs). Clip and cut. All the surrounding mobilized adipose tissues are defined as RGEM [10]. Move to the superior boarder of pancreas with the stomach reflected cephalad, incise the

  17. [Treatment of S-1 plus weekly CDDP for advanced gastric cancer].

    Science.gov (United States)

    Kemmochi, Takeshi; Egawa, Tomohisa; Mihara, Yasunori; Irino, Tomoyuki; Ito, Yasuhiro; Nagashima, Atsushi; Makino, Hiroyuki; Yamamuro, Wataru

    2011-11-01

    We analyzed the clinical efficacy and safety of chemotherapy using S-1 plus weekly CDDP( w-CS therapy) for unresectable gastric cancer. Twenty one patients were treated with this treatment. S-1 80 mg/m²/day was administered for 2 weeks followed by a 1-week rest. CDDP 20 mg/m² was injected intravenously on day 1 and 8. The overall response rate was 52. 3%. The disease control rate was 85.7%. Grade 3 or 4 major toxicity comprised neutropenia (14.2%), thrombocytopenia (4.7%) and plasma creatinine elevation (4.7%). w-CS therapy is satisfied resulting with efficacy and safety. Thus, future clinical trials and accumulation of futher cases are warranted.

  18. Expression of macrophage migration inhibitory factor is associated with enhanced angiogenesis and advanced stage in gastric carcinomas

    Institute of Scientific and Technical Information of China (English)

    Chia-Tung Shun; Jaw-Town Lin; Shih-Pei Huang; Min-Tsan Lin; Ming-Shiang Wu

    2005-01-01

    AIM: Macrophage migration inhibitory factor (MIF) was reported to inactivate p53 and play an essential role in the growth and angiogenesis of tumors that arise at sites of chronic inflammation. Gastric inflammation is a prerequisite for the development of gastric carcinoma (GC), which has recently been linked to Helicobacter pylori(H pylori)infection. This study aimed to investigate dinicopathologicalsignificance of MIF expression in GCs.METHODS: We selected 90 consecutive patients with GCs for investigation of the relation among MIF status, clinicopathological parameters, p53 expression and angiogenesis. MIF and p53 expression was assessed by immunohistochemistry as positive and negative groups. Tumor vascularity was evaluated by counting microvessel density on anti-CD34 stained sections. Expression status of MIF was correlated with determined clinicopathological data, p53 immunoreactivity and microvessel counts.RESULTS: Strong immunostainings of MIF were observed in the cytoplasm of cancerous cells in 40% (36/90) of cases but not in normal or metaplastic epithelia. There was no statistically significant correlation between MIFexpression and age, gender, H pylori infection, tumor location, histological subtypes, lymph node metastasis or p53 expression. Early GC less frequently overexpressed MIFas compared to advanced GCs (4/20 vs 32/70, P = 0.04).A remarkably increased microvessel count was noted inGCs with MIF expression than those without MIF expression (55.1±30.1 vs 31.3±28.8, P= 0.0001).CONCLUSION: Our results suggest that expression of MIF may contribute to the progression and enhanced angiogenesis in a substantial portion of GCs.

  19. Pilot study of postoperative adjuvant chemoradiation for advanced gastric cancer: Adjuvant 5-FU/cisplatin and chemoradiation with capecitabine

    Institute of Scientific and Technical Information of China (English)

    Hyung-Sik Lee; Min-Chan Kim; Youngmin Choi; Won-Joo Hur; Hyo-Jin Kim; Hyuk-Chan Kwon; Sung-Hyun Kim; Jae-Seok Kim; Jong-Hoon Lee; Ghap-Joong Jung

    2006-01-01

    AIM: To evaluate the efficacy and toxicity of postoperative chemoradiation using FP chemotherapy and oral capecitabine during radiation for advanced gastric cancer following curative resection.METHODS: Thirty-one patients who had underwent a potentially curative resection for Stage Ⅲ and Ⅳ (MO) gastric cancer were enrolled. Therapy consists of one cycle of FP (continuous infusion of 5-FU 1000 mg/m2 on d 1 to 5 and cisplatin 60 mg/m2 on d 1) followed by 4500 cGy (180 cGy/d) with capecitabine (1650 mg/m2 daily throughout radiotherapy). Four wk after completion of the radiotherapy, patients received three additional cycles of FP every three wk. The median follow-up duration was 22.2 mo.RESULTS: The 3-year disease free and overall survival in this study were 82.7% and 83.4%, respectively. Four patients (12.9%) showed relapse during follow-up. Eight patients did not complete all planned adjuvant therapy.Grade 3/4 toxicities included neutropenia in 50.2%, anemia in 12.9%, thrombocytopenia in 3.2% and nausea/vomiting in 3.2%. Neither grade 3/4 hand foot syndrome nor treatment related febrile neutropenia or death were observed.CONCLUSION: These preliminary results suggest that this postoperative adjuvant chemoradiation regimen of FP before and after capecitabine and concurrent radiotherapy appears well tolerated and offers a comparable toxicity profile to the chemoradiation regimen utilized in INT-0116. This treatment modality allowed successful loco-regional control rate and 3-year overall survival.

  20. Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma.

    Science.gov (United States)

    Zhang, Caiyun; Chen, Shicai; Zhu, Minhui; Chen, Donghui; Chen, Hezhong; Zheng, Hongliang

    2015-11-01

    Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered.

  1. Three Weekly Irinotecan and Bolus 5-Fluorouracil Combination in the First Line Treatment of Advanced Gastric Cancer - A Single Institution Experience

    Directory of Open Access Journals (Sweden)

    Mohamed Mesmoudi

    2016-06-01

    Full Text Available Background: The goal of this study is to determine the efficacy and toxicity of a non-platinum based chemotherapy combination using irinotecan associated to bolus 5-FU as first line treatment in advanced gastric cancer. Materiel and methods: Retrospective analysis of a population of patients treated for metastatic and locally advanced gastric cancer with irinotecan and 5-FU as upfront chemotherapy. Results: Thirteen patients were enrolled. The median age was 56 years. Seven patients were males and six were of females. Ten patients had a metastatic disease and three patients had a locally advanced disease. Patients received a total number of 43 cycles of chemotherapy. Overall response rate was 38,4%, median time to progression (TTP was 3 months, and median overall survival was 4 months. Three patients (23,1% presented grade 3 /4 neutropenia complicated with an infectious episode with fever in two cases, three patients (23,1% required blood transfusion for a grade 4 anemia, and one patient (7,6% was hospitalized for a severe episode of diarrhea. Conclusion: Three weekly irinotecan and bolus 5-FU is an interesting combination as first line treatment of advanced gastric cancer; designed clinical trials are needed to confirm the activity of this combination.

  2. Pre-adjuvant chemotherapy leukocyte count may predict the outcome for advanced gastric cancer after radical resection.

    Science.gov (United States)

    Pei, Dong; Zhu, Fang; Chen, Xiaofeng; Qian, Jing; He, Shaohua; Qian, Yingying; Shen, Hua; Liu, Yiqian; Xu, Jiali; Shu, Yongqian

    2014-03-01

    Gastric cancer (GC) has a high morbidity worldwide each year especially in China and advanced GC is well known with poor prognosis, for which surgical resection combine adjuvant chemotherapy is the optimal choice for therapy. Leukocyte is an important index during the treatment for its influence on drugs' dosage and tolerance. Therefore, peripheral blood leukocyte and its subsets during adjuvant chemotherapy may have great clinical value for predicting prognostic. In this retrospective study, we showed the distribution of white blood cell and its subsets in the baseline period before adjuvant chemotherapy in 399 patients who underwent radical resection for advanced GC from January 1, 2008 to August 31, 2012. We investigated the relationship between leukocyte count and overall survival (OS) as well as disease-free survival (DFS). In these patients, females were more likely to have less white blood cells after operation (P=0.016). Patients with pre-chemotherapy leukocyte count less than 4×10(9)/L got worse DFS (P=0.028) and OS (P=0.016). In multivariate analysis, tumor size ≥ 6cm (P=0.033), TNM stage IV (P=0.024), vascular or nerval invasion (P=0.005) and leukocyte count less than 4.0×10(9)/L (P=0.019) was associated with poor DFS. TNM stage IV (P=0.008), vascular or nerval invasion (P=0.001) and lower leukocyte count (P=0.045) were independent risk factors for poor OS. Taken together, our findings suggest that pre-adjuvant chemotherapy peripheral blood leukocyte count correlates with clinical outcome of patients with advanced GC after radical resection.

  3. FEP regimen (epidoxorubicin, etoposide and cisplatin) in advanced gastric cancer, with or without low-dose GM-CSF: an Italian Trial in Medical Oncology (ITMO) study.

    OpenAIRE

    Bajetta, E; Di Bartolomeo, M.; Carnaghi, C; Buzzoni, R.; Mariani, L; Gebbia, V.; Comella, G.; Pinotti, G; Ianniello, G.; Schieppati, G.; Bochicchio, A. M.; Maiorino, L.

    1998-01-01

    The new regimens developed over the last few years have led to an improvement in the treatment of advanced gastric cancer, and our previous experience confirmed the fact that the combination of etoposide, doxorubicin and cisplatin (EAP regimen) is an active treatment that leads to interesting complete remission rates. The primary end point of the present multicentre, randomized, parallel-group phase II study was to determine the activity of the simplified 2-day EAP schedule in patients with l...

  4. Neoadjuvant therapy in advanced gastric cancer:a case report%1例中晚期胃癌新辅助治疗探讨

    Institute of Scientific and Technical Information of China (English)

    刘勇; 张汝鹏; 黄鼎智; 潘源; 梁寒; 肖建宇; 战忠利; 韩如冰; 朱莉; 王宝贵; 巴一

    2013-01-01

      无远处转移的局部进展期胃癌,虽然有手术切除的机会,但与早期胃癌相比预后较差。局部晚期肿瘤不可切除率较高,且根治术后复发率较高。新辅助化疗对胃癌的治疗具有以下优点:减少肿瘤负荷,提高R0切除率,控制微转移,评价肿瘤对细胞毒药物的化疗敏感性。现介绍1例经天津医科大学附属肿瘤医院胃部肿瘤科治疗的进展期胃癌新辅助治疗病例,该患者经多学科协作诊疗后效果较好。通过报道该病例诊治以促进胃癌新辅助治疗经验交流,推动多学科间的合作。%Nearly 41%of the global gastric cancer cases occur in China, and the vast majority of cases in China present as ad-vanced gastric cancer. Advanced gastric cancer without distant metastasis remains a potentially curable disease, but the prognosis is poorer than the early-stage disease. The prognosis of locally advanced tumors is poor because of a high unresectability rate at presenta-tion and a much higher relapse rate after radical surgery. The administration of neoadjuvant chemotherapy has several potential benefits for gastric cancer. It can reduce tumor volume, improve R0 resection rate, act on micrometastases, and evaluate tumor chemosensitivity to cytotoxic medications. The current study presents an advanced gastric cancer patient who underwent neoadjuvant chemotherapy in our hospital. The multimodal treatment achieved a favorable curative effect for the patient. Mechanical diagnosis and therapy promotes comprehensive integration of gastric cancer diagnosis and treatment strategies. Moreover, it can enhance interdisciplinary communica-tion and cooperation among medical colleagues in the same fields.

  5. S-1 plus cisplatin versus fluorouracil plus cisplatin in advanced gastric or gastro-esophageal junction adenocarcinoma patients: a pilot study.

    Science.gov (United States)

    Li, Yu Hong; Qiu, Miao Zhen; Xu, Jian Ming; Sun, Guo Ping; Lu, Hui Shan; Liu, Yun Peng; Zhong, Mei Zuo; Zhang, He Long; Yu, Shi Ying; Li, Wei; Hu, Xiao Hua; Wang, Jie Jun; Cheng, Ying; Zhou, Jun Tian; Guo, Zeng Qing; Guan, Zhon Gzhen; Xu, Rui Hua

    2015-10-27

    The safety and efficacy of S-1 plus cisplatin in Chinese advanced gastric cancer patients in first line setting is unknown. In this pilot study, patients with advanced gastric or gastro-esophageal junction adenocarcinoma were enrolled and randomly assigned in a 1:1 ratio to receive S-1 plus cisplatin (CS group) or 5-FU plus cisplatin (CF group). The primary endpoint was time to progression (TTP). Secondary end points included overall survival (OS) and safety. This study was registered on ClinicalTrials. Gov, number NCT01198392. A total of 236 patients were enrolled. Median TTP was 5.51 months in CS group compared with 4.62 months in CF group [hazard ratio (HR) 1.028, 95% confidential interval (CI) 0.758-1.394, p = 0.859]. Median OS was 10.00 months and 10.46 months in CS and CF groups (HR 1.046, 95%CI 0.709-1.543, p = 0.820), respectively. The most common adverse events in both groups were anemia, leukopenia, neutropenia, nausea, thrombocytopenia, vomiting, anorexia and diarrhea. We find that S-1 plus cisplatin is an effective and tolerable option for advanced gastric or gastro-esophageal junction adenocarcinoma patients in China.

  6. Treatment of Advanced Gastric Carcinoma Patients with Calcium Folinate, a 5-Fluorouracil Bolus and Continous Infusion with 5-Infusion with 5-Fluorouracil Combined with Oxaliplatin

    Institute of Scientific and Technical Information of China (English)

    Qilian Liang; Saihong Chen; Dachao Pan; Jierong Xie; Liangzhen Cai; Shujun Li

    2008-01-01

    OBJECTIVE To examine the therapeutic effects and toxicity of high-dose-folinic acid plus a 5-fluorouracil (5-FU) bolus and continuous infusion with 5-FU combined with locally produced oxaliplatin (L-HOP)in treating advanced gastric carcinoma patients.METHODS Sixty-five patients with advanced gastric carcinoma were treated with high-dose-folinic acid plus a 5-FU bolus and a 48-h continuous infusion of 5-FU combined with oxaliplatin. The effects of treatment and toxicity were observed.RESULTS There were 4 complete responses, 26 partial responses,30 with no change and 5 with progressive disease. The overall effective response rate was 46.2% (30/65). The median duration was 7 months, with the main side effects including nausea and vomiting, peripheral phlebitis, alopecia, leukopenia, dental ulcers,peripheral neuritis and diarrhea. All the side effects were tolerated and minimal.CONCLUSION The results showed that high-dose folinic acid plus a 5-FU bolus and continuous infusion of 5-FU combined with oxaliplatin appears to be a safe and effective therapy for patients with advanced gastric carcinoma. This therapeutic regimen is of value for these patients.

  7. Combination therapy with docetaxel and S-1 as a first-line treatment in patients with advanced or recurrent gastric cancer: a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Yoshida Kazuhiro

    2010-05-01

    Full Text Available Abstract Background We performed a single-institution retrospective study to evaluate the efficacy and toxicities of combination therapy with docetaxel and S-1 in patients with advanced or recurrent gastric cancer. Methods Eighty-six patients with advanced or recurrent gastric cancer were enrolled. Patients received docetaxel, 40 mg/m2, on day 1 and oral S-1, 80 mg/m2/day, on days 1 to 14 every 3 weeks. Results All 84 patients were assessable for response. The overall response rate was 52.4% (44/84 and the disease control rate was 96.4% (81/84. Median time to progression (TTP and overall survival (OS were 6.5 (95% CI, 4.8-8.1 months and 15.1 months (95% CI, 11.7-18.5 months, respectively. The major toxicities were neutropenia, leukopenia, alopecia and anorexia. Grade 3 or 4 hematologic toxicities included neutropenia in 31 patients (36.0%, leukopenia in 27 (31.7%, febrile neutropenia in four (4.7%, and anemia in one (1.2%. Other grade 3 toxicities included anorexia in five patients (5.8%, and stomatitis, diarrhea and nausea in one each (1.2%. There was one treatment-related death (1.2%. Conclusion The combination of docetaxel and S-1 had good clinical activity with acceptable toxicity in patients with advanced or recurrent gastric cancer.

  8. An unusual presentation of tumor lysis syndrome in a patient with advanced gastric adenocarcinoma: case report and literature review.

    Science.gov (United States)

    Vodopivec, Danica Maria; Rubio, Jose Enrique; Fornoni, Alessia; Lenz, Oliver

    2012-01-01

    Tumor lysis syndrome (TLS) is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia in patients with a malignancy. When these laboratory abnormalities develop rapidly, clinical complications such as cardiac arrhythmias, acute renal failure, seizures, or death may occur. TLS is caused by rapid release of intracellular contents by dying tumor cells, a condition that is expected to be common in hematologic malignancies. However, TLS rarely occurs with solid tumors, and here we present the second chemotherapy-induced TLS in a patient with advanced gastric adenocarcinoma to be reported in the literature. We also provide information regarding the total cases of TLS in solid tumors reported from 1977 to present day. Our methodology involved identifying key articles from existing reviews of the literature and then using search terms from these citations in MEDLINE to find additional publications. We relied on a literature review published in 2003 by Baeksgaard et al., where they gathered all total 45 cases reported from 1977 to 2003. Then, we looked for new reported cases from 2004 to present day. All reports (case reports, brief reports, letters to editor, correspondence, reviews, journals, and short communications) identified through these searches were reviewed and included.

  9. An Unusual Presentation of Tumor Lysis Syndrome in a Patient with Advanced Gastric Adenocarcinoma: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Danica Maria Vodopivec

    2012-01-01

    Full Text Available Tumor lysis syndrome (TLS is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia in patients with a malignancy. When these laboratory abnormalities develop rapidly, clinical complications such as cardiac arrhythmias, acute renal failure, seizures, or death may occur. TLS is caused by rapid release of intracellular contents by dying tumor cells, a condition that is expected to be common in hematologic malignancies. However, TLS rarely occurs with solid tumors, and here we present the second chemotherapy-induced TLS in a patient with advanced gastric adenocarcinoma to be reported in the literature. We also provide information regarding the total cases of TLS in solid tumors reported from 1977 to present day. Our methodology involved identifying key articles from existing reviews of the literature and then using search terms from these citations in MEDLINE to find additional publications. We relied on a literature review published in 2003 by Baeksgaard et al., where they gathered all total 45 cases reported from 1977 to 2003. Then, we looked for new reported cases from 2004 to present day. All reports (case reports, brief reports, letters to editor, correspondence, reviews, journals, and short communications identified through these searches were reviewed and included.

  10. 胃癌干细胞研究概况%Advanced in Gastric Cancer Stem Cells

    Institute of Scientific and Technical Information of China (English)

    武慧军; 欧阳晓晖; 苏秀兰

    2014-01-01

    Gastric cancer stem cells in gastric cancer tissues, the stomach may originate from adult stem cells, bone marrow cells or by other stem cells transformed. At present, gastric cancer stem cell identification, separation methods mainly depend on gastric cancer stem cell markers, side group cells (side population cells, sP cells). Greater omentum milk spot and epithelial interstitial transformation helps to gastric cancer cell identification separation. Gastric cancer stem cells and gastric cancer treatment and prognosis were significantly related. in this paper the origin of gastric cancer stem cells, the identification of separation and the treatment of gastric cancer were summarized in this review.%胃癌干细胞(gastric cancer stem cell)存在于胃癌组织中,可能来源于胃成体干细胞、骨髓细胞或由其他干细胞转化而来。目前胃癌干细胞的鉴定、分离方法主要依靠胃癌干细胞标志物,侧群细胞(side population cells,sP)细胞。大网膜乳斑及上皮间质转化有助于胃癌细胞的鉴定分离。胃癌干细胞与胃癌的治疗和预后明显相关。本文就胃癌干细胞的起源、鉴定分离与胃癌的治疗作一综述。

  11. On the Effect of Triplet or Doublet Chemotherapy in Advanced Gastric Cancer: Results From a National Cancer Registry.

    Science.gov (United States)

    Carmona-Bayonas, Alberto; Jiménez-Fonseca, Paula; Lorenzo, Maria Luisa Sánchez; Ramchandani, Avinash; Martínez, Elena Asensio; Custodio, Ana; Garrido, Marcelo; Echavarría, Isabel; Cano, Juana María; Barreto, Jose Enrique Lorenzo; García, Teresa García; Manceñido, Felipe Álvarez; Lacalle, Alejandra; Cardona, Marta Ferrer; Mangas, Monserrat; Visa, Laura; Buxó, Elvira; Azkarate, Aitor; Díaz-Serrano, Asunción; Montes, Ana Fernández; Rivera, Fernando

    2016-11-01

    There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72-0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60-12.68) versus 9.60 months (95% CI, 8.44-10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65-0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64-0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60-1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63-0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity. Copyright © 2016 by the National Comprehensive Cancer Network.

  12. Adjuvant IMRT/XELOX radiochemotherapy improves long-term overall- and disease-free survival in advanced gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Boda-Heggemann, J.; Schneider, V. [Heidelberg Univ., Universitaetsmedizin Mannheim (Germany). Dept. of Radiation Oncology; Weiss, C. [Heidelberg Univ., Universitaetsmedizin Mannheim (Germany). Dept. of Biomathematics and Medical Statistics] [and others

    2013-05-15

    Purpose: In a retrospective analysis, adjuvant intensity-modulated radiation therapy (IMRT) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination of three-dimensional conformal radiation therapy (3D-CRT) and conventional chemotherapy. We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy, or 3D-CRT and conventional chemotherapy. Patients and methods: Between 2001 and 2008, 65 consecutive gastric cancer patients received either 3D-CRT (n = 27) or IMRT (n = 38) following tumor resection. Chemotherapy comprised predominantly 5-fluorouracil/folinic acid (5-FU/FA) in the earlier cohort and capecitabine plus oxaliplatin (XELOX) in the latter. The primary endpoints were overall survival (OS) and disease-free survival (DFS). Results: Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups, respectively (p = 0.0602). Actuarial 5-year OS rates were 26 and 47 %, respectively. Within the IMRT group, XELOX gave better results than 5-FU/FA in terms of OS, but this difference was not statistically significant. The primary cause of death in both groups was distant metastasis. Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups, respectively (p = 0.0693). Actuarial 5-year DFS rates were 22 and 44 %, respectively. Among patients receiving 5-FU/FA, DFS tended to be better in the IMRT group, but this was not statistically significant. A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients. No late toxicity exceeding grade 3 or secondary tumors were observed. Conclusion: After a median follow-up period of over 5 years, OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group. Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity. (orig.)

  13. Chemotherapy or targeted therapy as second-line treatment of advanced gastric cancer. A systematic review and meta-analysis of published studies.

    Directory of Open Access Journals (Sweden)

    Roberto Iacovelli

    Full Text Available Chemotherapy is a cornerstone in treatments of gastric cancer, but despite its benefit, less than 60% of patients receive salvage therapy in clinical practice. We performed a systematic review and meta-analysis based on trial data on the role of second-line treatment of advanced gastric cancer. MEDLINE/PubMed and Cochrane Library were searched for randomized phase III trials that compared active therapy to best supportive care in advanced gastric cancer. Data extraction was conducted according to the PRISMA statement. Summary HR for OS was calculated using a hierarchical Bayesian model and subgroup analysis was performed based on baseline Eastern Cooperative Oncology Group Performance Status (ECOG performance status (0 vs. 1 or more. A total of 1,407 patients were evaluable for efficacy, 908 were treated in the experimental arms, with chemotherapy (231 pts or with targeted therapies (677 pts. The risk of death was decreased by 18% (HR = 0.82; 95% CI, 0.79-0.85; posterior probability HR≥1: <0.00001 with active therapies. Chemotherapy and ramucirumab were able to decrease this risk by 27% and 22%, respectively. No differences were found between chemotherapy and ramucirumab. In patients with ECOG = 0 a greater benefit was found for chemotherapy with a reduction of the risk of death by 43% and no benefits were found for ramucirumab or everolimus. In patients with ECOG = 1 or more a significant reduction of the risk of death by 32% was reported in patients treated with ramucirumab, even if no significant difference was reported between chemotherapy and ramucirumab. This analysis reports that active and available therapies are able to prolong survival in patients with advanced gastric cancer with a different outcome based on initial patient's performance status. New trials based on a better patient stratification are awaited.

  14. Chemotherapy or targeted therapy as second-line treatment of advanced gastric cancer. A systematic review and meta-analysis of published studies.

    Science.gov (United States)

    Iacovelli, Roberto; Pietrantonio, Filippo; Farcomeni, Alessio; Maggi, Claudia; Palazzo, Antonella; Ricchini, Francesca; de Braud, Filippo; Di Bartolomeo, Maria

    2014-01-01

    Chemotherapy is a cornerstone in treatments of gastric cancer, but despite its benefit, less than 60% of patients receive salvage therapy in clinical practice. We performed a systematic review and meta-analysis based on trial data on the role of second-line treatment of advanced gastric cancer. MEDLINE/PubMed and Cochrane Library were searched for randomized phase III trials that compared active therapy to best supportive care in advanced gastric cancer. Data extraction was conducted according to the PRISMA statement. Summary HR for OS was calculated using a hierarchical Bayesian model and subgroup analysis was performed based on baseline Eastern Cooperative Oncology Group Performance Status (ECOG) performance status (0 vs. 1 or more). A total of 1,407 patients were evaluable for efficacy, 908 were treated in the experimental arms, with chemotherapy (231 pts) or with targeted therapies (677 pts). The risk of death was decreased by 18% (HR = 0.82; 95% CI, 0.79-0.85; posterior probability HR≥1: <0.00001) with active therapies. Chemotherapy and ramucirumab were able to decrease this risk by 27% and 22%, respectively. No differences were found between chemotherapy and ramucirumab. In patients with ECOG = 0 a greater benefit was found for chemotherapy with a reduction of the risk of death by 43% and no benefits were found for ramucirumab or everolimus. In patients with ECOG = 1 or more a significant reduction of the risk of death by 32% was reported in patients treated with ramucirumab, even if no significant difference was reported between chemotherapy and ramucirumab. This analysis reports that active and available therapies are able to prolong survival in patients with advanced gastric cancer with a different outcome based on initial patient's performance status. New trials based on a better patient stratification are awaited.

  15. Gastric Adenocarcinoma Presenting with Gastric Outlet Obstruction in a Child

    Directory of Open Access Journals (Sweden)

    Abdulrahman Al-Hussaini

    2014-01-01

    Full Text Available Gastric carcinoma is extremely rare in children representing only 0.05% of all gastrointestinal malignancies. Here, we report the first pediatric case of gastric cancer presenting with gastric outlet obstruction. Upper endoscopy revealed a markedly thickened antral mucosa occluding the pylorus and a clean base ulcer 1.5 cm × 2 cm at the lesser curvature of the stomach. The narrowed antrum and pylorus underwent balloon dilation, and biopsy from the antrum showed evidence of Helicobacter pylori gastritis. The biopsy taken from the edge of the gastric ulcer demonstrated signet-ring-cell type infiltrate consistent with gastric adenocarcinoma. At laparotomy, there were metastases to the liver, head of pancreas, and mesenteric lymph nodes. Therefore, the gastric carcinoma was deemed unresectable. The patient died few months after initiation of chemotherapy due to advanced malignancy. In conclusion, this case report underscores the possibility of gastric adenocarcinoma occurring in children and presenting with gastric outlet obstruction.

  16. Laparoscopic spleen-preserving splenic hilar lymphadenectomy performed by following the perigastric fascias and the intrafascial space for advanced upper-third gastric cancer.

    Directory of Open Access Journals (Sweden)

    Chang-Ming Huang

    Full Text Available BACKGROUND: Laparoscopic spleen-preserving Splenic hilar lymphadenectomy (LSPL is required in laparoscopy-assisted total gastrectomy for advanced proximal gastric cancer. However, it is considerably difficult and risk in clinical practice. Thus, we explore the application of LSPL performed by following the perigastric fascias and the intrafascial space in D2 radical gastrectomy for advanced upper-third gastric cancer. METHODS: From July 2010 to December 2012, 109 patients with T2-3 upper-third gastric cancer underwent LSPL. Of these patients, 55 underwent classic LSPL (classic group, and the remaining 54 patients underwent LSPL performed by following the fascias and intrafascial space (fascia group. Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups. RESULTS: There were no significant differences in clinicopathological characteristics between the two groups (P>0.05. All of the operations were successful without conversion to laparotomy. The operation time, mean splenic hilar lymph node (LN dissection time, mean total blood loss and mean blood loss from splenic hilar LN dissection were significantly lower in the fascia group than in the classic group (P0.05. At a median follow-up of 12 months(range 5 to 35 months, none of the patients had died or experienced recurrent or metastatic disease. CONCLUSION: LSPL performed by following the fascias and intrafascial space is an optimal and safe technique based on anatomical logic, and it reduces the difficulties associated with LSPL, making it easier to master and allowing its widespread adoption.

  17. Fluoropyrimidine-Based Chemotherapy as First-Line Treatment for Advanced Gastric Cancer: a Bayesian Network Meta-Analysis.

    Science.gov (United States)

    Zhu, Lucheng; Liu, Jihong; Ma, Shenglin

    2016-10-01

    Fluoropyrimidine-based regimens are the most common treatments in advanced gastric cancer. We used a Bayesian network meta-analysis to identify the optimal fluoropyrimidine-based chemotherapy by comparing their relative efficacy and safety. We systematically searched databases and extracted data from randomized controlled trials, which compared fluoropyrimidine-based regimens as first-line treatment in AGC. The main outcomes were overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and grade 3 or 4 adverse events (AEs). A total of 12 RCTs of 4026 patients were included in our network meta-analysis. Pooled analysis showed S-1 and capecitabine had a significant OS benefit over 5-Fu, with hazard ratios of 0.90 (95%CI = 0.81-0.99) and 0.88 (95%CI = 0.80-0.96), respectively. The result also exhibited a trend that S-1 and capecitabine prolonged PFS in contrast to 5-Fu, with hazard ratios of 0.84 (95%CI = 0.66-1.02) and 0.84 (95%CI = 0.65-1.03), respectively. Additionally, all the three fluoropyrimidine-based regimens were similar in terms of ORR and grade 3 or 4 AEs. Compared with regimens based on 5-Fu, regimens based on S-1 or capecitabine demonstrated a significant OS improvement without compromise of AEs as first-line treatment in AGC in Asian population. S-1 and capecitabine can be interchangeable according their different emphasis on AEs.

  18. A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

    Institute of Scientific and Technical Information of China (English)

    Lin Jianxian; Huang Changming; Zheng Chaohui; Li Ping; Xie Jianwei; Wang Jiabin; Lu Jun

    2014-01-01

    Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGC).This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion (pT2 and pT3) were matched by propensity scoring,and 116 patients (58 LATG and 58 OTG) were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8±10.2 vs.29.0±8.3).Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group (P <0.05,respectively).Rates of post-operative complications (12.1% vs.15.5%) and postoperative mortality (0% vs.1.7%),as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population.

  19. [Radiotherapy in cancers of the oesophagus, the gastric cardia and the stomach].

    Science.gov (United States)

    Créhange, G; Huguet, F; Quero, L; N'Guyen, T V; Mirabel, X; Lacornerie, T

    2016-09-01

    Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation. In the preoperative setting, chemoradiotherapy has become the standard in oesophageal cancer, even though there is no evidence that surgery may be beneficial in locally advanced tumours that respond to radiotherapy and chemotherapy. The main cause of failure after exclusive chemoradiotherapy in oesophageal cancer is locoregional relapse suggesting that doses and volumes usually considered may be inadequate. In gastric cancer, radiotherapy may be indicated postoperatively in patients with resected tumours that include less than D2 lymph node dissection or in the absence of perioperative chemotherapy. Preoperative chemoradiotherapy in gastric cancers is still under investigation. The evolving techniques of external radiotherapy, such as image-guided radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) have reduced the volume of lung and heart exposed to radiation, which seems to have diminished radiotherapy-related morbi-mortality rates. Given this, quality assurance for radiotherapy and protocols for radiotherapy delivery must be better standardized. This article on the indications for radiotherapy and the techniques used in oesophageal and gastric cancers is included in a special issue dedicated to national recommendations from the French society of radiation oncology (SFRO) on radiotherapy indications, planning, dose prescription, and techniques of radiotherapy delivery.

  20. A multi-center phase II study of sequential paclitaxel and bryostatin-1 (NSC 339555) in patients with untreated, advanced gastric or gastroesophageal junction adenocarcinoma.

    Science.gov (United States)

    Ajani, Jaffer A; Jiang, Yixing; Faust, Josephine; Chang, Baochong B; Ho, Linus; Yao, James C; Rousey, Steven; Dakhil, Shaker; Cherny, Richard C; Craig, Catherine; Bleyer, Archie

    2006-07-01

    Protein Kinase C (PKC), involved in transmembrane signaling of cell surface receptors, promotes carcinogenesis and tumor progression. Bryostatin-1 competes with PKC for phorbol esters (tumor promoters), thus inhibiting tumor progression. Bryostatin-1 also increases cytotoxicity of paclitaxel in a sequential fashion. We studied sequential paclitaxel and bryostatin-1 in patients with untreated, advanced gastric adenocarcinoma. Patients with histologic proof of gastric or gastroesophageal junction adenocarcinoma with advanced, measurable cancers were eligible. Patients were required to have near normal organ function and ECOG performance status of 0 or 1. All patients gave an informed consent. Patients received paclitaxel 80 mg/m2 in 2 h intravenously on day 1 and bryostatin-1 40 mcg/m2 in 1 h intravenously on day 2 each week for 3 consecutive weeks out of 4. Primary objective was to assess the objective response rate. In a multi-center setting, 37 patients were enrolled and 35 were assessable for response. A confirmed partial response rate was 29%. The median time-to-progression was 4.25 months and the median survival time was 8 months. Grade 3 cumulative myalgias occurred in 55% of patients. Twelve patients discontinued therapy due to myalgias, including 6 patients who had not progressed after achieving a partial response. Other toxic effects were uncommon. Sequential paclitaxel plus bryostatin-1 resulted in a superior response rate than would be expected of paclitaxel alone in patients with untreated, advanced gastric or gastroesophageal junction adenocarcinoma. Further development of this combination is warranted once an effective method to ameliorate or prevent myalgias can be established.

  1. Comparative effectiveness and safety between oxaliplatin-based and cisplatin-based therapy in advanced gastric cancer: A meta-analysis of randomized controlled trials

    Science.gov (United States)

    Zhu, Yanjie; Huang, Jiale; Liu, Yanna; Zhao, Liying; Li, Zhijia; Liu, Hao; Wang, Qi-long; Qi, Xiaolong

    2016-01-01

    Background & Aims Platinum-based drugs are the most significant chemotherapy for advanced gastric cancer. The study aims to compare the efficacy and safety of oxaliplatin-based therapy versus cisplatin-based therapy in patients with advanced gastric cancer. Materials and Methods An adequate literature search in EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) was conducted. Phase II or III randomized controlled trials (RCTs) that compared effectiveness and safety between oxaliplatin-based and cisplatin-based therapy in patients with advanced gastric cancer were eligible. The primary endpoint was overall response rate (ORR), progression free survival (PFS) and overall survival (OS). The second endpoint was the adverse events. Results Five phase II or III RCTs involving a total of 2,046 patients were identified. The results showed that there were no significant difference in ORR (OR = 1.17, 95% CI = 0.98–1.40, p = 0.08, I2 = 0%), PFS (HR = 0.92, 95% CI = 0.84–1.01, p = 0.09, I2 = 0%) and OS (HR = 0.91, 95% CI = 0.82–1.01, p = 0.07, I2 = 0%) between oxaliplatin-based therapy and cisplatin-based therapy. In addition, oxaliplatin-based therapy had lower risk of neutropenia, anemia, nausea, alopecia, thromboembolism, stomatitis and creatinine increased at all grades, and neutropenia, anemia, leukopenia and alopecia at 3–4 grades than cisplatin-based therapy. However, oxaliplatin-based therapy was associated with increased risk of neurosensory toxicity and thrombocytopenia. Conclusions Our meta-analysis showed that there were no significant difference in ORR, PFS and OS between oxaliplatin-based therapy and cisplatin-based therapy. The oxaliplatin-based therapy could generally decrease the risk of adverse effects except neurosensory toxicity and thrombocytopenia. PMID:27166187

  2. Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial

    Directory of Open Access Journals (Sweden)

    Vincenzi B

    2006-05-01

    Full Text Available Abstract Background Elderly patients have been often excluded from or underrepresented in the study populations of combination chemotherapy trials. The primary end point of this study was to determine the response rate and the toxicity of the weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF regimen in elderly patients with advanced gastric cancer. The secondary objective was to measure the time to disease progression and the survival time. Methods Chemotherapy-naive patients with advanced gastric cancer aged 70 or older were considered eligible for study entry. Patients received weekly oxaliplatin 40 mg/m2, fluorouracil 500 mg/m2 and folinic acid 250 mg/m2. All drugs were given intravenously on a day-1 schedule. Results A total of 42 elderly patients were enrolled. Median age was 73 years and all patients had metastatic disease. The response rate according to RECIST criteria was 45.2% (95% CIs: 30%–56% with two complete responses, 17 partial responses, 13 stable diseases and 10 progressions, for an overall tumor rate control of 76.2% (32 patients. Toxicity was generally mild and only three patients discontinued treatment because of treatment related adverse events. The most common treatment-related grade 3/4 adverse events were fatigue (7.1%, diarrhoea (4.8%, mucositis (2.4%, neurotoxicity (2.4% and neutropenia (4.8%. The median response duration was 5.3 months (95% CIs: 2.13 – 7.34, the median time to disease progression was 5.0 months (95% CIs: 3.75 – 6.25 and the median survival time was 9.0 months (95% CIs: 6.18 – 11.82. Conclusion OXALF represents an active and well-tolerated treatment modality for elderly patients with locally advanced and metastatic gastric cancer.

  3. EBV感染与胃癌关系的研究进展%Advances in understanding the relationship between EpsteinBarr virus infection and gastric carcinoma

    Institute of Scientific and Technical Information of China (English)

    陈江; 朱冠保

    2011-01-01

    EB病毒(Epstein-Barr virus,EBV)是引起胃癌的重要生物学因素之一,其感染与胃癌的发生和发展密切相关.随着分子生物学技术的发展和应用,研究者对与EBV感染相关胃癌(EBVaGC)的特征和发生机制进行了深入研究,发现EBV潜伏感染和细胞恶性转化是EBV致EBVaGC的重要基础,为EBVaGC的诊断、治疗和预防提供了理论基础.%Epstein-Barr virus (EBV) plays an important role in gastric carcinogenesis and EBV infection is closely related to the development and progression of gastric cancer. Advances in molecular biology techniques have deepened our understanding of the characteristics of EBV-associated gastric cancer (EBVaGC). It has been found that latent EBV infection and EBV-induced malignant transformation are an important basis for the pathogenesis of EBVaGC. Understanding the pathogenesis of EBVaGC provides a theoretical basis for the diagnosis, treatment and prevention of this disease.

  4. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy

    DEFF Research Database (Denmark)

    Quist, Morten; Rørth, Mikael; Langer, Seppo

    2012-01-01

    To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy.......To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy....

  5. High-mobility group box 1 inhibits gastric ulcer healing through Toll-like receptor 4 and receptor for advanced glycation end products.

    Science.gov (United States)

    Nadatani, Yuji; Watanabe, Toshio; Tanigawa, Tetsuya; Ohkawa, Fumikazu; Takeda, Shogo; Higashimori, Akira; Sogawa, Mitsue; Yamagami, Hirokazu; Shiba, Masatsugu; Watanabe, Kenji; Tominaga, Kazunari; Fujiwara, Yasuhiro; Takeuchi, Koji; Arakawa, Tetsuo

    2013-01-01

    High-mobility group box 1 (HMGB1) was initially discovered as a nuclear protein that interacts with DNA as a chromatin-associated non-histone protein to stabilize nucleosomes and to regulate the transcription of many genes in the nucleus. Once leaked or actively secreted into the extracellular environment, HMGB1 activates inflammatory pathways by stimulating multiple receptors, including Toll-like receptor (TLR) 2, TLR4, and receptor for advanced glycation end products (RAGE), leading to tissue injury. Although HMGB1's ability to induce inflammation has been well documented, no studies have examined the role of HMGB1 in wound healing in the gastrointestinal field. The aim of this study was to evaluate the role of HMGB1 and its receptors in the healing of gastric ulcers. We also investigated which receptor among TLR2, TLR4, or RAGE mediates HMGB1's effects on ulcer healing. Gastric ulcers were induced by serosal application of acetic acid in mice, and gastric tissues were processed for further evaluation. The induction of ulcer increased the immunohistochemical staining of cytoplasmic HMGB1 and elevated serum HMGB1 levels. Ulcer size, myeloperoxidase (MPO) activity, and the expression of tumor necrosis factor α (TNFα) mRNA peaked on day 4. Intraperitoneal administration of HMGB1 delayed ulcer healing and elevated MPO activity and TNFα expression. In contrast, administration of anti-HMGB1 antibody promoted ulcer healing and reduced MPO activity and TNFα expression. TLR4 and RAGE deficiency enhanced ulcer healing and reduced the level of TNFα, whereas ulcer healing in TLR2 knockout (KO) mice was similar to that in wild-type mice. In TLR4 KO and RAGE KO mice, exogenous HMGB1 did not affect ulcer healing and TNFα expression. Thus, we showed that HMGB1 is a complicating factor in the gastric ulcer healing process, which acts through TLR4 and RAGE to induce excessive inflammatory responses.

  6. High-mobility group box 1 inhibits gastric ulcer healing through Toll-like receptor 4 and receptor for advanced glycation end products.

    Directory of Open Access Journals (Sweden)

    Yuji Nadatani

    Full Text Available High-mobility group box 1 (HMGB1 was initially discovered as a nuclear protein that interacts with DNA as a chromatin-associated non-histone protein to stabilize nucleosomes and to regulate the transcription of many genes in the nucleus. Once leaked or actively secreted into the extracellular environment, HMGB1 activates inflammatory pathways by stimulating multiple receptors, including Toll-like receptor (TLR 2, TLR4, and receptor for advanced glycation end products (RAGE, leading to tissue injury. Although HMGB1's ability to induce inflammation has been well documented, no studies have examined the role of HMGB1 in wound healing in the gastrointestinal field. The aim of this study was to evaluate the role of HMGB1 and its receptors in the healing of gastric ulcers. We also investigated which receptor among TLR2, TLR4, or RAGE mediates HMGB1's effects on ulcer healing. Gastric ulcers were induced by serosal application of acetic acid in mice, and gastric tissues were processed for further evaluation. The induction of ulcer increased the immunohistochemical staining of cytoplasmic HMGB1 and elevated serum HMGB1 levels. Ulcer size, myeloperoxidase (MPO activity, and the expression of tumor necrosis factor α (TNFα mRNA peaked on day 4. Intraperitoneal administration of HMGB1 delayed ulcer healing and elevated MPO activity and TNFα expression. In contrast, administration of anti-HMGB1 antibody promoted ulcer healing and reduced MPO activity and TNFα expression. TLR4 and RAGE deficiency enhanced ulcer healing and reduced the level of TNFα, whereas ulcer healing in TLR2 knockout (KO mice was similar to that in wild-type mice. In TLR4 KO and RAGE KO mice, exogenous HMGB1 did not affect ulcer healing and TNFα expression. Thus, we showed that HMGB1 is a complicating factor in the gastric ulcer healing process, which acts through TLR4 and RAGE to induce excessive inflammatory responses.

  7. Inoperable esophageal cancer and outcome of palliative care

    Institute of Scientific and Technical Information of China (English)

    Sima Besharat; Ali Jabbari; Shahryar Semnani; Abbasali Keshtkar; Jeran Marjani

    2008-01-01

    AIM: To determine the outcome of esophageal cancer patients referred for palliative care, in Gorgan and Gonbad gastrointestinal clinics, northeast of Iran.METHODS: This cross-sectional study was done on inoperable esophageal cancer cases referred to gastrointestinal clinics in Gorgan and Gonbad city (2005-2006). Demographic data were collected during the procedure and cases were followed up every one month. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness.RESULTS: We recruited 39 cases into the study. Squamous cell carcinoma was the most prevalent (92.3%). The middle third of the esophagus was involved predominantly (51.3%). Dilation was the most preferred method (89.7%) and stenting was done in 4 cases. Decreasing dysphagia score was not related to palliation method or pathology type of carcinoma. Age of the patients was significantly related to the improvement of dysphagia score. Mean survival time was 137.6d and median was 103d.CONCLUSION: Results of this study showed a low survival rate after palliative care in esophageal cancer cases despite dysphagia scores' improvement after dilating or stenting.

  8. A multicenter phase II study of TAS-102 monotherapy in patients with pre-treated advanced gastric cancer (EPOC1201).

    Science.gov (United States)

    Bando, Hideaki; Doi, Toshihiko; Muro, Kei; Yasui, Hirofumi; Nishina, Tomohiro; Yamaguchi, Kensei; Takahashi, Shunji; Nomura, Shogo; Kuno, Hirofumi; Shitara, Kohei; Sato, Akihiro; Ohtsu, Atsushi

    2016-07-01

    American phase I studies have reported that the recommended dose of TAS-102 (trifluridine/tipiracil) was 25 mg/m(2) twice a day (b.i.d.), although this schedule did not provide clinically relevant improvements in a phase II study of advanced gastric cancer (AGC). However, a pivotal phase III study revealed that TAS-102 at 35 mg/m(2) b.i.d. provided a clinically relevant improvement in overall survival (OS) among patients with metastatic colorectal cancer. Therefore, we re-evaluated the efficacy, safety, and pharmacokinetic parameters of TAS-102 at 35 mg/m(2) b.i.d among Japanese patients with AGC. All patients had undergone one or two previous chemotherapy regimens that contained fluoropyrimidine, platinum agents, and taxanes or irinotecan. The primary end-point target was a disease control rate (DCR) of ≥50% after 8 weeks of the 35 mg/m(2) b.i.d. schedule. Twenty-nine patients were assessable after completing the 35 mg/m(2) b.i.d. schedule. The investigator-determined DCR was 65.5% (95% confidence interval [CI], 45.7-82.1%) and the independent central review's DCR was 51.9% (95% CI, 31.9-71.3%); both results exceeded the primary end-point target. The median progression-free survival and OS were 2.9 months (95% CI, 1.1-5.3 months) and 8.7 months (95% CI, 5.7-14.9 months), respectively. The grade III/IV adverse events included neutropenia (69.0%), leucopaenia (41.4%), anaemia (20.7%), and anorexia (10.3%). No AGC-specific toxicities were detected. The 35 mg/m(2) b.i.d. dose of TAS-102 provided positive efficacy and an acceptable toxicity profile in patients with AGC. A randomised, double-blind, placebo-controlled, phase III study is ongoing to validate these findings. UMIN000007421. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Exposure-Response Analyses of Ramucirumab from Two Randomized, Phase III Trials of Second-line Treatment for Advanced Gastric or Gastroesophageal Junction Cancer.

    Science.gov (United States)

    Tabernero, Josep; Ohtsu, Atsushi; Muro, Kei; Van Cutsem, Eric; Oh, Sang Cheul; Bodoky, György; Shimada, Yasuhiro; Hironaka, Shuichi; Ajani, Jaffer A; Tomasek, Jiri; Safran, Howard; Chandrawansa, Kumari; Hsu, Yanzhi; Heathman, Michael; Khan, Azhar; Ni, Lan; Melemed, Allen S; Gao, Ling; Ferry, David; Fuchs, Charles S

    2017-10-01

    Ramucirumab is an IgG1 monoclonal antibody specific for the vascular endothelial growth factor receptor-2. Ramucirumab, 8 mg/kg every 2 weeks, administered as monotherapy (REGARD) or in combination with paclitaxel (RAINBOW), was safe and effective in patients with previously treated advanced gastric or gastroesophageal junction (GEJ) cancer. We evaluated exposure-efficacy and exposure-safety relationships of ramucirumab from two randomized, placebo-controlled phase III trials. Sparse pharmacokinetic samples were collected, and a population pharmacokinetic analysis was conducted to predict ramucirumab minimum trough concentration at steady state (Cmin,ss). Kaplan-Meier methods and Cox proportional hazards models were used to evaluate the ramucirumab exposure (Cmin,ss)-efficacy relationship to overall survival (OS) and progression-free survival (PFS). Logistic regression analyses were used to evaluate exposure-safety relationships. Analyses included 321 ramucirumab + paclitaxel and 335 placebo + paclitaxel patients from RAINBOW and 72 ramucirumab and 35 placebo patients from REGARD. Exposure-efficacy analysis showed ramucirumab Cmin,ss was a significant predictor of OS and PFS in both trials. Higher ramucirumab exposure was associated with longer OS and PFS. In RAINBOW, grade ≥3 hypertension, leukopenia, and neutropenia, but not febrile neutropenia, significantly correlated with Cmin,ss, with increased exposure leading to increased incidence. Exploratory exposure-response analyses suggest a positive relationship between efficacy and ramucirumab exposure with manageable toxicities at exposures generated from a dose of 8 mg/kg ramucirumab given every 2 weeks for patients with advanced gastric/GEJ cancer. These findings suggest an opportunity to further optimize benefit versus risk profiles of ramucirumab treatment in patients with gastric/GEJ cancer. Mol Cancer Ther; 16(10); 2215-22. ©2017 AACR. ©2017 American Association for Cancer Research.

  10. A phase Ⅱ trial of oxaliplatin plus S-1 as a first-line chemotherapy for patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    YANG Lin; SONG Yan; ZHOU Ai-ping; QIN Qiong; CHI Yihebali; HUANG Jing; WANG Jin-wan

    2013-01-01

    Background Palliative chemotherapy has been shown to have a survival benefit for patients with recurrent or metastatic gastric cancer.We conducted a Phase Ⅱ trial to determine the efficacy and safety of S-1 plus oxaliplatin (SOX regimen) as first-line chemotherapy for patients with unresectable locally advanced or metastatic gastric cancer.Methods Eligible patients had measurable lesions and no previous history of chemotherapy (except adjuvant chemotherapy).Oxaliplatin was administered intravenously at a dose of 130 mg/m2 on day 1.S-1 was administered orally in doses of 80,100,or 120 mg/d according to body surface areas of <1.25 m2,1.25-1.5 m2,or >1.5 m2 respectively;the total dose was divided into two daily doses on days 1-14.Treatments were repeated every 3 weeks until disease progression or intolerable toxicity occurred.Results Forty-three patients were enrolled in the study.All were assessable for efficacy and adverse events.The objective response and disease control rates were 55.8% and 76.7% respectively.The median follow-up time was 16.5 months.The median progression-free survival time was 7 months (95% Cl,5.8-8.2 months) and the median overall survival time was 16.5 months (95% Cl,9.7-23.3 months).The one-year survival rate was 54.2%.Major adverse reactions were grade 3/4 neutropenia (9.3%) and thrombocytopenia (20.9%).Conclusion The SOX regimen with oxaliplatin at a dose of 130 mg/m2 was found to be effective and safe as a first-line chemotherapy in Chinese patients with advanced gastric cancer.

  11. Clinical Research on Use of Oxaliplcrtin in Combination with HCPT, LV and 5FU in a Regimen for Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    GuoqingHu; QiangFu; MaolinJin; JieLi; LiangxiPan; YuxianBai; HuaijinWang; JianweiZhang; DingYu

    2004-01-01

    OBJECTIVE To observe the effects and adverse reactions of a OXA-HCPT LV/5FU 3 regimen for patients with advanced gastric cancer.METHODS OHLF3 regimen: OXA 130 mg/m2iv d 1, HCPT6 mg/m2, iv d 1-5, LV 200 mg/m2iv 2 h followed by a 5FU 400 mg/m2 iv bolus and 5FU 600mg/m2 iv d 1-3, were given, every 21 days as 1 cycle. Assessment of the tumor was conducted after 3 cycles and the effective cases were confirmed after 4 weeks.RESULTS Among 39 patients, 36 were actually evaluable. Overall response rates (CR + PR} were 50%' the major adverse reactions were mild hematological toxicity, nausea and vomiting and peripheral nerve abnormalities.CONCLUSION The OHLF 3 regimen using OXA and HCPT is effective and results in mild toxicity when used in combined chemotherapy for advanced gastric cancer.

  12. A systematic review and meta-analysis of randomized trials on the role of targeted therapy in the management of advanced gastric cancer: Evidence does not translate?

    Science.gov (United States)

    Ciliberto, Domenico; Staropoli, Nicoletta; Caglioti, Francesca; Gualtieri, Simona; Fiorillo, Lucia; Chiellino, Silvia; De Angelis, Antonina Maria; Mendicino, Francesco; Botta, Cirino; Caraglia, Michele; Tassone, Pierfrancesco; Tagliaferri, Pierosandro

    2015-01-01

    Summary It is still uncertain if targeted therapy-based regimens in advanced gastric cancer actually produce survival benefit. To shed light on this important question, we performed a systematic review and meta-analyses on each relevant targeted-pathway. By searching literature databases and proceedings of major cancer meetings in the time-frame 2005–2014, 22 randomized clinical trials exploring targeted therapy for a total of 7022 advanced gastric cancer patients were selected and included in the final analysis. Benefit was demonstrated for antiangiogenic agents in terms of overall survival (HR 0.759; 95%CI 0.655–0.880; p < 0.001). Conversely no benefit was found for EGFR pathway (HR 1.077; 95%CI 0.847–1.370; p = 0.543). Meta-analysis of HER-2 pathway confirmed improvement in terms of survival outcome, already known for this class of drugs (HR 0.823; 95%CI 0.722–0.939; p = 0.004). Pooled analysis demonstrated a significant survival benefit (OS: HR 0.823; PFS: HR 0.762) with acceptable tolerability profile for targeted-based therapies as compared to conventional treatments. This finding conflicts with the outcome of most individual studies, probably due to poor trial design or patients selection. In conclusion, our findings demonstrate a significant survival benefit for targeted therapy in its whole, which can be ascribed to anti-angiogenic and anti-HER2 agents. PMID:26061272

  13. International trade inoperability input-output model (IT-IIM): theory and application.

    Science.gov (United States)

    Jung, Jeesang; Santos, Joost R; Haimes, Yacov Y

    2009-01-01

    The inoperability input-output model (IIM) has been used for analyzing disruptions due to man-made or natural disasters that can adversely affect the operation of economic systems or critical infrastructures. Taking economic perturbation for each sector as inputs, the IIM provides the degree of economic production impacts on all industry sectors as the outputs for the model. The current version of the IIM does not provide a separate analysis for the international trade component of the inoperability. If an important port of entry (e.g., Port of Los Angeles) is disrupted, then international trade inoperability becomes a highly relevant subject for analysis. To complement the current IIM, this article develops the International Trade-IIM (IT-IIM). The IT-IIM investigates the resulting international trade inoperability for all industry sectors resulting from disruptions to a major port of entry. Similar to traditional IIM analysis, the inoperability metrics that the IT-IIM provides can be used to prioritize economic sectors based on the losses they could potentially incur. The IT-IIM is used to analyze two types of direct perturbations: (1) the reduced capacity of ports of entry, including harbors and airports (e.g., a shutdown of any port of entry); and (2) restrictions on commercial goods that foreign countries trade with the base nation (e.g., embargo).

  14. 胃癌基因治疗研究进展%Advancement on gene therapy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    孙栋; 王西涛; 王新涛; 刘凤军

    2009-01-01

    胃癌的传统治疗措施效果不理想,近来随着分子生物学及基因工程技术的发展,基因治疗作为肿瘤治疗的新方法逐渐受到人们的重视,胃癌基因治疗研究主要包括以下几个方面:抑癌基因的替代治疗、反义基因治疗、"自杀"基因治疗、免疫基因治疗等.%Gastric cancer is one of the most common tumors. The outcome of conventional therapies is inefficient. In recent years,with development of molecular biology and genetic engineering technology,people pay more attention to gene therapy. The gene therapy for gastric cancer approaches include the following aspects: tumor suppressor gene replacement therapy, antisense gene therapy," suicide" gene therapy,immune gene thera-py,and so on. This review provides an update of the new developments in cancer gene therapy,new principles, techniques, strategies and vector systems, and shows how they may be applied in the treatment of gastric cancer.

  15. Clinical Study of S-1 Plus Oxaliplatin Versus S-1 Plus Cisplatin as First-Line Treatment for Elderly Patients with Advanced Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Deng-feng BO

    2015-12-01

    Full Text Available Abstract Objective: To explore the efficacy and safety of S-1 plus oxaliplatin versus S-1 plus cisplatin as the first-line treatment for elderly patients with advanced gastric cancer. Methods: A total of 60 patients with advanced gastric cancer admitted in Xi’an Yanliang Railway Hospital from Jan., 2011 to Oct., 2013 were selected as study objects and randomly divided into 2 groups: S1 plus oxaliplatin group (SOX group, 30 cases and S1 plus cisplatin group (SP group, 30 cases. SOX group were given intravenous drip of 130 mg/m2 oxaliplatin for 2 h on d1. And S-1 was also given according to body surface area: body surface area <1.25 m2, 40 mg once; 1.25-1.5 m2, 60 mg once; >1.5, 28 d as 1 cycle. SP group was administered with intravenous drip of 25 mg/m2 cisplatin during d1-d3. Treatment was discontinued until the occurrence of disease progression or patients’ intolerance to chemotherapy. Results: SOX group was non-inferior to SP group in overall response rate (ORR (53.3% vs. 43.3%, disease control rate (DCR (83.3% vs. 80.0%, median progression-free survival (PFS (7.0 vs. 6.0 months and median overall survival (OS (11.0 vs. 10.5 months. However, the difference was statistical significant in the rate of increased KPS score (86.7% vs. 46.7%, χ2=10.800, P=0.001 and the rate of increased FACT-G score (73.3% vs. 36.7%, χ2=8.148, P=0.004. The main toxic and side effects of two groups was hematological toxicity. There was no degree III-IV toxic and side effects occurring in non hematological toxicity in two groups. The main toxic effect was peripheral neuritis in SOX group, and nausea and vomiting and renal dysfunction in SP group, and there were statistical differences in the above toxic and side effects between two groups (P<0.05. Conclusion: SOX regimen is as safe and effective as SP regimen for elderly patients with advanced gastric cancer, with better quality of life and less toxic and side effects.

  16. FEP regimen (epidoxorubicin, etoposide and cisplatin) in advanced gastric cancer, with or without low-dose GM-CSF: an Italian Trial in Medical Oncology (ITMO) study.

    Science.gov (United States)

    Bajetta, E.; Di Bartolomeo, M.; Carnaghi, C.; Buzzoni, R.; Mariani, L.; Gebbia, V.; Comella, G.; Pinotti, G.; Ianniello, G.; Schieppati, G.; Bochicchio, A. M.; Maiorino, L.

    1998-01-01

    The new regimens developed over the last few years have led to an improvement in the treatment of advanced gastric cancer, and our previous experience confirmed the fact that the combination of etoposide, doxorubicin and cisplatin (EAP regimen) is an active treatment that leads to interesting complete remission rates. The primary end point of the present multicentre, randomized, parallel-group phase II study was to determine the activity of the simplified 2-day EAP schedule in patients with locally advanced or metastatic gastric cancer, and to verify whether the addition of low doses of granulocyte-macrophage colony-stimulating factor (GM-CSF) made it possible to increase dose intensity. Of the 62 enrolled patients, 30 were randomized to receive epirubicin 35 mg m(-2), etoposide 120 mg m(-2) and cisplatin 45 mg m(-2) (FEP) on days 1 and 2 every 28 days and 32 to receive the same schedule plus subcutaneous GM-CSF (molgramostin) 150 microg day(-1) on days 5-14 every 21 days. The patients were stratified by age and the number of disease sites. The characteristics of the patients were well balanced between the two groups. The objective response rate of the patients as a whole was 34% (21 out of 62; 95% confidence interval 22-46), with only one complete remission. The median response duration was 4.5 months (range 1-24 months). The median time to treatment failure was 5 months (range 1-14 months), without any difference between the two groups. The median survival of the patients as a whole was 9 months. Full doses were administered in 92% and 94% of the cycles in the control and GM-CSF arms respectively. The average dose intensity calculated for all drugs was 0.96% in the control and 1.27% in the GM-CSF group. CTC-NCI grade 3-4 neutropenia was reported in 39% vs 45% of patients, thrombocytopenia in 11% vs 35% (P = 0.020) and anaemia in 7% vs 35% (P = 0.014). The FEP combination is as active (OR: 34%) in the treatment of patients with advanced gastric cancer as the EAP

  17. Trial of the correlation between cytochrome oxidase CYP3A4 with the susceptibility of paclitaxel-based regimen for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jianwei Yang; Yan Meng; Ying Su; Zeng Chen; Wei Gao; Jinyuan Lin; Jing Jia; Huamei Lin

    2014-01-01

    Objective: The aim of the study was to investigate the relationship between susceptibility of paclitaxel-based regimen and gene polymorphisms of cytochrome oxidase CYP3A4 for advanced gastric cancer.Methods: Peripheral venous blood sample of 53 advanced gastric cancer patients were enroled to test the mutation of CYP3A4 gene by denaturing high performance liquid chromatography (DHPLC) and DNA sequencing. The relation between the eficacy of paclitaxel-based regimen and CYP3A4 gene polymorphisms was further analyzed.Results: DHPLC indicated that among the 53 patients, 21 cases showed biomodal type (mutation) and 32 cases were of unimodal type (wild-type). Sequencing results showed that the deletion mutation was found at the 27th basic group of C in exon 10 of CYP3A4 gene. The response rate (RR) and disease control rate (DCR) of wild-type group were 40.6% and 84.4%, while in mutation group they were 33.3% and 85.7%, respective-ly, with no significances between the two groups (P > 0.05). Of al 53 cases, the median progression-free survival (PFS) was 6.5 months (95% CI: 3.576-9.424 months), and the median overal survival (OS) was 11.0 months (95% CI: 6.955-15.045 months). The median PFS and OS in wild-type group had no diferences compared with those in mutation group (7.0 months vs. 7.0 months,P > 0.05; 10.0 months vs. 14.0 months,P > 0.05). Between wild-type and mutation groups, the median PFS of patients applied with oxaliplatin containing regimen and the median OS in patients applied with/without oxaliplatin had no significant diferences (P > 0.05), while the median PFS in patients received non-oxaliplatin regime had statistical diferences (P = 0.024). The median PFS and OS in patients receiving 3-drug or 2-drug regimes had no correlation with CYP3A4 gene polymorphisms. The adverse efects in the two groups were mild, mainly in grades 1-2. The common adverse efects were anorexia, nausea/vomiting and leucopenia.Conclusion: Deletion mutation was located in the 27th

  18. Advances of Epstein-Barr virus-associated gastric carcinoma%EB病毒相关胃癌研究进展

    Institute of Scientific and Technical Information of China (English)

    王长亮; 崔凯; 李胜

    2009-01-01

    Epstien-Barr病毒(EBV)在EBV阳性胃癌的演进中有重要作用.最近的研究集中在本病的流行病学和生物学发病机制.复习近年来针对EBV相关胃癌有关的基础、临床和流行病学研究,讨论EBV在胃癌发生发展中的作用,介绍此领域最新的研究成果.%Epstein-Barr virus(EBV) plays an important role in the development of EBV positive gas- tric carcinomas. Recent studies focus on epidemiological evidence and biological role of EBV infection in patho-genesis of gastric cancer. This article reviews mainly biological, epidemiological and clinicopathological stud-ies , discusses the roles of EBV in carcinogenesis and development of gastric cancer and introduce the latest ad-vancement in this area.

  19. Helicobacter pylori in gastric carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    Hyo; Jun; Ahn; Dong; Soo; Lee

    2015-01-01

    Gastric cancer still is a major concern as the third most common cancer worldwide, despite declining rates of incidence in many Western countries. Helicobacter pylori(H. pylori) is the major cause of gastric carcinogenesis, and its infection insults gastric mucosa leading to theoccurrence of atrophic gastritis which progress to intestinal metaplasia, dysplasia, early gastric cancer, and advanced gastric cancer consequently. This review focuses on multiple factors including microbial virulence factors, host genetic factors, and environmental factors, which can heighten the chance of occurrence of gastric adenocarcinoma due to H. pylori infection. Bacterial virulence factors are key components in controlling the immune response associated with the induction of carcinogenesis, and cag A and vac A are the most well-known pathogenic factors. Host genetic polymorphisms contribute to regulating the inflammatory response to H. pylori and will become increasingly important with advancing techniques. Environmental factors such as high salt and smoking may also play a role in gastric carcinogenesis. It is important to understand the virulence factors, host genetic factors, and environmental factors interacting in the multistep process of gastric carcinogenesis. To conclude, prevention via H. pylori eradication and controlling environmental factors such as diet, smoking, and alcohol is an important strategy to avoid H. pylori-associated gastric carcinogenesis.

  20. S-1 Joint Cisplatin Cannot Improve Survival Advanced Gastric Carcinoma%S-1联合顺铂不能提高晚期胃癌的生存率

    Institute of Scientific and Technical Information of China (English)

    巴一; 马冬

    2011-01-01

    @@ 1 文献来源 Ajani JA,Rodriguez W,Bodoky G ,et al.Multicenter phase Ⅲ comparison of Cisplatin/S-1with Cisplatin/Infusional Fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study:The FLAGS trial [J].J Clin Oncol,2010,28(9):1547-1553.

  1. A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis Treated with Preoperative FOLFOX Chemotherapy Followed by Radical Subtotal Gastrectomy and D2 Lymph Node Dissection

    Directory of Open Access Journals (Sweden)

    Byoung Jo Suh

    2017-02-01

    Full Text Available We report the case of a 73-year-old female who was diagnosed with advanced gastric cancer. Esophagogastroduodenoscopy was used to diagnose Borrmann type 3 advanced gastric cancer located at the gastric antrum. A biopsy revealed poorly differentiated adenocarcinoma. Abdominopelvic computed tomography (CT and 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET-CT scans demonstrated multiple lymph node metastases, including the para-aortic lymph nodes. Systemic chemotherapy with 5-fluoruracil (5-FU, oxaliplatin, and leucovorin (FOLFOX was initiated. An abdominopelvic CT scan taken after 4 cycles of chemotherapy showed improvement in the ulceroinfiltrative gastric lesion and marked regression of several enlarged lymph nodes. Consequently, we performed a subtotal gastrectomy with D2 lymphadenectomy. The postoperative histopathological report was early gastric carcinoma with no lymph node metastasis in the 48 resected lymph nodes. Another 4 cycles of FOLFOX chemotherapy were performed after surgery. A FDG-PET-CT scan taken 12 months postoperatively showed no definite evidence of local recurrence or distant metastasis, and the previously noted retroperitoneal lymph nodes had disappeared. A FDG-PET-CT taken 16 months postoperatively showed multiple lymph node metastases, including the left supraclavicular lymph node. Despite 8 cycles of secondary chemotherapy with 5-FU, irinotecan, and leucovorin (FOLFIRI and radiotherapy, the patient died 38 months after the operation.

  2. Palliative Radiation Therapy for Symptomatic Control of Inoperable Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Anatoly Nikolaev

    2016-01-01

    Full Text Available Renal cell carcinoma (RCC is traditionally considered to be resistant to conventional low dose radiation therapy (RT. The emergence of image-guided stereotactic body radiation therapy (SBRT made it possible to deliver much higher doses of radiation. Recent clinical trials of SBRT for RCC showed improvement in local control rates and acceptable toxicity. Here we report a case of inoperable symptomatic RCC that was managed with SBRT. Strikingly, the presenting symptoms of gross hematuria and severe anemia were completely resolved following a course of SBRT. Thus, our case report highlights the potential benefit of this technique for patients with inoperable RCC.

  3. Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer

    Directory of Open Access Journals (Sweden)

    Mylvaganam S

    2006-07-01

    Full Text Available Abstract Background The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery. Patients and methods All the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation. Results Overall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93. The median number of sessions per patient was 2 (range 1 – 13 sessions. Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months and the median survival from 1st palliation was 5 months (range 0.5–68.5 months. Conclusion Endoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

  4. Prognostic factors in the treatment of inoperable orofacial tumours with simultaneous radio- and intraarterial chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Szepesi, T.; Stadler, B.; Hohenberg, G.; Hollmann, K.; Mailath, G.; Kuehboeck, J.

    1985-05-01

    Between January 1973 and April 1982 66 evaluable patients with advanced inoperable orofacial tumours underwent intraarterial Bleomycin and Methotrexate with simultaneous radiotherapy in a prospective study. 32 patients had no previous treatment, 34 patients had initial surgery, radiotherapy and/or chemotherapy. 15 mg Bleomycin were administered through a catheter into the arteria externa carotis daily in the morning. 25 mg Methotrexate were given in the same way at night followed by 3 mg Calcium-Leucovorin i.m. every 8 hours. The cumulative dose was 300 mg Bleomycin and 500 mg Methotrexate. Four hours after the administration of Bleomycin the target volume was irradiated (single fraction 2 Gy, total dose 60 to 65 Gy). The overall response rate was 65% containing 17% complete and 48% partial remission. Destruction of the bone appeared to be the most important index at the start of the therapy. Further prognostic determinants as previous treatment, localisation of the primary tumours (maxilla and start of the therapy. Further prognostic determinants as previous treatment, localisation of the primary tumours (maxilla and mandibula respectively oral cavity and oropharynx) and local regional lymphonode stage missed statistically significance in the survival time, may be due to a possible radiosensitizing effect of the simultaneous chemotherapy. Complete remission turned out to be the most important prognostic factor after the end of treatment. Patients responding with complete remission show a mediam disease free survival of 56+months and a median survival time of 82 months. Acute reactions were reversibel. Only in 14% of the patients the treatment could not be finished. Better results could be obtained by electron-affinic radiosensitizers and high LET radiation.

  5. Towards Fluorescence In Vivo Hybridization (FIVH) Detection of H. pylori in Gastric Mucosa Using Advanced LNA Probes

    DEFF Research Database (Denmark)

    Fontenete, Sílvia; Leite, Marina; Guimarães, Nuno

    2015-01-01

    acid (LNA)/ 2' O-methyl RNA (2'OMe) probe using standard phosphoramidite chemistry and FISH hybridization was then successfully performed both on adhered and suspended bacteria at 37°C. In this work we simplified, shortened and adapted FISH to work at gastric pH values, meaning that the hybridization......In recent years, there have been several attempts to improve the diagnosis of infection caused by Helicobacter pylori. Fluorescence in situ hybridization (FISH) is a commonly used technique to detect H. pylori infection but it requires biopsies from the stomach. Thus, the development of an in vivo...

  6. Analysis of Traditional Chinese Medicine in the Treatment of Advanced Gastric Cancer%中医药治疗晚期胃癌的思路与方法

    Institute of Scientific and Technical Information of China (English)

    王长志; 孙绪勇

    2013-01-01

    目的:探析中医药治疗晚期胃癌的理论依据.方法:根据中医“有胃气则生,无胃气则死”和“脾胃为后天之本,气血生化之源”的理论,一方面急则对症治标,另一方面缓则饮食调配,中医药健脾和胃,益气止血,消癥散结,兼以抗癌治本.结果:中医药治疗患者的生存时间均超过手术治疗和化疗患者的生存时间,患者的生活质量也明显改善.结论:中医药治疗晚期胃癌有较好疗效.%Objective:To improve the life quality and survival time of patients with advanced gastric cancer.Methods:On the one hand,alleviate the symptoms of a problem.On the other hand keep diet order combined with traditional Chinese medicine strengthening the spleen and stomach,benefiting vital energy so as to radical therapy.Results:The survival time of patients treated by traditional Chinese medicine was longer than patients treated by palliative surgery and chemotherapy.The life quality is much better than patients treated by western medicine.Conclusion:Chinese medicine has good curative effect in treating advanced gastric cancer.

  7. Arteriovenous neoadjuvant FLEOX chemotherapy with nutritional support improves the resectable rate for advanced gastric cancer%动静脉联合给药的FLEOX新辅助化疗加营养支持提高晚期胃癌可切除率

    Institute of Scientific and Technical Information of China (English)

    李国立; 鲍阳; 姜军; 范朝刚; 汪志明; 李宁; 黎介寿

    2008-01-01

    with advanced abdominal lymph node metastases, and downstages inoperable metastatic lymph nodes for radical operation. This combined modality regimen and nutritional support may play an important role in the treatment of advanced gastric cancer.%目的 总结动静脉联合给药的FLEOX新辅助化疗加营养支持对以淋巴结转移为主的晚期胃癌的手术可切除率.方法 对术前CT检查发现伴有严重的第3、7、9、12组淋巴结转移、或第14、16组淋巴结转移而难以切除的50例晚期胃癌患者进行新辅助化疗:氟尿嘧啶(5-FU)370 mg/m2,静滴,第1-5天;亚叶酸钙200 mg静滴,第1-5天;足叶乙苷80 mg/m2与奥沙利铂120 mg/m2经动脉注射.第6、20天:每5周重复1次.其中12例伴有中、重度营养不良者酌情进行肠外、肠内营养支持.状况好转后进行化疗,以使患者获得手术切除的机会.结果 50例晚期胃癌患者的影像学及组织学评价有效率(CR加PR)为84.0%;12例伴营养不良的病例在化疗结束、拟行手术前体重均较入院时明显增加,血清白蛋白等营养指标恢复正常.手术切除率为78.0%,全组均成功进行了胃次全切除、全胃或联合脏器切除和D2+α、D3淋巴结清扫术.结论 动静脉联合给药的FLEOX新辅助化疗加合理的营养支持对以淋巴结转移为主的晚期胃癌具有满意的治疗效果.

  8. Advanced gastric adenocarcinoma. Influence of preoperative radiation therapy on toxicity and long-term survival rates; Adenocarcinoma gastrico avancado. Analise da toxicidade e da influencia da radioterapia pre-operatoria nos indices de sobrevivencia a longo prazo

    Energy Technology Data Exchange (ETDEWEB)

    Malzoni, Carlos Eduardo

    1996-12-31

    The surgical treatment of gastric cancer has better long-term survival rates when performed in patients with early gastric cancer. Worse results are obtained in treatment of advanced gastric cancer. Most patients in west centers are treated in advanced stages. A great number of them go through a surgical treatment unable by itself to cure them. the frequent local recurrence caused by failure of the surgical treatment has been keeping poor survival rates in patients with advanced gastric cancer for decades. The desire of improving survival is the reason of the use of adjuvant therapies. This paper achieved the retrospective study of the influence of preoperative radiation therapy (2000 cGy) in long-term survival rates (120 months) of patients with advanced gastric cancer on stages IIIa, IIIb and IV. The possible injuries caused in the liver and kidney were observed also as well as first group was treated by surgical and radiation therapies and the second received surgical treatment only. There was no statistical difference between the two groups when sex, age, race, occurrence of other diseases, nutritional assessment, TNM stage, occurrence of obstruction or bleeding caused by tumor, surgical procedure and hepatic and renal function were considered. Survival rates and changes on hepatic and renal function were statistically compared. The results showed a statistic improvement on the long-term survival rates of stage IIIa patients treated by preoperative radiation therapy. No statistic difference was observed on hepatic or renal function between the groups. No adverse influence of radiation therapy method was detected by the used parameters. There was no statistical difference between the two groups when immediate surgical complications were considered. (author) 112 refs., 34 tabs.

  9. [F-18] FDG-PET/CT parameters as predictors of outcome in inoperable NSCLC patients

    Directory of Open Access Journals (Sweden)

    Nappi Antonio

    2015-12-01

    Full Text Available Background. We evaluated the prognostic significance of standardized uptake value (SUVmax, metabolic tumour volume (MTV, and total lesion glycolysis (TLG in [F-18] FDG PET/CT findings in patients with inoperable non-small-cell lung cancer (NSCLC.

  10. Ovarian irradiation in recurrent endometriosis; Irradiation ovarienne pour endometriose refractaire inoperable

    Energy Technology Data Exchange (ETDEWEB)

    Kochbati, L.; Chaari, N.; Besbes, M.; Maalej, M. [Institut Salah-Azaiz, Service de Radiotherapie Carcinologique Tunis (Tunisia); Neji, K.; Ben Amara, F. [Centre de Maternite et de Neonatologie de Tunis, Service B (Tunisia); Ben Romdhane, N.K. [Hopital La-Rabta, Service d' Hematologie, Tunis (Tunisia)

    2005-09-15

    We describe a case of a young woman with a history of an aplastic anaemia in which pelvic radiotherapy was used successfully in the management of a recurrent and inoperable endometriosis. The use of therapeutic pelvic or ovarian irradiation in endometriosis may be considered, when surgical and medical treatments have been exhausted and have failed. (authors)

  11. Reversal of Jaundice in Two Patients with Inoperable Cholangiocarcinoma Treated with Cisplatin and Gemcitabine Combination

    Directory of Open Access Journals (Sweden)

    Maarten Criel

    2012-01-01

    Full Text Available Two patients are presented with severe jaundice, due to inoperable cholangiocarcinoma. The chemotherapeutic approach in patients with severe jaundice is discussed. Many schedules of chemotherapy were developed in this tumor type with normal serum bilirubin. We report here the first successful use of cisplatin and gemcitabine combination chemotherapy in these patients. Tolerability was good and liver function tests gradually improved.

  12. Paclitaxel plus valproic acid versus paclitaxel alone as second- or third-line therapy for advanced gastric cancer: a randomized Phase II trial

    Directory of Open Access Journals (Sweden)

    Fushida S

    2016-07-01

    -free survival was 4.5 months in the wPTX group and 3.0 months in the wPTX plus VPA group (hazard ratio 1.29; 95% CI 0.753–2.211; P=0.35. Grade 3–4 adverse events were neutropenia (3.1%, pneumonia (1.6%, liver injury (1.6%, brain infarction (1.6%, and rupture of aorta (1.6%.Conclusion: No statistically significant difference was observed between wPTX and wPTX plus VPA for OS. Keywords: valproic acid, paclitaxel, second- or third-line therapy, advanced gastric cancer

  13. Learning Curve of the Application of Huang Three-Step Maneuver in a Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy for Advanced Gastric Cancer.

    Science.gov (United States)

    Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong

    2016-03-01

    To investigate the learning curve of the application of Huang 3-step maneuver, which was summarized and proposed by our center for the treatment of advanced upper gastric cancer. From April 2012 to March 2013, 130 consecutive patients who underwent a laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) by a single surgeon who performed Huang 3-step maneuver were retrospectively analyzed. The learning curve was analyzed based on the moving average (MA) method and the cumulative sum method (CUSUM). Surgical outcomes, short-term outcomes, and follow-up results before and after learning curve were contrastively analyzed. A stepwise multivariate logistic regression was used for a multivariable analysis to determine the factors that affect the operative time using Huang 3-step maneuver. Based on the CUSUM, the learning curve for Huang 3-step maneuver was divided into phase 1 (cases 1-40) and phase 2 (cases 41-130). The dissection time (DT) (P < 0.001), blood loss (BL) (P < 0.001), and number of vessels injured in phase 2 were significantly less than those in phase 1. There were no significant differences in the clinicopathological characteristics, short-term outcomes, or major postoperative complications between the learning curve phases. Univariate and multivariate analyses revealed that body mass index (BMI), short gastric vessels (SGVs), splenic hilar artery (SpA) type, and learning curve phase were significantly associated with DT. In the entire group, 124 patients were followed for a median time of 23.0 months (range, 3-30 months). There was no significant difference in the survival curve between phases. AUGC patients with a BMI less than 25 kg/m², a small number of SGVs, and a concentrated type of SpA are ideal candidates for surgeons who are in phase 1 of the learning curve.

  14. Relationship Between the DPD and TS mRNA Expression and the Response to S-1-Based Chemotherapy and Prognosis in Patients with Advanced Gastric Cancer.

    Science.gov (United States)

    Shen, Xiao-Ming; Zhou, Chong; Lian, Lian; Li, Li-Qun; Li, Wei; Tao, Min

    2015-04-01

    The aim was to determine changes in dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) mRNAs in the blood of advanced gastric cancer (AGC) patients to see whether these enzymes affected the patients' response to S-1-based chemotherapy and prognosis. For this purpose, pretreatment DPD/TS mRNA expressions were determined in 40 AGC patients using RT-PCR. The patients were then administered with S-1-based regimen (S-1 + cisplatin) and toxicities were recorded. The relationship between the DPD/TS mRNA expressions and the chemotherapy response, drug resistance, and prognosis was analyzed. The data show that DPD mRNA expression correlated significantly with Lauren type while TS mRNA expression correlated with distant metastasis. Patients with higher DPD and/or TS mRNA expression(s) showed poor response, while those with low DPD mRNA expression showed better response to the chemotherapy. Pooled analysis showed that the patients with low DPD/TS mRNA expressions had better therapeutic response. The incidence of bone marrow suppression, diarrhea, and oral mucositis was high in patients with low DPD mRNA expression. Median overall survival (OS) in 40 patients was 13.5 months. It was 17 months for low and 10 months for high DPD (P = 0.044) and TS mRNA expression (P = 0.047). Pooled analysis showed that the patients with both low DPD/TS mRNA expressions had longer OS (P = 0.001). In conclusion, the detection of DPD and/or TS mRNA expression can be used to predict the response to S-1-based chemotherapy, drug resistance, and prognosis in AGC patients as well as to help guide the individualized treatment of gastric cancer.

  15. Association between polymorphisms in XRCC1 gene and treatment outcomes of patients with advanced gastric cancer: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zhuo Cao

    Full Text Available BACKGROUND: Many reports have shown inconsistent results on the relationship between single nucleotide polymorphisms (SNPs of X-ray repair cross complementing protein (XRCC1 gene and platinum-based chemotherapeutic efficacy. This meta-analysis aimed to summarize published data about the association between two SNPs of XRCC1 (Arg194Trp and Arg399Gln and treatment outcomes of patients with advanced gastric cancer. METHODOLOGY/PRINCIPAL FINDINGS: We retrieved the relevant articles from MEDLINE, Web of Knowledge, and the China National Knowledge Infrastructure (CNKI databases. Studies were selected according to specific inclusion and exclusion criteria. Study quality was assessed according to the guidelines outlined by Hayden, et al. and PRISMA guidelines. We estimated the odds ratio (OR for response rate versus no response after platinum-based chemotherapy. Progression-free survival (PFS and overall survival (OS were evaluated by pooled Cox proportional hazard ratios (HRs and 95% confidence intervals (CIs. We found that none of the XRCC1 Arg194Trp and Arg399Gln polymorphisms was significantly associated with tumor response. Stratified analysis by ethnicity or sensitivity analysis also showed that XRCC1 SNPs were not related with chemotherapy response. Patients with minor variant A allele were likely to have poorer 2-year survival rate than those with G/G genotype. However, in the group of 5-year follow up, there was no significant association between the A allele and OS yet. CONCLUSIONS/SIGNIFICANCE: There is no evidence to support the use of XRCC1 Arg194Trp and Arg399Gln polymorphisms as prognostic predictors of TR and PFS in gastric patients treated with platinum-based chemotherapy. The relationship between minor variant A allele and OS requires further verification.

  16. A Case Report of One-Point Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Guoqing Song; Qiang Wang

    2008-01-01

    @@ Introduction Carcinoma of the stomach is the most common malignant tumor in China. Due to advanced endoscopic techniques and equipment, the detection of early gastric carcinoma (EGC) has increased worldwide.Yet gastric one-point cancer is rarely detected.

  17. Fluoroscopic-guided covered metallic stent placement for gastric outlet obstruction and post-operative gastroenterostomy anastomotic stricture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Lee, Sang Young; Lee, Soo Teik; Yang, Doo Hyun

    2001-07-01

    AIM: To evaluate the feasibility and safety of fluoroscopic-guided covered metallic stent placements in providing palliative care for patients with inoperable malignant gastric outlet obstruction. MATERIALS AND METHODS: Under fluoroscopic guidance, placement of self-expandable, covered stents was attempted in 20 patients with inoperable or recurrent gastric cancer (age range 36-79 years). All patients had inoperable gastric outlet obstruction, 13 with native anatomy and seven with post-operative anatomy (gastrointestinal anastomotic sites). All patients had intolerance to oral alimentation and/or vomiting after ingestion. Success was defined both technically and clinically. RESULTS: The placement of the stent was technically successful in 18 patients and failed in two patients (technical success: 90%). The cause of the technical failures was an inability to negotiate the guide wire through the obstruction sites in spite of the use of both fluoroscopic and endoscopic guidance. After stent placement, 15 patients were able to ingest at least liquids and had a markedly decreased incidence of vomiting (clinical success: 75%). During the mean follow-up of 6 weeks, there have been no stent reocclusion and no life-threatening complications except migration of two stents in one patient. CONCLUSION: Fluoroscopically guided covered metallic stent placement appears to be valuable for the palliative treatment of malignant obstruction of gastric outlet and post-operative gastrointestinal anastomoses. Lee, J.M. et al. (2001)

  18. Towards Fluorescence In Vivo Hybridization (FIVH Detection of H. pylori in Gastric Mucosa Using Advanced LNA Probes.

    Directory of Open Access Journals (Sweden)

    Sílvia Fontenete

    Full Text Available In recent years, there have been several attempts to improve the diagnosis of infection caused by Helicobacter pylori. Fluorescence in situ hybridization (FISH is a commonly used technique to detect H. pylori infection but it requires biopsies from the stomach. Thus, the development of an in vivo FISH-based method (FIVH that directly detects and allows the visualization of the bacterium within the human body would significantly reduce the time of analysis, allowing the diagnosis to be performed during endoscopy. In a previous study we designed and synthesized a phosphorothioate locked nucleic acid (LNA/ 2' O-methyl RNA (2'OMe probe using standard phosphoramidite chemistry and FISH hybridization was then successfully performed both on adhered and suspended bacteria at 37°C. In this work we simplified, shortened and adapted FISH to work at gastric pH values, meaning that the hybridization step now takes only 30 minutes and, in addition to the buffer, uses only urea and probe at non-toxic concentrations. Importantly, the sensitivity and specificity of the FISH method was maintained in the range of conditions tested, even at low stringency conditions (e.g., low pH. In conclusion, this methodology is a promising approach that might be used in vivo in the future in combination with a confocal laser endomicroscope for H. pylori visualization.

  19. Towards Fluorescence In Vivo Hybridization (FIVH) Detection of H. pylori in Gastric Mucosa Using Advanced LNA Probes

    Science.gov (United States)

    Fontenete, Sílvia; Leite, Marina; Guimarães, Nuno; Madureira, Pedro; Ferreira, Rui Manuel; Figueiredo, Céu; Wengel, Jesper; Azevedo, Nuno Filipe

    2015-01-01

    In recent years, there have been several attempts to improve the diagnosis of infection caused by Helicobacter pylori. Fluorescence in situ hybridization (FISH) is a commonly used technique to detect H. pylori infection but it requires biopsies from the stomach. Thus, the development of an in vivo FISH-based method (FIVH) that directly detects and allows the visualization of the bacterium within the human body would significantly reduce the time of analysis, allowing the diagnosis to be performed during endoscopy. In a previous study we designed and synthesized a phosphorothioate locked nucleic acid (LNA)/ 2’ O-methyl RNA (2’OMe) probe using standard phosphoramidite chemistry and FISH hybridization was then successfully performed both on adhered and suspended bacteria at 37°C. In this work we simplified, shortened and adapted FISH to work at gastric pH values, meaning that the hybridization step now takes only 30 minutes and, in addition to the buffer, uses only urea and probe at non-toxic concentrations. Importantly, the sensitivity and specificity of the FISH method was maintained in the range of conditions tested, even at low stringency conditions (e.g., low pH). In conclusion, this methodology is a promising approach that might be used in vivo in the future in combination with a confocal laser endomicroscope for H. pylori visualization. PMID:25915865

  20. Immunotherapy in gastric cancer.

    Science.gov (United States)

    Matsueda, Satoko; Graham, David Y

    2014-02-21

    Gastric cancer is the second most common of cancer-related deaths worldwide. In the majority of cases gastric cancer is advanced at diagnosis and although medical and surgical treatments have improved, survival rates remain poor. Cancer immunotherapy has emerged as a powerful and promising clinical approach for treatment of cancer and has shown major success in breast cancer, prostate cancer and melanoma. Here, we provide an overview of concepts of modern cancer immunotherapy including the theory, current approaches, remaining hurdles to be overcome, and the future prospect of cancer immunotherapy in the treatment of gastric cancer. Adaptive cell therapies, cancer vaccines, gene therapies, monoclonal antibody therapies have all been used with some initial successes in gastric cancer. However, to date the results in gastric cancer have been disappointing as current approaches often do not stimulate immunity efficiently allowing tumors continue to grow despite the presence of a measurable immune response. Here, we discuss the identification of targets for immunotherapy and the role of biomarkers in prospectively identifying appropriate subjects or immunotherapy. We also discuss the molecular mechanisms by which tumor cells escape host immunosurveillance and produce an immunosuppressive tumor microenvironment. We show how advances have provided tools for overcoming the mechanisms of immunosuppression including the use of monoclonal antibodies to block negative regulators normally expressed on the surface of T cells which limit activation and proliferation of cytotoxic T cells. Immunotherapy has greatly improved and is becoming an important factor in such fields as medical care and welfare for human being. Progress has been rapid ensuring that the future of immunotherapy for gastric cancer is bright.

  1. The potential predictive role of nuclear NHERF1 expression in advanced gastric cancer patients treated with epirubicin/oxaliplatin/capecitabine first line chemotherapy

    Science.gov (United States)

    Mangia, Anita; Caldarola, Lucia; Dell'Endice, Stefania; Scarpi, Emanuela; Saragoni, Luca; Monti, Manlio; Santini, Daniele; Brunetti, Oronzo; Simone, Giovanni; Silvestris, Nicola

    2015-01-01

    Cellular resistance in advanced gastric cancer (GC) might be related to function of multidrug resistance (MDR) proteins. The adaptor protein NHERF1 (Na+/H+ exchanger regulatory factor) is an important player in cancer progression for a number of solid malignancies, even if its role to develop drug resistance remains uncertain. Herein, we aimed to analyze the potential association between NHERF1 expression and P-gp, sorcin and HIF-1α MDR-related proteins in advanced GC patients treated with epirubicin/oxaliplatin/capecitabine (EOX) chemotherapy regimen, and its relation to response. Total number of 28 untreated patients were included into the study. Expression and subcellular localization of all proteins were assessed by immunohistochemistry on formalin-fixed paraffin embedded tumor samples. We did not found significant association between NHERF1 expression and the MDR-related proteins. A trend was observed between positive cytoplasmic NHERF1 (cNHERF1) expression and negative nuclear HIF-1α (nHIF-1α) expression (68.8% versus 31.3% respectively, P = 0.054). However, cytoplasmic P-gp (cP-gp) expression was positively correlated with both cHIF-1α and sorcin expression (P = 0.011; P = 0.002, respectively). Interestingly, nuclear NHERF1 (nNHERF1) staining was statistically associated with clinical response. In detail, 66.7% of patients with high nNHERF1 expression had a disease control rate, while 84.6% of subjects with negative nuclear expression of the protein showed progressive disease (P = 0.009). Multivariate analysis confirmed a significant correlation between nNHERF1 and clinical response (OR 0.06, P = 0.019). These results suggest that nuclear NHERF1 could be related to resistance to the EOX regimen in advanced GC patients, identifying this marker as a possible independent predictive factor. PMID:26126066

  2. Epidemiologic Study of Human Epidermal Growth Factor Receptor 2 Expression in Advanced/Metastatic Gastric Cancer: an Assessment of Human Epidermal Growth Factor Receptor 2 Status in Tumor Tissue Samples of Gastric and Gastro-Esophageal Junction Cancer

    Science.gov (United States)

    Seo, Kyung Won; Jeon, Taeyong; Kim, Sewon; Kim, Sung Soo; Kim, Kwanghee; Suh, Byoung-Jo; Hwang, Sunhwi; Choi, SeongHee; Ryu, Seungwan; Min, Jae Seok; Lee, Young-Joon; Jee, Ye Seob; Chae, Hyeondong

    2017-01-01

    Purpose The Trastuzumab for gastric cancer (GC) trial identified human epidermal growth factor receptor 2 (HER2) as a predictor of successful treatment with trastuzumab (HER2 receptor targeting agent) among patients with advanced/metastatic GC. To date, the prevalence of HER2 overexpression in the Korean population is unknown. The present study aimed to assess the incidence of HER2 positivity among GC and gastroesophageal (GE) junction cancer samples and the relationship between HER2 overexpression and clinicopathological characteristics in Korean patients. Materials and Methods Tumor samples collected from 1,695 patients with histologically proven GC or GE junction enrolled at 14 different hospitals in Korea were examined. After gathering clinicopathological data of all patients, HER2 status was assessed by immunohistochemistry (IHC) at each hospital, and IHC 2+ cases were subjected to silver-enhanced in situ hybridization at 3 central laboratories. Results A total of 182 specimens tested positive for HER2, whereas 1,505 tested negative. Therefore, the overall HER2-positive rate in this study was 10.8% (95% confidence interval=9.3%–12.3%). The HER2-positive rate was higher among intestinal-type cases (17.6%) than among other types, and was higher among patients older than 70 years and 50 years of age, compared to other age groups. Conclusions Our evaluation of the HER2 positivity rate (10.8%) among Korean patients with GC and GE junction indicated the necessity of epidemiological data when conducting studies related to HER2 expression in GC and GE junction.

  3. Inoperable metastatic giant basal cell trunk carcinoma: radiotherapy can be useful; Carcinome basocellulaire geant du tronc metastatique inoperable: la radiotherapie peut etre utile

    Energy Technology Data Exchange (ETDEWEB)

    Mania, A.; Durando, X.; Lapeyre, M. [Centre Jean-Perrin, Clermont-Ferrand (France); Barthelemy, I. [CHU Estaing, Clermont-Ferrand (France)

    2011-10-15

    The authors evoke some characteristics of the basal cell carcinoma (slow evolution, local morbidity) and report and discuss the case of a giant basal cell trunk carcinoma, associated with several symptoms (pain, bleeding, anaemia), already metastatic at the moment of diagnosis, and locally treated by irradiation. Due to its size and expansion, this carcinoma was considered as inoperable. An external radiotherapy has been performed and resulted in a significant clinical tumour reduction. But the metastatic risk is high in such cases. Radiotherapy is then a therapeutic option for a local treatment with a durable efficiency. Short communication

  4. Advanced progress of thermal therapy with other therapy on gastric cancer%进展期胃癌热疗联合其他治疗的进展

    Institute of Scientific and Technical Information of China (English)

    赵玲俊; 李佳; 姜丽真; 刘彦同; 王大庆; 张清泉

    2015-01-01

    Advanced gastric cancer is one of the common malignant tumor of gastrointestinal, most patient has entered the late, and lost opportunity operation, it is in order to be poor prognosis, difficult treatment. In recent years, with ad-vanced gastric cancer, the use of thermal therapy with other therapy, such as heat therapy combined chemotherapy, chemotherapy drug penetration and absorption. Thermal therapy adjuvant radiotherapy, arrive in smaller radiation doses, high curative effect, they have a complementary effect. Heat therapy combined radiation and chemotherapy, at the same time increase the tumor control rates and survival,as far as possible to reduce the radioactive damage. The cur-rent clinical application of targeted drugs prones to resistance, combined drugs sensitivity increased after heat treat-ment, to improve the curative effect. Heat treatment in addition to its own joint effect of opioid drugs, quick and effi-cient treatment of osseous pain, make all kinds of analgesic effect to enlarge.%进展期胃癌是消化道常见恶性肿瘤之一,多数患者就诊时已进入晚期,失去手术机会,预后差,治疗难度较大。近年来,对于进展期胃癌,采用热疗联合其他治疗,如热疗联合化疗,利于化疗药物的渗透和吸收,使疗效有一定提高。热疗联合放疗在较小放疗剂量下,到达较高疗效,两者有互补功效;热疗联合放化疗在提高肿瘤控制率和患者生存率同时,尽可能减轻放射性损伤,避免放疗并发症;目前临床应用靶向药物极易产生耐药,联合热疗后药物敏感程度增高,提高了疗效;热疗除自身效果外联合阿片类药物,可快速、高效治疗骨性疼痛,使得各种止痛效果得以放大。

  5. Combination chemotherapy with paclitaxel, cisplatin and fluorouracil for patients with advanced and metastatic gastric or esophagogastric junction adenocarcinoma: a multicenter prospective study

    Institute of Scientific and Technical Information of China (English)

    Xiao-Dong Zhang; Cheng-Ye Guo; Lin Shen; Mao-Lin Jin; Yong-Qian Shu; Jun Liang; Feng-Chun Zhang; Xue-Zhen Ma; Jian-Jin Huang; Li Chen; Gen-Ming Shi; Wei-Guo Cao

    2012-01-01

    Objective:To evaluate the efficacy and toxicity of the combination regimen of paclitaxel,cisplatin and 5-FU (PCF) as first-line or second-line therapy in patients with advanced gastric and esophagogastric junction (EGJ) adenocarcinoma in China.Methods:The patients were treated with paclitaxel 150 mg/m2 on d1; fractionated cisplatin 15 mg/m2 and continuous infusion 5-FU 600 mg/(m2·d) intravenously on d1-d5 of a 21-d cycle until disease progression or unacceptable toxicities.Results:Seventy-five patients have been enrolled,among which,41 received PCF regimen as the first-line therapy (group A) and 34 received the regimen as the second-line therapy (group B) with the median age of 59 years old and Karnofsky performance status (KPS) score ≥80.Toxicities were analyzed in all 75 patients.Seventy-one patients were evaluable for efficacy.The median overall survival (mOS) was 12.0 months (95% CI:7.9-16.2 months) in group A and 7.3 months (95% CI:4.3-10.3 months) in group B,respectively.The median progression-free survival (mPFS) was 5.7 months (95% CI:4.1-7.2 months) and 5.0 months (95% CI:3.1-6.9 months),respectively.The response rate (CR+PR) was 40% (16/40; 95% CI:24.9-56.7%) in group A and 22.6% (7/31; 95% CI:9.6-41.1%) in group B.Major grade 3 or 4 adverse events include neutropenia (41.3%),febrile neutropenia (9.3%),nausea/anorexia (10.7%),and vomiting (5.3%).There was no treatment-related death.Conclusions:The combination chemotherapy with PCF is active and tolerable as first-line and second-line therapy in Chinese patients with advanced gastric and EGJ adenocarcinoma.The response and survival of PCF are same as those of DCF,but the tolerance is much better.

  6. The Application of Laparoscopic in Patients with Advanced Gastric Cancer%腹腔镜在进展期胃癌中的应用

    Institute of Scientific and Technical Information of China (English)

    刘宏斌; 韩晓鹏; 朱万坤; 苏琳; 李坤

    2011-01-01

    Objective To evaluate the application of laparoscopic in preoperative exploration and radical resection of gastric cancer in patients with advanced gastric cancer. Methods The clinical data of 30 patients with advanced gastric cancer from July 2008 to September 2009 were reviewed and analyzed with preoperative laparoscopic staging, the surgical procedure, operative time, blood loss, postoperative recovery of gastrointestinal function time, postoperative ambulation, time to eat liquid diet, pathological and follow -up and so on. Results Laparoscopy found 9 cases of peritoneal metastases which were considered no metastasis according to preoperative clinic staging,and unfeasible operations were avoided in 4 patients because of numerous metastases to the distant peritoneum, palliative operations were performed in 5 patients because partial peritoneal metastases were discovered in laparoscopic staging, and 21 patients underwent radical surgery. Twenty-six cases were successfully performed by laparoscopy and one case was converted to open surgery. Laparoscopic assisted total gastrectomy was performed in 6 cases, proximal gastrectomy in 4 cases, distal gastrectomy in 16 cases. The average operative time for total gastrectomy, proximal gastrectomy and distal gastrectomy was 380( 350 ~ 410 )min, 276( 240 ~ 350 )min and 265( 250 ~310 )min respectively. The average blood loss in total gastrectomy, proximal gastrectomy and distal gastrectomy was 490( 400 ~ 600 )ml,120( 50 ~ 170 )ml and 130( 70 ~ 200 )ml respectively. No blood transfusion was used in patients during the operation. The average time of gastrointestinal function recovery was 3.2( 2 ~ 4 )days. The average time for postoperative ambulation was 3.3( 3 ~ 4 ). The average time to start liquid diet was 3.9( 3 ~ 5 )days. Histopathological examination of all specimens margins was negative, and the mean total number of lymph nodes dissected was 20.8. There was no postoperative complication. The short

  7. 晚期胃癌患者中心静脉营养支持的应用与护理%Application and Nursing Care of Total Parenteral Nutrition for the Patients with Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    王丽君; 马军捷; 刘卫云

    2014-01-01

    目的:解决胃癌晚期患者因幽门梗阻不能进食问题。为患者提供基本营养成分,保证生存质量,延长患者寿命。方法:对26例晚期胃癌患者给予中心静脉营养支持,并进行跟踪观察和统计。结果:对26例晚期患者应用中心静脉营养支持,并进行观察和记录,维持生命3个月至6个月者21例,12个月者5例。结论:中心静脉营养支持对晚期胃癌患者确有维持基本生命活动,解决各种营养需求,提高免疫力,延长患者寿命,提高生存质量的作用。%Objective:To solve the deficient nutritional problem caused by pyloric obstruction associat-ed with patients with advanced gastric cancer in order to provide basic nutritional components , ensure the quality of survival , prolong the life of patients .Method:26 patients with advanced gastric cancer adopted the way of total parenteral nutrition .These patients were observed and recorded .Result: 21 patients were prolonged the life for 3 months to 6 months.5 patients were prolonged the life for 12 months.Conclusion:The way of total parenteral nutrition is beneficial for patients with advanced gastric cancer .It can maintain basic activities of the life , solve various nutritional needs , enhance the immunity , prolong the life and im-prove the quality of life for patients with advanced gastric cancer .

  8. Sentinel node biopsy using blue dye and technetium99 in advanced gastric cancer: anatomical drainage and clinical application

    Directory of Open Access Journals (Sweden)

    F.A.V. Santos

    2016-01-01

    Full Text Available Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging.

  9. Sentinel node biopsy using blue dye and technetium{sup 99} in advanced gastric cancer: anatomical drainage and clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Santos, F.A.V.; Rodrigues, M.A.; Cabral, M.A.; Pedrosa, M.S.; Braga, H. [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina. Departamento de Cirurgia; Drummond-Lage, A.P.; Wainstein, A.J.A., E-mail: albertojaw@gmail.com [Faculdade de Ciencias Medicas de Minas Gerais, Belo Horizonte, MG (Brazil)

    2016-11-01

    Lymph node metastases are an independent prognosis factor in gastric carcinoma (GC) patients. Radical lymphadenectomy can improve survival but it can also increase surgical morbidity. As a principle, sentinel node (SN) navigation surgery can avoid unnecessary lymphadenectomy without compromising prognosis. In this pilot study, 24 patients with untreated GC were initially screened for SN navigation surgery, of which 12 were eligible. Five patients had T2 tumors, 5 had T3 tumors and 2 had T1 tumors. In 33% of cases, tumor diameter was greater than 5.0 cm. Three hundred and eighty-seven lymph nodes were excised with a median of 32.3 per patient. The SN navigation surgery was feasible in all patients, with a median of 4.5 SNs per patient. The detection success rate was 100%. All the SNs were located in N1 and N2 nodal level. In 70.9% of cases, the SNs were located at lymphatic chains 6 and 7. The SN sensitivity for nodal staging was 91.6%, with 8.3% of false negative. In 4 patients who were initially staged as N0, the SNs were submitted to multisection analyses and immunohistochemistry, confirming the N0 stage, without micrometastases. In one case initially staged as negative for nodal metastases based on SN analyses, metastases in lymph nodes other than SN were found, resulting in a 20% skip metastases incidence. This surgery is a reproducible procedure with 100% detection rate of SN. Tumor size, GC location and obesity were factors that imposed some limitations regarding SN identification. Results from nodal multisection histology and immunohistochemistry analysis did not change initial nodal staging. (author)

  10. 62例不可手术的局部晚期非小细胞肺癌同步放化疗分析%Clinical analysis of concurrent chemoradiotherapy of 62 patients with inoperable locally advanced non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    孙志华; 李青峰; 伍钢

    2012-01-01

    目的:评价局部晚期不可手术的非小细胞肺癌同步放化疗的疗效和安全性.方法:对62例经细胞学或病理学明确诊断的局部晚期非小细胞肺癌患者进行同步放化疗,4个周期的NP加上同步放疗,第1周期NP化疗第1天就开始实施放疗.放疗采用15MV -X线,3D - CRT常规分割照射,总剂量60Gy.结果:可评价的60例患者,完全缓解11例,部分缓解36例,稳定11例,进展2例,总有效率为78.3%,1年、2年、3年生存率分别为90%,48.3%和23.3%,中位生存时间为23.2个月.结论:疗前正确评估合适的局部晚期非小细胞肺癌患者,同步放化疗有较好的1年、2年、3年生存率及中位生存时间,毒副反应多能耐受.%Objective:To evaluate the efficacy and safety of concurrent chemoradiotherapy in patients with locally advanced non - small cell lung cancer. Methods: All 62 patients diagnosised as locally advanced non - small cell lung cancer by clear cytology or pathology accepted 3D - CRT of thoracic radiotherapy and concurrent chemotherapy of NP. 3D - CRT, started on day I in the first cycle of NP chemotherapy. Chemotherapy was carried out for 4 cycles, every cycle 21 days. Thoracic radiotherapy adopted 3D - CRT of 15MV - X ray with conventional fractionated irradiation, a total dose of 60 Gy. Results; In 60 evaluable patients, there were 11 cases complete response 36 cases had partial response (PR) , llcases with no change(NC) and 2 cases with progression disease (PD). The overall response rates were 78.3% .1,2,3 year survival rate was 90% ,48.3% and 23.3% , respectively, and a median survival time was 23.2 months. Conclusion: For patients with locally advanced unresectable non -small cell lung cancer concurrent chemoradiotherapy is effective and have a good 1,2,3- year survival rate, median survival time, and side effects are tolerable.

  11. Apparatus for rendering at least a portion of a device inoperable and related methods

    Science.gov (United States)

    Daniels, Michael A.; Steffler, Eric D.; Hartenstein, Steven D.; Wallace, Ronald S.

    2016-11-08

    Apparatus for rendering at least a portion of a device inoperable may include a containment structure having a first compartment that is configured to receive a device therein and a movable member configured to receive a cartridge having reactant material therein. The movable member is configured to be inserted into the first compartment of the containment structure and to ignite the reactant material within the cartridge. Methods of rendering at least a portion of a device inoperable may include disposing the device into the first compartment of the containment structure, inserting the movable member into the first compartment of the containment structure, igniting the reactant material in the cartridge, and expelling molten metal onto the device.

  12. Apparatus for rendering at least a portion of a device inoperable and related methods

    Energy Technology Data Exchange (ETDEWEB)

    Daniels, Michael A.; Steffler, Eric D.; Hartenstein, Steven D.; Wallace, Ronald S.

    2016-11-08

    Apparatus for rendering at least a portion of a device inoperable may include a containment structure having a first compartment that is configured to receive a device therein and a movable member configured to receive a cartridge having reactant material therein. The movable member is configured to be inserted into the first compartment of the containment structure and to ignite the reactant material within the cartridge. Methods of rendering at least a portion of a device inoperable may include disposing the device into the first compartment of the containment structure, inserting the movable member into the first compartment of the containment structure, igniting the reactant material in the cartridge, and expelling molten metal onto the device.

  13. The clinical research of elemene emulsion combined with F0LF0X4 regimen in the treatment of advanced gastric carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yanzhi Bi; Dongxiang Zeng; Yang Ling

    2012-01-01

    Objective: The aim of this study was to observe the effects and adverse reactions of elemene emulsion added to the chemotherapy in the treatment of advanced gastric carcinoma (AGC). Methods: Forty-nine patients were divided randomly into two groups, elemene emulsion group (25 cases, treated with chemotherapy and elemene emulsion) and chemotherapy group (24 cases, treated with chemotherapy only). All patients received chemotherapy. The clinical effects and adverse reactions were evaluated after four cycles. Results: The response rate (RR) were 60% in elemene emulsion group and 41.7% in chemotherapy group respectively (P < 0.05). The median time to progression and overall survival in elemene emulsion group and in chemotherapy group were 7.1 months and 11.0 months vs 5.2 months and 9.3 months (P < 0.05). A lower rate of neutropenia, nausea, vomiting and diarrhea occurred in elemene emulsion group compared with chemotherapy group (P < 0.05), and there was significant difference in the elevation of life quality as well (48% vs 25%; P < 0.05). Conclusion: Elemene emulsion in combination with FOLFOX4 regimen can improve the efficacy, decrease the incidence of side effects of chemotherapy and elevate the life quality and prolong the survival time in AGC.

  14. Quality of life in patients with advanced gastric cancer: a randomized trial comparing docetaxel, cisplatin, 5-FU (TCF with epirubicin, cisplatin, 5-FU (ECF

    Directory of Open Access Journals (Sweden)

    Montazeri Ali

    2006-12-01

    Full Text Available Abstract Background Health related quality of life (HRQOL is an important outcome after treatment for upper gastrointestinal carcinoma. This study aimed to compare HRQOL in patients with advanced gastric cancer (GC receiving either a standard or an experimental treatment. Methods Seventy-one patients have been treated in Cancer Institute (Tehran, Iran with docetaxel, cisplatin, 5 FU (TCF or epirubicin, cisplatin, 5-FU (ECF and were followed from Jan 2002 to Jan 2005. End points were response rate, HRQOL and survival. HRQOL was assessed using the EORCT QLQ-C30 at baseline and after the third cycle of chemotherapy. Results The baseline HRQOL scores were comparable between two groups. After treatment improvement was seen in a number of items and domains except for cognitive functioning, and diarrhoea. Pain decreased and physical functioning improved in both groups. However, only the TCF group showed statistically and clinically meaningful improvement in global QOL (P = 0.001. Surgical and pathologic response was better with TCF but there was no difference in survival rate between two groups. Conclusion Docetaxel based treatment (TCF showed better palliation and improvement of global QOL as compared with epirubicin based treatment (ECF. However, it seems that regardless of treatment offered, effective chemotherapy was the most important factor affecting QOL in these patients.

  15. Role of concurrent chemoradiation in inoperable carcinoma esophagus: A prospective study

    Directory of Open Access Journals (Sweden)

    Virendra Bhandari

    2014-01-01

    Full Text Available Introduction: The treatment of choice in cancer esophagus is controversial. Radiation therapy oncology group, Eastern cooperative oncology group and Cochrane studies have shown superiority of concurrent chemoradiation in inoperable carcinoma esophagus. In these studies full dose cisplatin was given every 3 weeks along with radiotherapy and hence had some toxicity. So, we started treating inoperable carcinoma esophagus patients with low dose weekly cisplatin given concurrently with radiotherapy aiming at low toxicity and similar results. Materials and Methods: A total of 31 cases of inoperable cases of carcinoma esophagus were treated with once weekly cisplatin 30 mg/m 2 along with radiotherapy 60 Gy in 30 fractions in 6 weeks on Telecobalt/Linear accelerator. Results : w0 e could achieve lower toxicity with 80%, 35% and 19% with 1, 2, and 3 year′s survival with a median survival of 18 months. So, we conclude that this regimen is better than 3 weekly chemotherapy regimen as is better tolerated with less toxicity and similar outcome.

  16. Excision repair cross-complementation group 1 codon 118 polymorphism, micro ribonucleic acid and protein expression, clinical outcome of the advanced gastric cancer response to first-line FOLFOX-4 in Qinghai-Tibetan plateau population

    Directory of Open Access Journals (Sweden)

    Yu-Juan Qi

    2013-01-01

    Full Text Available Context: The excision repair cross-complementation group 1 (ERCC1 codon 118 C/T polymorphism has been associated with clinical outcome in cancer patients treated with platinum chemotherapy. Ethnic differences in the frequency of this polymorphism have been observed in Caucasian and African populations. Aim: The aim of this study was to evaluate the frequency and survival benefit of the ERCC1 codon 118 C/T polymorphism in a high-altitude population with advanced gastric cancer. Materials and Methods: Polymerase chain reaction-restriction fragment length polymorphism was used to determine the frequency of ERCC1 118 codon C/T polymorphism in 206 advanced gastric cancer patients residing in the high-altitude Qinghai-Tibetan plateau. The influence of the ERCC1 codon 118 C/T polymorphism on its micro ribonucleic acid (mRNA and protein expression, clinicopathological features; response to the platinum-based combination chemotherapy, and the outcome was evaluated. Statistical Analysis: The Kaplan-Meier method was used for survival analysis. The correlation of ERCC1 codon 118 polymorphism with ERCC1 mRNA and protein expression, clinicopathological characteristics, and first-line oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX-4 response was determined by χ2 -test. Results and Conclusions: ERCC1 codon 118 C/T polymorphism was not associated with ERCC1 mRNA and protein expression, FOLFOX-4 response, and progression-free survival (PFS or overall survival (OS. High ERCC1 mRNA and protein expression levels were associated with significantly lower FOLFOX-4 responses, PFS, and OS. ERCC1 codon 118 C/T polymorphism is not an important prognostic marker for advanced gastric cancer. Determination of ERCC1 mRNA and protein levels may be beneficial in predicting the response and outcome of FOLFOX-4 therapy in gastric cancer.

  17. Hereditary Diffuse Gastric Cancer

    Science.gov (United States)

    ... Hereditary Diffuse Gastric Cancer Request Permissions Hereditary Diffuse Gastric Cancer Approved by the Cancer.Net Editorial Board , 11/2015 What is hereditary diffuse gastric cancer? Hereditary diffuse gastric cancer (HDGC) is an inherited ...

  18. Advances of anti-EGFR family targeted drugs in the treatment of gastric cancer%抗EGFR家族靶向药物在胃癌治疗中的研究进展∗

    Institute of Scientific and Technical Information of China (English)

    秦军伟; 韩宇; 白玉贤

    2014-01-01

    Incidence of gastric cancer accounted for the fourth in global cancer incidence, and the mortality accounted for the second. Most patients bearing gastric cancer are already advanced and unresectable at the time of diagnosis. Chemotherapy and molecu⁃lar targeted therapy have been more and more emphasised on clinical research and practice as an effective means of treatment of gastric cancer. In recent years, the targeted therapy of epidermal growth factor receptor(EGFR) family has achieved fruitful results in the treatment of gastric cancer. This article summarizes the signal transduction mechanisms of EGFR family and associated targeted drugs in the treatment of gastric cancer.%胃癌发病率占全球癌症发病率的第4位,死亡率占第2位。大多数胃癌患者就诊时已属中晚期,失去手术机会,化疗及分子靶向治疗作为胃癌治疗的有效手段,越来越受到临床研究及实践的重视。近年来,抗表皮生长因子受体( EGFR)家族靶向治疗在胃癌治疗中取得了丰硕的成果。本文总结了EGFR家族信号转导机制及相关靶向药物在胃癌治疗中的研究进展。

  19. A Phase I Trial of an Immune Checkpoint Inhibitor Plus Stereotactic Ablative Radiotherapy in Patients with Inoperable Stage I Non-Small Cell Lung Cancer

    Science.gov (United States)

    2016-10-01

    with Inoperable Stage I Non-Small Cell Lung Cancer PRINCIPAL INVESTIGATOR: Karen Kelly, MD CONTRACTING ORGANIZATION: University of California...Checkpoint Inhibitor Plus Stereotactic Ablative Radiotherapy in Patients with Inoperable Stage I Non-Small Cell Lung Cancer 5b. GRANT NUMBER W81XWH-15...checkpoint inhibitor MPDL3280A (atezolizumab) in early stage inoperable non-small cell lung cancer. The trial is comprised of a traditional 3 + 3 phase I

  20. Efficacy and safety of cord blood-derived dendritic cells plus cytokine-induced killer cells combined with chemotherapy in the treatment of patients with advanced gastric cancer: a randomized Phase II study

    Directory of Open Access Journals (Sweden)

    Mu Y

    2016-07-01

    Full Text Available Ying Mu,1,* Wei-hua Wang,2,* Jia-ping Xie,1 Ying-xin Zhang,2 Ya-pei Yang,2 Chang-hui Zhou2 1Department of Gastroenterology, 2Department of Central Laboratory, Liaocheng People’s Hospital, Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong Province, People’s Republic of China *These authors contributed equally to this work Background: Cellular immunotherapy has been widely used in the treatment of solid tumors. However, the clinical application of cord blood-derived dendritic cells and cytokine-induced killer cells (CB-DC-CIK for the treatment of gastric cancer has not been frequently reported. In this study, the efficacy and safety of CB-DC-CIK for the treatment of gastric cancer were evaluated both in vitro and in vivo. Methods: The phenotypes, cytokines, and cytotoxicity of CB-DC-CIK were detected in vitro. Patients with advanced gastric cancer were divided into the following two groups: the experimental group (CB-DC-CIK combined with chemotherapy and the control group (chemotherapy alone. The curative effects and immune function were compared between the two groups. Results: First, the results showed that combination therapy significantly increased the overall disease-free survival rate (P=0.0448 compared with chemotherapy alone. The overall survival rate (P=0.0646, overall response rate (P=0.410, and disease control rate (P=0.396 were improved in the experimental group, but these changes did not reach statistical significance. Second, the percentage of T-cell subsets (CD4+, CD3-CD56+, and CD3+CD56+ and the levels of IFN-γ, TNF-α, and IL-2, which reflect immune function, were significantly increased (P<0.05 after immunotherapy. Finally, no serious side effects appeared in patients with gastric cancer after the application of cellular immunotherapy based on CB-DC-CIK. Conclusion: CB-DC-CIK combined with chemotherapy is effective and safe for the treatment of patients with advanced gastric cancer. Keywords: cord

  1. Dose-escalation study for the targeting of CD44v(+) cancer stem cells by sulfasalazine in patients with advanced gastric cancer (EPOC1205).

    Science.gov (United States)

    Shitara, Kohei; Doi, Toshihiko; Nagano, Osamu; Imamura, Chiyo K; Ozeki, Takeshi; Ishii, Yuya; Tsuchihashi, Kenji; Takahashi, Shunji; Nakajima, Takako E; Hironaka, Shuichi; Fukutani, Miki; Hasegawa, Hiromi; Nomura, Shogo; Sato, Akihiro; Einaga, Yasuaki; Kuwata, Takeshi; Saya, Hideyuki; Ohtsu, Atsushi

    2017-03-01

    Cancer stem cells (CSCs) have enhanced mechanisms of protection from oxidative stress. A variant form of CD44 (CD44v), a major CSC marker, was shown to interact with xCT, a subunit of cystine-glutamate transporter, which maintains high levels of intracellular reduced glutathione (GSH) which defend the cell against oxidative stress. Sulfasalazine (SSZ) is an inhibitor of xCT and was shown to suppress the survival of CD44v-positive stem-like cancer cells both in vitro and in vivo. To find the dose of SSZ which can safely reduce the population of CD44v-positive cells in tumors, a dose-escalation study in patients with advanced gastric cancer was conducted. SSZ was given four times daily by oral administration with 2 weeks as one cycle. Tumor biopsies were obtained before and after 14 days of administration of SSZ to evaluate expression of CD44v and the intratumoral level of GSH. Eleven patients were enrolled and received a dosage from 8 to 12 g/day. Safety was confirmed up to a dosage of 12 g/day, which was considered the maximum tolerated dose. Among the eight patients with CD44v-positive cells in their pretreatment biopsy samples, the CD44v-positive cancer cell population appeared to be reduced in the posttreatment biopsy tissues of four patients. Intratumoral GSH levels were also decreased in two patients, suggesting biological effectiveness of SSZ at 8 g/day or greater. This is the first study of SSZ as an xCT inhibitor for targeting CSCs. Reduction of the levels of CD44v-positive cells and GSH was observed in some patients, consistent with the mode of action of SSZ in CSCs.

  2. Long-term outcomes for surgical treatment in patients with locally advanced and disseminated gastric cancer combined with intraoperative photodynamic therapy

    Directory of Open Access Journals (Sweden)

    L. A. Vashakmadze

    2013-01-01

    Full Text Available This article represents the study of safety and efficiency of intraoperative photodynamic peritoneal therapy (IOPDT developed in P.A. Herzen Moscow Cancer Research Institute. IPPDT was performed in 84 patients with locally advanced and disseminated gastric cancer. The control group included 100 patients with surgical treatment only. All patients underwent subradical or palliative subtotal distal gastroectomy or total gastrectomy with D2, D3 lymph node dissection. For IOPDT group Photohem was administrated intravenously in dose 2,5 mg/kg 48 h prior to operation, the session of peritoneal irradiation was performed after completion of the surgery (with laser device LFT-630-01 «Biospec», wavelength 630nm, light dose 6 J/cm2. IOPDT of peritoneum was associated with good tolerance, did not increase the rate and severity of post-operative complications. The efficiency of IOPDT was assessed with adjusted survival rates in study and control groups by Kaplan-Meier analysis. IOPDT significantly improved the prognosis in patients with subradical treatment, with metastasis in less then 15 lymph nodes. The use of IOPDT after surgery in this group of patients contributed to increase of median survival rate from 29.3 up to 43.6 months, annual survival rates from 80.0±5.7% to 93.7±4.2%, 3-year survival rates from 45.5±7.6% to 82.1±7.1%. Accordingly, IOPDT did not improved outcomes for palliative surgery R1–R2 and in patients with more than 15 involved lymph nodes. 

  3. Current issues in gastric cancer epidemiology.

    Science.gov (United States)

    Patru, C L; Surlin, V; Georgescu, I; Patru, Emilia

    2013-01-01

    Gastric cancer, one of the most common malignant tumors of digestive tract continues to be a major health problem by frequency, aggressiveness and low rate of cure in symptomatic stage. Although its incidence is decreasing (especially in the West), globally the gastric cancer is ranked fourth in incidence among cancers at various sites. Despite these developments, the gastric cancer mortality, overall declining globally, is high. especially in the West where even if diagnosed fewer cases of gastric cancer, TNM stages are advanced and have a poor prognosis. In contrast, in Japan, where the incidence is still high, the percentage of cases diagnosed at the stage of "early gastric cancer" has greatly increased, thus improving prognosis. Gastric neoplasia affects more men, age range 50-70 years, disadvantaged social classes and black race. In Romania the gastric cancer incidence is increasing over recent years, presenting variations across the country being more common in men compared with women, reaching a peak of incidence around age 60. Gastric cancer mortality in the world places Romania among the countries with average mortality. Gastric cancer prognosis remains extremely reserved, in close correlation with tumor stage at diagnosis, surgical treatment being the only possibility to provide improved survival, especially in the early stages. Improvement of survival rate in recent years is due to increased gastric resectability result of an earlier diagnosis, a more complex treatment and a closer monitoring of the population at risk.

  4. Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer

    Science.gov (United States)

    Petsuksiri, J; Chansilpa, Y; Hoskin, P J

    2014-01-01

    Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively). PMID:24807067

  5. Long-term efficacy of bosentan in inoperable chronic thromboembolic pulmonary hypertension

    Science.gov (United States)

    Post, M.C.; Plokker, H.W.M.; Kelder, J.C.; Snijder, R.J.

    2009-01-01

    Background. Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is associated with a poor survival. Objectives. To evaluate the long-term response to a dual endothelin receptor antagonist in patients with inoperable CTEPH. Methods. All consecutive 18 patients (mean age 63±14 years) treated with bosentan for symptomatic inoperable CTEPH were included. Efficacy was evaluated by the log value of serum levels of N-terminal-pro brain natriuretic peptide (log NTpro BNP), New York Heart Association functional class (NYHA), and the six-minute walk test (6-MWT). All follow-up data (median 31 months) were compared with baseline and divided into: short-term (24 months). Results. At baseline, 15 patients were in NYHA class III and three in NYHA class IV, mean log NT-pro BNP level was 7.2±1.4 log pg/ml, and mean 6-MWT distance was 404±125 m. During short-term follow-up (n=18), the NYHA class improved (p=0.001), 6-MWT distance increased by 33 m (p=0.03), and log NT-pro BNP decreased to 6.9±1.4 log pg/ml (p=0.007). During mid-term follow-up (n=17), the NYHA class improved (p<0.001), the mean 6-MWT distance increased by 41 m (p=0.01), and log NT-pro BNP was 6.9±1.4 log pg/ml (p=0.31). During late followup (n=14) the NYHA class was still improved (p=0.03), the 6-MWT distance decreased by 9 m (p=0.73), and log NT-pro BNP was 7.1±1.5 log pg/ml (p=0.91). The overall four year survival rate was 88%. Conclusion: Bosentan seems to be effective during long-term treatment in patients with inoperable CTEPH. (Neth Heart J 2009;17:329-33.19949474) PMID:19949474

  6. [Gastric cancer].

    Science.gov (United States)

    Belén Fraile, M; Serra Bartual, M; Segarra Sánchez, J; Richart Rufino, M J

    1991-11-01

    Gastric cancer represents a disorder which incidence has come down last years. Its etiology is unknown, but diet is the principal determinant risk of suffering it. Clinic history is not much useful, because in the early stage symptoms can fail and in the late stage are inespecific. Election diagnosis is endoscopy. Surgery is the only curative treatment. By these features, it would be useful to left under vigilance to: a) patients 40 years older with dispepsia; b) patients following gastric operations; c) patients with disorders presenting aclorhidria. The authors report a clinic case that can be of frequent presentation in primary assistance.

  7. Mixed gastric carcinoma with intestinal and cribriform patterns: a distinctive pathologic appearance associated with poor prognosis in advanced stages and a potential mimicker of metastatic breast carcinoma.

    Science.gov (United States)

    Lino-Silva, Leonardo Saúl; Salcedo Hernández, Rosa Angélica; Molina-Frías, Ernesto

    2013-02-01

    Gastric adenocarcinoma is characterized by marked heterogeneity at cytological and architectural level and frequently shows overlap between microscopic patterns. This article describes a peculiar pattern of gastric adenocarcinoma, previously unreported, that combines intestinal type adenocarcinoma with areas of cribriform pattern that resembles both architectural and cytological in situ ductal carcinoma of the breast and to the best of the authors' knowledge, there are no earlier reports of this pattern in the stomach, which has been named "gastric carcinoma with cribriform component (CGA). The authors analyzed 12 cases of intestinal type adenocarcinoma with areas at least 20% of cribriform pattern (range from 20% to 90%) that was present in 9% of intestinal type gastric adenocarcinomas in their institution. There is slight predilection for male sex, and the median age of presentation is 55.8 years. The phenotype by immunohistochemistry is the same as with conventional (non-CGA) carcinomas. CGA shows more frequent lymphovascular invasion (P = .039), perineural invasion (P = .027) and resembles both in situ and invasive cribriform carcinoma of the breast. In clinical stage III the overall 3-year survival of CGA was worse than those with non-CGA component (38.6% vs 25%; 3-year survival, P = .010) and proves to be an independent adverse factor for overall survival in a multivariate analysis. Compared with conventional gastric carcinomas, CGA is deep infiltrating, has more nodal metastases, more lymphovascular and perineural invasion, and has decreased overall survival. Thus, proper recognition and report is important, even in small biopsies or small foci.

  8. [A successful resected case of advanced esophageal cancer with early gastric cancer responding to neoadjuvant chemotherapy of docetaxel, CDDP and 5-FU].

    Science.gov (United States)

    Matsutani, Takeshi; Yoshida, Hiroshi; Sasajima, Koji; Maruyama, Hiroshi; Yokoyama, Tadashi; Matsushita, Akira; Hirakata, Atsushi; Takao, Yoshimune; Umakoshi, Michinobu; Hayakawa, Tomohiro; Katayama, Hironori; Hosone, Masaru; Uchida, Eiji

    2012-04-01

    A 72-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopic examination showed double cancers with thoracic esophageal cancer in the middle esophagus and gastric cancer in the antrum. Pathological examinations of the double cancer revealed the first one to be moderately-differentiated squamous cell carcinoma and the second to be well-differentiated adenocarcinoma. Computed tomography (CT) of the chest and abdomen showed no distant or lymph node metastases. Clinical stagings of the double cancer were stage II (T2N0M0)in esophageal cancer and stage I A (T1N0M0) in gastric cancer. The patient received neoadjuvant chemotherapy using docetaxel, CDDP and 5-FU. After 2 courses of chemotherapy, the adverse event was grade 2 in leucopenia and grade 2 in alopecia. Repeated macroscopic and histological examinations after chemotherapy revealed that the esophageal cancer had significant reductions in the size of tumors, leading to a partial response, and the gastric cancer had disappeared, leading to a complete response. He underwent thoracoscopy-assisted esophagectomy in the prone position, and laparoscopy-assisted gastric tube reconstruction. This neoadjuvant chemotherapy of docetaxel, CDDP and 5-FU might be effective and tolerable as with patients with double cancer of esophageal and gastric cancers.

  9. Definitive radiochemotherapy of advanced head and neck cancer with carboplatin and paclitaxel. A phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Semrau, Robert; Temming, Susanne; Mueller, Rolf-Peter [Cologne Univ., Koeln (Germany). Dept. of Radiation Oncology; Preuss, Simon Florian [Cologne Univ., Koeln (Germany). Dept. of Otorhinolaryngology, Head and Neck Surgery; Klussmann, Jens Peter [Giessen Univ. (Germany). Dept. of Otorhinolaryngology and Head and Neck Surgery; Guntinas-Lichius, Orlando [Friedrich-Schiller Univ. Jena (Germany). Dept. of Otorhinolaryngology and Head and Neck Surgery

    2011-10-15

    To report outcome and toxicity of concurrent radiochemotherapy with carboplatin and paclitaxel in advanced squamous cell carcinomas of the oropharynx and hypopharynx. Advanced inoperable carcinomas of the oropharynx and hypopharynx were treated with either hyper-fractionated, accelerated radiotherapy (50.0 Gy/2.0 with concomitant boost to 69.2 Gy/1.6) or conventional fractionated radiotherapy (70.2-72 Gy/1.8) concurrent with paclitaxel 40 mg/m{sup 2} and carboplatin AUC 1 weekly for 6 weeks. Acute and long-term toxicity was measured according to WHO- and CTC-criteria. A total of 84 patients were included between 2000 and 2008. Median follow-up time of patients alive was 36 months. Conventionally fractionated radiotherapy was given to 16 patients, while 68 patients were treated with concomitant boost. Finally, 88.1% of patients received full dose paclitaxel. Acute mucositis {>=} grade 3 was present in 51.2% of patients, while 6% of patients experienced {>=} grade 3 leucopenia and thrombopenia. A supportive gastric feeding tube was implanted in 89.1% of patients. Overall survival after 2 years was 46.3%, progression-free survival after 2 years was 41.0%. There was no significant survival difference between the different radiotherapy protocols. Concomitant carboplatin and paclitaxel is feasible and effective in advanced carcinomas of the head and neck.

  10. Gastric lipoma

    Directory of Open Access Journals (Sweden)

    Zameer M

    2010-01-01

    Full Text Available We report a 12-year-old-boy with gastric lipoma. Upper gastrointestinal (GI endoscopy with biopsy and abdominal computed tomogram (CT scan revealed the diagnosis. Open surgical excision of the mass with stomach preservation was done. The clinical presentation and management are discussed and the literature reviewed here. This is the sixth pediatric case reported in the English literature.

  11. The advance in nutritional support of the patients with gastric cancer during the perioperative%胃癌患者围术期营养支持的研究进展

    Institute of Scientific and Technical Information of China (English)

    张志松; 乔祥社; 李夏鲁

    2015-01-01

    大多数胃癌患者由于食欲欠佳和肿瘤的长期消耗,术前存在不同程度的营养不良综合症,加之手术的应激创伤及术后的长期禁食,则更加重患者的营养不良的各种临床表现,导致增加手术风险及并发症的发生率。在临床实践中,随着对胃癌病理生理的探索进步和新认识,结合对肠内营养(EN)和肠外营养(PN)研究成果,使得胃癌患者围术期营养支持的问题得到了较合理的解决。文章综述了目前国内外胃癌患者围术期营养支持的研究进展,希望能给同行们起到一定的参考借鉴作用。%The majority of patients with gastric cancer have been existed syndrome of varying malnutrition before surgery result from poor appetite, long-term consumption of tumor. In addition, surgical stress and long-term fasting will aggravate a variety of clinical manifestations of malnutrition, and increase the risk of surgery and complications rate. With the exploration of pathophysiology of gastric cancer, combined with the latest finding of EN and PN, it has been solved appropriately to the problem of nutrition support therapy in the patients with gastric cancer in the perioperative. This paper reviews the advance in nutritional support of the patients with gastric cancer during the perioperative from home and abroad currently, which will offer the preference for the peers.

  12. Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin's tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD).METHODS: The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD,EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient's death associated with inadequate drainage.RESULTS: One hundred thirty-four patients (93 men,41 women; 21 Bismuth type Ⅱ, 47 Ⅲ, 66 Ⅳ; 34 ERBD,66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups.Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type Ⅲ.IPTBD provided an excellent response for Bismuth type Ⅳ. However, there was no difference in the patency rate among drainage procedures for Bismuth type Ⅱ.Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD.CONCLUSION: ERBD is recommended as the firstline drainage procedure for the palliation of jaundice in patients with inoperable Klatskin's tumor of Bismuth type Ⅱ or Ⅲ, but IPTBD is the best option for Bismuth type Ⅳ.

  13. Symptomatic subserosal gastric lipoma successfully treated with enucleation.

    Science.gov (United States)

    Krasniqi, Avdyl-Selmon; Hoxha, Faton-Tatil; Bicaj, Besnik-Xhafer; Hashani, Shemsedin-Isuf; Hasimja, Shpresa-Mehmet; Kelmendi, Sadik-Mal; Gashi-Luci, Lumturije-Hasan

    2008-10-14

    Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

  14. Symptomatic subserosal gastric lipoma successfully treated with enucleation

    Institute of Scientific and Technical Information of China (English)

    Avdyl Selmon Krasniqi; Faton Tatil Hoxha; Besnik Xhafer Bicaj; Shemsedin Isuf Hashani; Shpresa Mehmet Hasimja; Sadik Mal Kelmendi; Lumturije Hasan Gashi-Luci

    2008-01-01

    Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

  15. Gastric Sleeve Surgery

    Science.gov (United States)

    ... A Week of Healthy Breakfasts Shyness Gastric Sleeve Surgery KidsHealth > For Teens > Gastric Sleeve Surgery Print A ... buying healthy food ) continue Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  16. Advances in Photodynamic Therapy for Gastric Cancer%光动力技术治疗胃癌的进展及展望

    Institute of Scientific and Technical Information of China (English)

    章忠强; 姚宏亮; 文宇; 苗雄鹰; 熊力

    2012-01-01

    The application of photodynamic treatment of gastric cancer in recent years has made encouraging progress, and it has satisfactory clinical effect for the various periods of gastric cancer. This paper reviews the domestic and foreign literatures of the photodynamic therapy ( PDT) for gastric cancers and elaborates their mechanisms and principle, various special photosensitizers, laser light sources and the clinical treatment of it and so on respectively. We summarized the advantages of PDT for gastric cancers in this paper and discussed some problems on PDT.%近年来应用光动力技术治疗胃癌取得了可喜的进步,它对各个时期的胃癌均有比较满意的临床效果.本文通过对国内外近年来用光动力技术治疗胃癌方面的文献进行综述,系统阐述光动力运用于胃癌治疗这一项技术的原理、机制,光敏剂、光源及临床效果等方面,并总结了这项技术在治疗胃癌方面的优点和相关问题.

  17. Gastric cancer after mini-gastric bypass surgery: a case report and literature review.

    Science.gov (United States)

    Wu, Chun-Chi; Lee, Wei-Jei; Ser, Kong-Han; Chen, Jung-Chien; Tsou, Jun-Juin; Chen, Shu-Chun; Kuan, Wai-Sang

    2013-11-01

    Gastric cancer in the stomach after Roux-en-Y gastric bypass or mini-gastric bypass is rare, but a few cases have been reported since 1991, when the first case emerged. According to the literature, the interval between bypass surgery and the diagnosis of cancer ranged from 1 to 22 years. Given the difficulty of monitoring a bypassed stomach, the potential for gastric cancer must be considered, especially in countries with high incidence of this cancer. The literature reported the first case in the Asia-Pacific region - a woman developed advanced gastric cancer in her stomach 9 years after laparoscopic mini-gastric bypass for morbid obesity. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  18. The importance of pre-treatment haemoglobin level in inoperable non-small cell lung carcinoma treated with radical radiotherapy

    NARCIS (Netherlands)

    Langendijk, H; de Jong, J; Wanders, R; Lambin, P; Slotman, B

    2003-01-01

    Background and purpose: The purpose of this study was to evaluate the prognostic significance of the pre-treatment haemoglobin level among patients with inoperable non-small cell lung carcinorna (NSCLC) treated with definitive radiotherapy with regard to loco-regional tumour control (LC) and overall

  19. Cell proliferation and apoptosis in stage III inoperable non-small cell lung carcinoma treated by radiotherapy

    NARCIS (Netherlands)

    Langendijk, H; Thunnissen, E; Arends, JW; de Jong, J; ten Velde, G; Lamers, R; Guinee, D; Holden, J; Wouters, M

    2000-01-01

    Purpose: The purpose of this study was to assess the prognostic value of the expression of p53 and bcl-2, the apoptotic index and the expression of topoisomerase II alpha in patients with inoperable non-small cell lung cancer (NSCLC) treated with high dose radiotherapy. Patients and methods: A numbe

  20. Gastric atrophy, diagnosing and staging

    Institute of Scientific and Technical Information of China (English)

    Hala MT El-Zimaity

    2006-01-01

    H pylori is now accepted as the cause of gastritis and gastritis-associated diseases, such as duodenal ulcer,gastric ulcer, gastric carcinoma, and gastric MALT lymphoma. The natural history of H pylori gastritis includes inflammation progressing from the antrum into the adjacent corpus resulting in an atrophic front of advancing injury leading to a reduction in acid secretion and eventual loss of parietal cells and development of atrophy. Sub-typing intestinal metaplasia has no clinical value to the patient, the pathologist, or the endoscopist.The pattern, extent, and severity of atrophy, with or without intestinal metaplasia, is a far more important predictor than is intestinal metaplasia subtype. The challenge remains to identify a reliable marker that relates to pre-malignant potential.

  1. Prognostic factorsin inoperable adenocarcinoma of the lung: A multivariate regression analysis of 259 patiens

    DEFF Research Database (Denmark)

    Sørensen, Jens Benn; Badsberg, Jens Henrik; Olsen, Jens

    1989-01-01

    and degree of differentiation, the new international staging system for lung cancer, and seven laboratory parameters. Staging of the patients included bone marrow examination but were otherwise nonextensive without routine bone, liver, and brain scans. Factors predicting poor survival were low performance...... status, stage IV disease, no prior nonradical resection, liver metastases, high values of white blood cell count, and lactate dehydrogenase, and low values of aspartate aminotransaminase. The nonradical resection may not be a prognostic factor because of the resection itself but may rather serve...... in the former Cox model to be of importance (performance status, stage, surgical resection, WBC, aspartate aminotransaminase, and lactate dehydrogenase). This simplified model appears to be a feasible clinical tool, allowing for prognostic stratification of patients when first the inoperability of the patient...

  2. Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

    Directory of Open Access Journals (Sweden)

    Joong Keun Kim

    2014-12-01

    Full Text Available Malignant pheochromocytoma (PCC is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE. A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

  3. Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension: A Prospective Cohort Study

    Institute of Scientific and Technical Information of China (English)

    Juan-Ni Gong; Zhen-Guo Zhai; Yuan-Hua Yang; Yan Liu; Song Gu; Tu-Guang Kuang; Wan-Mu Xie

    2015-01-01

    Background: Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction.However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined.Our study aimed to evaluate the potential role of liver function markers (such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]) combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH.Methods: From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study.Baseline clinical characteristics and 6-min walk distance (6MWD) results were collected.Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment.All-cause mortality was recorded during the follow-up period.Results: During the follow-up, 22 patients (29%) died.Cox regression analyses demonstrated that increased serum concentration of total bilirubin (hazard ratio [HR] =7.755, P < 0.001), elevated N-terminal of the prohormone brain natriuretic peptide (HR =1.001, P =0.001), decreased 6MWD (HR =0.990, P < 0.001), increased central venous pressure (HR =1.074, P =0.040), and higher pulmonary vascular resistance (HR =1.001, P =0.018) were associated with an increased risk of mortality.Serum concentrations of total bilirubin (HR =4.755, P =0.007) and 6MWD (HR =0.994, P =0.017) were independent prognostic predictors for CTEPH patients.Patients with hyperbilirubinemia (≥23.7 μ mol/L) had markedly worse survival than those with normobilirubinemia.Conclusion: Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.

  4. Curative effect observation for advanced gastric cancer by laparoscopic-assisted surgery%腹腔镜辅助下近端胃癌D2根治术的近期疗效分析

    Institute of Scientific and Technical Information of China (English)

    延学军

    2015-01-01

    Objective To explore the curative effect for advanced gastric cancer of laparoscopic-assisted surgery. Methods All 66 patients with advanced gastric cancer were retrospectively analyzed from January 2014 to March 2015 as the research object.According to the different methods of operation, they were divided into observation group and control group, the observation group (36 cases) had cure by laparoscopic-assisted surgery, the control group (30 cases) were by radical open surgery. Related indicators of two groups were compared. Results Operation time, intraoperative blood loss, time of the liquid diets, ambulation time, incision length, cleaning the number of lymph nodes, and hospital-ization days of two groups were compared, in addition to cleaning the number of lymph nodes, the difference was statis-tically significant (P<0.05);the incidence of complications of anastomotic leakage, anastomotic bleeding, abdominal cav-ity infection, pleural effusion, and lymph leakage, pulmonary infection, infection of incision liquefaction, and gastric paralysis of two groups have a comparison, the incidence of postoperative complications of the observation group was 11.11% (4/36), the control group was 33.33% (10/30), the difference was statistically significant (P<0.05). Conclusion Advanced gastric cancer by laparoscopic-assisted surgery have obvious advantages,it is expected to become the stan-dard operation for advanced gastric cancer.%目的:探讨腹腔镜辅助下近端进展期胃癌D2根治术的近期疗效。方法回顾性分析我院2014年1月~2015年3月间行手术治疗的66例进展期近端胃癌患者的临床资料,根据手术方式的不同分为观察组和对照组,观察组(36例)采用腹腔镜辅助下胃癌根治术,对照组(30例)采用经腹近端胃癌根治术,对两组患者手术相关指标及术后并发症等进行比较。结果两组患者手术时间、术中出血量、进流食时间、下床活动时间、切口长度、清

  5. Inoperable Pancreatic Cancer Patients Who Have Prolonged Survival Exhibit an Increased Risk of Cholangitis

    Science.gov (United States)

    Buxbaum, James L; Biggins, Scott W; Bagatelos, Karen C; Inadomi, John M; Ostroff, James W

    2012-01-01

    Context Endoscopically placed metal stents, which are patent for 4-9 months, have been the favored decompressive strategy for biliary obstruction due to inoperable pancreatic cancer in order to minimize interventions. However, in the past decade chemotherapeutic options have improved survival. This raises the question of whether metal stents will continue to be the optimal method of decompression. Objective We performed a study to determine the outcome of patients with non-operatively managed pancreatic adenocarcinoma with regards to the development of cholangitis. Design We reviewed all ERCP performed for malignant distal biliary obstruction in between December 1999 and December 2005 at University of California, San Francisco (UCSF). Patients Only patients who received chemotherapy for pancreatic adenocarcinoma were included. Patients who underwent surgical biliary diversion procedures were excluded. Primary outcome measurement The primary outcome was the development of cholangitis requiring hospitalization. Results Among 200 patients with malignant distal biliary obstruction who underwent endoscopic biliary decompression procedures, 54 met study criterion. Metal stents were employed in 90.7% of these cases. The median survival of this population was 12.7 months (range: 2.6-34.6 months). Only 3 of 26 patients (11.5%) surviving one year or less developed cholangitis compared to 13 of 28 (46.5%) who survived more than one year. Thus patients surviving greater than one year had a five fold increase in the odds of developing cholangitis (odds ratio: 4.92; P=0.017). Conclusions This cohort of inoperable pancreatic cancer patients undergoing chemotherapy survived longer than the expected patent period of metal stents employed for biliary decompression. The occurrence of cholangitis requiring hospitalization does increase markedly among long term survivors. PMID:21737900

  6. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  7. 进展期胃癌腹腔镜淋巴结清扫的研究进展%Research progress of laparoscopic-assisted lymphadenectomy in patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    任宝清

    2013-01-01

    The diagnosis rate of early gastric cancer in China is low,most patients seeing the doctor are already in advanced period.Lymphadenectomy is the key factor affecting the tumor treatment and prognosis.With the depth of the research on tumor immunology,the function of lymph nodes in tumor immunity has been gradually paid more and more attention.The role of lymphadenectomy according to the rule of the lymph nodes metastasis has become the research point of the radical gastrectomy.Gastrectomy with D2 lymphadenectomy is the standard surgical treatment for advanced cancer.Laparoscopic-assisted gastrectomy with D3 lymphadenectomy is also in active exploring.In this article,the application of laparoscopy in advanced gastric cancer of current status,near-term efficacy,long-term outcome and complications are reviewed.%中国早期胃癌诊断率低,大部分患者就诊时已处于进展期.随着肿瘤免疫学研究的深入,淋巴结在肿瘤免疫中的作用逐渐受到重视.根据淋巴结转移规律进行淋巴结清扫已成为胃癌根治术研究的重点.D2根治术是治疗进展期胃癌的标准术式,而腹腔镜下D3根治术目前亦在积极探索之中.就腹腔镜在进展期胃癌淋巴结清扫应用中的现状、近期和远期疗效等进行综述.

  8. The journey of personalizing gastric cancer treatment

    Institute of Scientific and Technical Information of China (English)

    Li Yan

    2016-01-01

    Gastric cancer ranks the fourth most prevalent malignancy yet it is the second leading cause of cancer-related death. Every year, gastric cancer adds nearly 1 million new cancer cases, and 723,000 or 10%of cancer deaths to the global cancer burden. Approximately, 405,000 or 43%of the new cases and 325,000 or 45%of the deaths are in China, mak-ing gastric cancer a particularly challenging malignancy. This thematic series discusses the molecular classiifcations of gastric cancer by the Cancer Genome Atlas ( TCGA) and the Asian Cancer Research Group (ACRG) as well as the implications in personalized therapeutic choices;discusses the evolution of gastric surgery and presents perspectives on surgical techniques in treating gastric cancer;and reviews current and emerging targeted agents as well as immu-notherapies in treating gastric cancer. With these advancements in molecular characterization, surgical intervention, and targeted and immunotherapies, gastric cancer will enter a personalized medicine era in the next 5 years.

  9. Research Advances in Cyclooxygenase-2 and Gastric Carcinoma%环氧合酶-2在胃癌中的研究进展

    Institute of Scientific and Technical Information of China (English)

    王璟; 韩晓鹏; 李洪涛; 于建平; 刘宏斌

    2015-01-01

    我国胃癌发病人数居全球首位,其发生机制及安全有效的治疗是研究重点.大量研究结果表明,环氧化酶-2(Cyclooxygenase-2,COX-2)过度表达促进肿瘤细胞增殖和抑制细胞凋亡,并与胃癌的发生发展、淋巴转移、分化程度、病理分期及预后密切相关.随着COX-2与胃癌关系的研究的深入,COX-2已逐渐成为胃癌治疗的新的靶点.近年来,针对细胞受体、信号传导、细胞周期和血管生成等靶点的抗肿瘤治疗已成为肿瘤治疗研究的新方向.因此,以COX-2为特异靶点的治疗策略有望为胃癌治疗提供新的思路.%The population of patients with gastric carcinoma in China ranks first in the world.A safe and effective treatment of gastric carcinoma is the key point in the research.Several studies have shown that Cyclooxygenase-2 (COX-2) overexpression promotes tumor cell proliferation and inhibition of apoptosis.COX-2 is closely associated with the development of gastric carcinoma,lymph node metastasis,differentiation,pathological staging and prognosis.COX-2 has become a new target for cancer therapy with COX-2 and gastric carcinoma in-depth study.In recent years,along with the molecular biology of cancer occurrence and development mechanism of the deepening of the research,directed cell receptor,signal transduction,cell cycle and angiogenesis targeted anti tumor therapy has become a new research direction in tumor therapy.Therefore,COX-2,as a specific target for therapeutic strategies for the treatment of gastric carcinoma,is expected to provide new ideas.

  10. Gastric carcinoma: when is palliative gastrectomy justified?

    Directory of Open Access Journals (Sweden)

    Hubert Scheidbach

    2011-12-01

    Full Text Available Gastric carcinoma is frequently diagnosed with an advanced stage of non-curable tumor growth characterized by infiltration of the gastric serosa, peritoneal tumor spread and/or metastases within lymph nodes and liver. Currently, there is a controversy on the value of palliative resection with regard to the safety and benefit to the patient outcome. Based on the available literature, this overview summarizes the various aspects and interprets the limited data on the palliative resection of gastric carcinoma. It turns out that the available study results may indicate potential for an improved quality of life and a prolongation of survival if an acceptable morbidity and mortality are present.

  11. Clinical research on patients with advanced gastric cancer treated with mFOLFOX6%mFOLFOX6方案治疗28例进展期胃癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    李秀翠; 姜维美

    2012-01-01

    目的 观察改良FOLFOX6(mFOLFOX6)方案治疗进展期胃癌的临床疗效和毒副反应.方法 28例进展期胃癌采用奥沙利铂(L-OHP) 85 mg·m-2,d1(2 h);甲酰四氢叶酸(CF) 200 mg·m-2,d1(2 h);5-氟尿嘧啶(5-Fu) 400 mg·m-2,d1,5-Fu 2 400~3 000 mg·m-2,维持静脉滴注(CIV)46 h,每14 d为1周期,完成4周期后评价疗效.结果 全组28例,完全缓解2例(7.14%),部分缓解10例(35.71%),稳定11例(39.29%),进展5例(17.86%),近期有效率(CR+PR)为42.86%.最常见的毒副反应为血液学毒性、神经毒性及胃肠道毒性.结论 mFOLFOX6方案治疗进展期胃癌疗效可靠,毒副反应可以耐受.%Objective To study the efficacy and toxicity of the chemotherapy regimen mF0LF0X6 for 28 cases of patients with advanced gastric cancer. Methods L-OHP 85 mg · M-2 ,iv infusion for 2 hours,dl ,CF 200 mg · M-2 for 2 hours,dl ;5-Fu 400 mg · M-2 ,iv bolus,5-Fu 2 400 ~3 000 mg · M-2 ,civ infusion for 46 hours, repeated every 2 weeks. 28 patients with advanced gastric cancer were studied. Results There were 2 cases CR ( 7. 14% ) and 10 cases PR ( 35. 71% ), 11 cases SD ( 39. 29% ) and 5cases PD ( 17. 86% ). The overall response rate( CR + PR )was 42. 86% . The main toxicies were gastrointestinal adverse effects,bone marrow suppression and neuro-sensory toxicity. Conclusion mF0LF0X6 has better efficacy for advanced gastric cancer, and its toxicity is tolerable.

  12. 多西紫杉醇联合5-FU和顺铂改善进展期胃癌生存%Docetaxel and Cisplatin Plus Fluorouracil as First-Line Therapy for Advanced Gastric Cancer Can Improve TTP and OS

    Institute of Scientific and Technical Information of China (English)

    沈琳; 张华

    2008-01-01

    @@ 1 文献来源 van Cutsem E,Moiseyenko VM,Tjulandin S,et al.Phase Ⅲ study of Docetaxel and Cisplatin plus Fluorouracil compared with Cisplatin and Fluorouracil as first-line therapy for advanced gastric cancer:A report of the V325 study group[J].J Clin Oncol,2006,24(31):4991-4997.

  13. Long term (five-year survival following radical surgical treatment plus adjuvant chemotherapy (FAM in advanced gastric cancer: a controlled study

    Directory of Open Access Journals (Sweden)

    Bresciani Cláudio

    2000-01-01

    Full Text Available Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C. In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1 The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2 There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3 Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4 There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5 Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate.

  14. Meta-analysis of Huoxue Jiedu Medicine Combined with Chemotherapy Treating Ad-vanced Gastric Cancer%活血解毒药联合化疗治疗中晚期胃癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王晓妍; 曹志群

    2015-01-01

    Objective:To evaluate the effectiveness and safety of Huoxue Jiedu medicine combined with chemotherapy in the treatment of advanced gastric cancer. Methods:Using the evaluation method of Cochrane system,we have searched VIP,CNKI,CBM,WanFang database,collected randomized controlled trials about Huoxue Jiedu medicine combined with chemotherapy in the treatment of advanced gastric cancer. According to the inclusion and exclusion criteria,quality assessment,screening and extracting the effective data,Meta-! analysis was performed with RevMan 5.0 software. Results:In 14 articles,901 patients met the inclusion cri-teria and enter the study. The results of Meta-analysis showed,improving the clinical efficacy,clinical symp-tom and life quality,reduce the reaction of digestive tract,blood cell toxicity and liver and kidney toxicity, Huoxue Jiedu medicine combined with chemotherapy was better than alone western medicine chemotherapy for advanced gastric cancer , with significant difference ( P<0 . 01 ) . Conclusions:Huoxue Jiedu medicine has certain auxiliary therapeutic effect on patients with advanced gastric cancer. It could improve the clinical ef-ficacy,clinical symptom and life quality,reduce the reaction of digestive tract,blood cell toxicity and toxicity of liver and kidney.%目的:系统评价活血解毒药联合化疗治疗中晚期胃癌的有效性和安全性。方法:采用Cochrane系统评价方法,检索维普资讯中文科技期刊数据库、中国知网数据库、中国生物医学期刊引文数据库及万方医学网数据库相关文献,收集活血解毒药联合化疗治疗中晚期胃癌的临床随机对照试验。按纳入排除标准、文献质量评价、筛选并提取有效数据,采用RevMan 5.0软件进行Meta分析。结果:共有14篇文献,共计901名患者符合纳入标准而进入研究。 Meta分析显示,在提高中晚期胃癌患者临床疗效、改善临床证候、提高生活质量以及减少消化道

  15. Clinicopathological analysis of patients with gastric cancer in 1200 cases

    Institute of Scientific and Technical Information of China (English)

    Wei Xin Niu; Xin Yu Qin; Han Liu; Cheng Pei Wang

    2001-01-01

    @@INTRODUCTION Gastric cancer is one of the most common fatal malignancies in the world. The prognosis is generally poor in advanced gastric cancer .The low survival is related to delayed diagnosis, metastasis and recurrence after operation .The aim of this paper was to find correlation between clinical factors was to find correlation between clinical factors and biologic behavior of gastric cancer in a series of 1200 patients undergoing surgical resection.

  16. Randomized trials and quality assurance in gastric cancer surgery.

    Science.gov (United States)

    Dikken, Johan L; Cats, Annemieke; Verheij, Marcel; van de Velde, Cornelis J H

    2013-03-01

    A D2 lymphadenectomy can be considered standard of surgical care for advanced resectable gastric cancer. Currently, several multimodality strategies are used, including postoperative monochemotherapy in Asia, postoperative chemoradiotherapy in the United States, and perioperative chemotherapy in Europe. As the majority of gastric cancer patients are treated outside the framework of clinical trials, quality assurance programs, including referral to high-volume centers and clinical auditing are needed to improve gastric cancer care on a nationwide level. Copyright © 2012 Wiley Periodicals, Inc.

  17. Clinicopathologic features and prognosis analysis of mucinous gastric carcinoma.

    Science.gov (United States)

    Yin, Chunming; Li, Deming; Sun, Zhe; Zhang, Ting; Xu, Yan; Wang, Zhenning; Xu, Huimian

    2012-06-01

    Mucious gastric carcinoma (MGC) is a subtype of gastric carcinoma and its clinicopathologic features and prognosis still remain unclear. To investigate the clinical significance and surgical outcomes of mucinous gastric carcinoma, 2,769 patients with gastric carcinoma were analyzed in a case control study. We reviewed the records of 196 patients with mucinous gastric carcinoma and 2,573 with nonmucinous gastric carcinoma (NGC). Clinicopathologic features and survival rate of patients were analyzed. In all registered patients, patients with MGC had a larger size, more T3 and T4 invasion to the gastric wall, more positive lymph node metastasis, more III and IV stage and more positive peritoneal dissemination, but less curative gastrectomy. In curative gastrectomy patients, MGC had larger size, deeper invasion to gastric wall, more positive lymph node metastasis and more advanced TNM stage. The overall survival rate in curative gastrectomy patients with MGC was significantly lower than that for patients with NGC (P gastric carcinoma, but MGC itself was not. The prognosis of MGC did not have significant difference compared with NGC. Frequently, MGC was of advanced stage at the time of diagnosis. Age, location of tumor, Borrmann type, depth of invasion, lymph node metastasis and lymphovascular invasion are independent prognostic factors of gastric carcinoma, but mucinous histological type itself is not. Further study on the origin and progression of MGC is needed in future.

  18. Incidence of hand-foot syndrome with capecitabine in combination with chemotherapy as first-line treatment in patients with advanced and/or metastatic gastric cancer suitable for treatment with a fluoropyrimidine-based regimen.

    Science.gov (United States)

    Gómez-Martin, Carlos; Sánchez, Antonio; Irigoyen, Antonio; Llorente, Beatriz; Pérez, Begoña; Serrano, Raquel; Safont, M José; Falcó, Esther; Lacasta, Adelaida; Reboredo, Margarita; Aparicio, Jorge; Dueñas, Rosario; Muñoz, Marta Llanos; Regueiro, Pilar; Sanchez-Viñes, Elena; López, Rafael López

    2012-09-01

    Hand-foot syndrome (HFS) is a limiting toxicity of capecitabine, which is not life-threatening but could compromise capecitabine efficacy. This phase II, multicenter, non-controlled study assessed the safety, particularly grade three HFS incidence, and efficacy of four capecitabine-based chemotherapy regimens [cisplatin/capecitabine (CX), epirubicin/cisplatin/capecitabine (ECX), epirubicin/oxaliplatin/capecitabine (EOX) and docetaxel/cisplatin/capecitabine (DCX)] as first-line treatment for advanced and/or metastatic gastric cancer. One hundred and eight patients were assigned to one of the four treatment groups, according to investigator's criteria, and grouped together for both safety and efficacy primary analyses. HFS was reported in 31 patients (19.6%) and its first presentation occurred at a median of 72 days (range 19-209 days). Grade 3 HFS developed in 6.3, 5.2, 3.7 and 2.4%, of patients receiving ECX, DCX, EOX or CX chemotherapy regimen, respectively. Capecitabine dose reduction/discontinuation due to HFS was required in 5.7% of patients (9/158). The most common (> 10%) grade 3-4 treatment-related AEs were neutropenia (15.2%), asthenia (12.0%) and diarrhoea (11.4%). A moderate incidence of HFS was reported in patients treated with capecitabine, which generally presented late and required dose reduction in < 1/3 of patients. The results suggest that capecitabine may be useful in combination with standard fluorouracil-based regimens in patients with advanced and/or metastatic gastric cancer with favourable safety profile.

  19. Application Effect of Home Enteral Nutrition for Advanced Gastric Cancer%家庭肠内营养应用于胃癌晚期患者中的效果

    Institute of Scientific and Technical Information of China (English)

    明军; 徐克强; 袁友强

    2015-01-01

    目的 探讨家庭肠内应用对胃癌晚期患者营养状态以及生活质量的效果. 方法 选取96例晚期胃癌患者作为研究对象,其中46例患者采用家庭肠内营养支持为EN组,另50例患者进行院内肠外营养支持为PN组,比较两组患者营养支持前后营养状态的变化以及营养支持6个月后患者生活质量的变化. 结果 两组患者经营养支持治疗后其血液成分和机体组成成分均与营养支持前存在明显差异(P0.05),但EN组患者的体重、BMI以及脂肪群均明显高于PN组患者(P0.05),but the body weight,BMI and fat mass of patients in EN group were significantly higher than those of the PN group( P<0.05) ,and the KPS,OLI and func-tional scores of EORTC QLQ C30EN of EN group were significantly higher than those of the PN group,while the single score of EORTC QLQ C30 was significantly lower than that of the PN group(P<0.05),the differences were statistically significant.Con-clusion Home enteral nutrition can effectively improve the nutritional status of advanced gastric cancer,and compared with par-enteral nutrition,it has better effect in improving quality of life of patients,it is worthy of application in advanced gastric cancer patients.

  20. Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hyun; Park, Joong-Won; Kim, Yeon-Joo; Kim, Bo Hyun; Woo, Sang Myung; Moon, Sung Ho; Kim, Sang Soo; Lee, Woo Jin; Kim, Dae Yong; Kim, Chang-Min [National Cancer Center, Center for Liver Cancer, Research Institute and Hospital, Goyang-si, Gyeonggi-do (Korea, Republic of)

    2014-10-15

    The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC). A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) < 1 cm from gastrointestinal structures, received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 (PTV1) and 2 (PTV2), respectively. The 12 patients in the high dose-fractionation (HD) group, with ITV ≥ 1 cm from gastrointestinal structures, received total doses of 66 and 55 Gy in 22 fractions to the PTV1 and PTV2, respectively. Overall, treatment was well tolerated, with no grade > 3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7 %) than patients in the HD group (p < 0.05 each). The median overall survival (OS) was 25.1 months and the actuarial 2-year local progression-free survival (LPFS), relapse-free survival (RFS), and OS rates were 67.3, 14.7, and 54.7 %, respectively. The HD group tended to show better tumor response (100 vs. 62.2 %, p = 0.039) and 2-year LPFS (85.7 vs. 59 %, p = 0.119), RFS (38.1 vs. 7.3 %, p = 0.063), and OS (83.3 vs. 44.3 %, p = 0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS. SIB-IMRT is feasible and safe for patients with inoperable HCC. (orig.) [German] Ziel der Arbeit war es, die klinische Wirksamkeit und die Sicherheit der intensitaetsmodulierten Radiotherapie mit simultanem integriertem Boost (SIB-IMRT) fuer Patienten mit einem inoperablen hepatozellulaeren Karzinom (HCC) zu evaluieren. Bei 53 Patienten mit inoperablem HCC wurden zwei unterschiedliche Dosierungskonzepte je nach Lagebeziehung des

  1. Post-marketing Safety Evaluation of S-1 in Patients with Inoperable or Recurrent Breast Cancer: Especially in Patients Treated with S-1 + Trastuzumab

    OpenAIRE

    Saito, Yuki; Oshitanai, Risa; Terao, Mayako; Terada, Mizuho; Tsuda, Banri; Okamura, Takuho; Suzuki, Yasuhiro; Tokuda, Yutaka

    2011-01-01

    Objective The purpose of this study was to assess the safety of S-1 in Japanese in inoperable or recurrent breast cancer patients. Methods A prospective post-marketing surveillance was performed at 313 sites in Japan in patients with inoperable or recurrent breast cancer treated with S-1. We examined 1361 patients between January 2006 and December 2007 with regard to the incidence of adverse drug reactions graded by the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Resu...

  2. Research Advances in the Hedgehog Signaling Pathway in Gastric Cancer%Hedgehog信号通路在胃癌中的研究进展

    Institute of Scientific and Technical Information of China (English)

    郝亚琴

    2011-01-01

    Hedgehog信号通路是来自内胚层的信号分子之一,在个体胚胎发育诱导、模式的形成和细胞命运的决定中起着关键的作用,信号紊乱会导致各种组织器官畸形.在个体发育成熟后,Hedgehog信号通路只在特定的部位表达,与器官正常功能的维持、机体内环境的稳定有着密切的关系.然而,越来越多的研究显示Hedgehog信号通路与肿瘤的发生发展有着密切的关联.已有研究报道胃癌中也明显存在Hedgehog信号通路的异常活化.本文从Hedgehog信号通路过度表达的机制、成员突变、非经典Hedgehog信号通路、胃癌干细胞、上皮间质转化等方面出发,将近几年来Hedgehog信号通路与胃癌发生发展关联方面的研究进展进行报道.%The Hedgehog signaling pathway involves cells originaing from the endoderm. It plays a crucial role in embryonic development, pattern formation and cell fate. Its mutation or abnormal expression can result in malformations of various tissues and organs. After maturation of the individual, the Hedgehog signaling pathway is either not expressed, has low expression or is only expressed in a few specific parts. This pathway is important for maintaining normal organ function and a stable internal environment.However, many studies have revealed that abnormal expression of the Hedgehog signaling pathway is found in carcinogenesis. These studies also determined that this pathway can be activated by mutations or other mechanisms, leading to abnomal expression in adult tissue. It appears to play a crucial role in the development of tumors, including basal cell cancer, lung cancer, prostate cancer, colorectal cancer, and pancreatic cancer A special inhibitor of the Hedgehog signaling pathway can inhibit the proliferation of these tumor cells.Gastric cancer is a significant threat to human health; as a malignant disease, it ranks second worldwide and first in China in incidence and mortality, It has been reported

  3. [Photodynamic therapy for gastric cancer].

    Science.gov (United States)

    Mimura, S; Narahara, H; Uehara, H; Otani, T; Okuda, S

    1996-01-01

    In this article, we first present our clinical data on PDT for the treatment of gastric cancer and make a comparison between a continuous wave laser and a pulsed laser. The reasons for PDT failure in certain cases are also discussed. In the fifteen years from 1981 to 1995, we have treated a total of 76 gastric cancer lesions (73 cases), which was consist of 69 early gastric cancer lesions (66 cases) and seven advanced gastric cancer lesions (seven cases) by PDT. From 1981 to 1990, we used an argon dye laser (ADL, Models 171-08 and 375-03, Spectra-Physics, Mountain View, Calif., US) as an excitation light source for PDT with HpD (Photofrin I), DHE (Photofrin II) or PHE (freeze-dried Photofrin II). From analysis of the results in terms of the depth of cancer invasion in these 44 lesions (41 cases), the rate of cure for mucosal carcinomas was 57% (13/23), that of submucosal carcinomas was 53% (10/19), and that of carcinomas invading more than the muscularis propria was 0% (0/2). These data can be interpreted to indicate that the ADL laser beam could not penetrate and supply sufficient energy to activate HpD not only in the submoucosal layer but also in the mucosal layer. In 1990, therefore, we investigated an excimer dye laser (EDL, Hamamatsu Photonics, Hamamatsu, Japan), because its pulsed beam with extremely high peak power was expected to be more efficient at exciting HpD than continuous wave lasers such as ADL and high frequency pulsed lasers such as cooper vapor dye laser (Cu VDL). From 1990 to 1995, twenty-seven early gastric cancer lesions (27 cases) and five advanced gastric cancer lesions (five cases) were treated by PDT with EDL and PHE. Of these 32 lesions, the rate of cure for mucosal carcinomas was 100% (15/15), that of submucosal carcinomas was 75% (9/12), and that of carcinomas invading more than the muscularis propria was 20% (1/5). For the purpose of determining how much energy was required for a complete cure in early gastric cancer, and to compare

  4. Oncogenic Transformation of Human-Derived Gastric Organoids.

    Science.gov (United States)

    Bertaux-Skeirik, Nina; Centeno, Jomaris; Gao, Jian; Gabre, Joel; Zavros, Yana

    2016-08-19

    The culture of organoids has represented a significant advancement in the gastrointestinal research field. Previous research studies have described the oncogenic transformation of human intestinal and mouse gastric organoids. Here we detail the protocol for the oncogenic transformation and orthotopic transplantation of human-derived gastric organoids.

  5. Hyperfractionated radiotherapy combined with chemotherapy for inoperable non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Atsushi; Shimokata, Kaoru; Nomura, Fumio; Saka, Hideo (Nagoya Univ. (Japan). Faculty of Medicine); Horio, Yoshitsugu; Minami, Hironobu; Iwahara, Tsuyoshi; Shibagaki, Tomohisa; Sakai, Shuzo

    1991-02-01

    Eleven cases of inoperable non-small cell lung cancer were treated with hyperfractionated radiotherapy combined with chemotherapy. Hyperfractionated radiotherapy consisted of 1.6 Gy per fraction, 2 fractions a day with 6 hours between fractions, 5 days a week for a total of 60.8 Gy. After 38.4 Gy of irradiation to the primary tumor, hilar, and mediastinal lymph nodes, an additional 22.4 Gy was given to primary lesion. Chemotherapy consisted of cisplatin, 80 mg/m{sup 2} day 1, mitomycin C, 10 mg/m{sup 2} day 1, and vinblastine, 5 mg/m{sup 2}, days 1 and 15. At least 2 courses were administered. The combination of radiotherapy and chemotherapy was sequential. Of 6 patients in whom hyperfractionated radiotherapy was performed first, 5 achieved partial response (PR). Of 5 patients in whom chemotherapy was performed first, 2 achieved PR. Median survival time was 300 days. Nine of the eleven patients experienced esophagitis, but in all patients this was controlled easily by oral antacids and/or H{sub 2} blockers. In regard to radiation pneumonitis, fibrosis occurred in seven of nine cases, but they did not require corticosteroids. Levels of hematological toxicity were similar to previous reports, but were somewhat severe in cases receiving chemotherapy after irradiation. We conclude that hyperfractionated radiotherapy combined with chemotherapy including cisplatin is safe, but further evaluation to determine optimal dose and combination methods is necessary. (author).

  6. Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors

    Science.gov (United States)

    Niessen, C.; Thumann, S.; Beyer, L.; Pregler, B.; Kramer, J.; Lang, S.; Teufel, A.; Jung, E. M.; Stroszczynski, C.; Wiggermann, P.

    2017-01-01

    Aim of this retrospective analysis was to evaluate the survival times after percutaneous irreversible electroporation (IRE) in inoperable liver tumors not amenable to thermal ablation. 71 patients (14 females, 57 males, median age 63.5 ± 10.8 years) with 103 liver tumors were treated in 83 interventions using IRE (NanoKnife® system). The median tumor short-axis diameter was 1.9 cm (minimum 0.4 cm, maximum 4.5 cm). 35 patients had primary liver tumors and 36 patients had liver metastases. The Kaplan-Meier method was employed to calculate the survival rates, and the different groups were compared using multivariate log-rank and Wilcoxon tests. The overall median survival time was 26.3 months; the median survival of patients with primary land secondary liver cancer did not significantly differ (26.8 vs. 19.9 months; p = 0.41). Patients with a tumor diameter >3 cm (p Child-Pugh class B or C cirrhosis died significantly earlier than patients with Child-Pugh class A (p < 0.05). Patients with very early stage HCC survived significantly longer than patients with early stage HCC with a median survival of 22.3 vs. 13.7 months (p < 0.05). PMID:28266600

  7. Active but inoperable thrombin is accumulated in a plasma protein layer surrounding Streptococcus pyogenes.

    Science.gov (United States)

    Naudin, Clément; Hurley, Sinead M; Malmström, Erik; Plug, Tom; Shannon, Oonagh; Meijers, Joost C M; Mörgelin, Matthias; Björck, Lars; Herwald, Heiko

    2015-10-01

    Activation of thrombin is a critical determinant in many physiological and pathological processes including haemostasis and inflammation. Under physiological conditions many of these functions are involved in wound healing or eradication of an invading pathogen. However, when activated systemically, thrombin can contribute to severe and life-threatening conditions by causing complications such as multiple multi-organ failure and disseminated intravascular coagulation. In the present study we investigated how the activity of thrombin is modulated when it is bound to the surface of Streptococcus pyogenes. Our data show that S. pyogenes bacteria become covered with a proteinaceous layer when incubated with human plasma, and that thrombin is a constituent of this layer. Though the coagulation factor is found attached to the bacteria with a functional active site, thrombin has lost its capacity to interact with its natural substrates and inhibitors. Thus, the interaction of bacteria with human plasma renders thrombin completely inoperable at the streptococcal surface. This could represent a host defense mechanism to avoid systemic activation of coagulation which could be otherwise induced when bacteria enter the circulation and cause systemic infection.

  8. Experience with gemcitabine and cisplatin in the therapy of inoperable and metastatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Chaiyut Charoentum; Sumitra Thongprasert; Busyamas Chewaskulyong; Sutthirak Munprakan

    2007-01-01

    AIM:To study the activity of gemcitabine and cisplatin in a cohort of patients with inoperable or metastatic cholangiocarcinoma.METHODS: Chemotherapy-naive patients with pathologically proven cholangiocarcinoma, receiving treatment that consisted of gemcitabine at 1250 mg/m2in a 30-min infusion on d 1 and 8, and cisplatin at 75 mg/m2 at every 21-d cycle, were retrospectively analyzed.RESULTS: From June 2003 to December 2005, 42patients were evaluated. Twelve patients (28%) had unresectable disease and 30 (72%) had metastatic disease. There were 28 males and 14 females with a median age of 51 years (range 33-67) and median ECOG PS of 1 (range 0-2). A total of 171 cycles were given with a median number of cycles of 4 (range 1-6).There were 0 CR, 9 PR, 11 SD and 13 PD (response rate 21%). Grade 3-4 hematologic toxicities were: anemia in 33%, neutropenia in 22% and thrombocytopenia in 5%.Non-hematologic toxicity was generally mild. No cases of febrile neutropenia or treatment-related death were noted. The median survival was 10.8 mo (range 8.4-13mo) and progression free survival was 8.5 mo. One-year survival rate was 40%.CONCLUSION: Our results indicate that the combination of gemcitabine and cisplatin had consistent efficacy in patients with unresectable or metastatic cholangiocarcinoma.

  9. 生长激素释放肽和瘦素与进展期胃癌低蛋白血症的关系%Relationship between the levels of ghrelin and leptin and the hypoalbuminemia of advanced gastric carcinoma

    Institute of Scientific and Technical Information of China (English)

    王海鹏; 朱袭嘉; 王丽兰; 田小林; 何永玲; 庞凌坤; 戴凌; 陈霄

    2016-01-01

    Objective To discuss the relationship between the level of ghrelin and leptin of patients with gastric carcinoma and the hypoalbu-minemia of advanced gastric carcinoma , and its significance of clinical pathology as well.Methods Radioimmunoassay ( RIA ) and enzyme linked immunosorbent assay (ELISA) were used to determine the changes of the ghrelin and leptin level in 20 cases of normal healthy people and 120 patients with gastric cancer ( including 37 cases of hypoalbuminemia ( albumin<35 g· L-1 ) and 88 cases of normal protein people ( albumin≥35 g· L-1 ) , their expressions and the relevance of clinical pathology parameters were also detected.Results The ghrelin and leptin levels of patients with gastric carcinoma were significantly higher than those of nor-mal group (P<0.01), and the ghrelin and leptin levels of patients with the hypoalbuminemia were obviously higher than those of health subjects with normal protein.In addition, in patients with high content of ghrelin and leptin , the rate of patients with poorly differentiated carcinoma and lymph node metastasis was obviously increased.Conclusion The detec-tion of the changes of ghrelin and leptin levels will be of great significance in the diagnosis and prognosis of gastric carcinoma , which provides theoretical basis for the diagnosis and treatment of cancerous hypoalbuminemia .%目的:观察胃癌患者血清生长激素释放肽(ghrelin)和瘦素(leptin)水平与进展期胃癌低蛋白血症的关系及临床病理学意义。方法用放射免疫分析法(RIA)和酶联免疫吸附法(ELISA)测定20例健康受试者(正常组)和低蛋白血症者37例(试验组,白蛋白<35 g· L-1)和蛋白正常者88例(对照组,白蛋白≥35 g· L-1)的血清生长激素释放肽和瘦素水平的变化,并检测其与临床病理学参数的关联性。结果试验组和对照组血清生长激素释放肽和瘦素水平均显著高于正常组( P<0.01);试验

  10. Stomach (Gastric) Cancer Prevention

    Science.gov (United States)

    ... Treatment Stomach Cancer Prevention Stomach Cancer Screening Research Stomach (Gastric) Cancer Prevention (PDQ®)–Patient Version What is ... to keep cancer from starting. General Information About Stomach Cancer Key Points Stomach (gastric) cancer is a ...

  11. Advance in Relationship between Gastric Carcinoma and Selenium or Selenide%硒及其化合物与胃癌研究进展

    Institute of Scientific and Technical Information of China (English)

    代明真

    2009-01-01

    Gastric carcinoma is one of the most common malignant tumor in the world,its incidence and mortality are second only to lung cancer, and China owns its highest incidence now. Many studies have shown that selenium and its chemical com-pounds have wide biological action and can stop the existence and deterioration of varied tumors. There may be some considerable relations between selenium and gastric carcinoma,yet not clear and definite. So to have a better understanding to this and make further improvements to clarify relations between the two and their possible function mechanism, this article will summarize rela-tive studies in recent years.%胃癌是全世界发病率和死亡率仅次于肺癌的恶性肿瘤,而我国是世界上胃癌发病率最高的国家之一.大量的研究资料表明,硒及其化合物具有广泛的生物学作用,具有阻止多种肿瘤发生发展的作用,硒与胃癌之间有着较大的关联性,但两者之间的关系尚不明确.为更好地认识硒及其化合物对胃癌发生发展的影响,进一步了解两者之间的关系以及可能的作用机制,本文就近年采相关的研究进行综述.

  12. {sup 18}F-FDG PET/CT for monitoring induction chemotherapy in patients with primary inoperable penile carcinoma: first clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Graafland, Niels M.; Horenblas, Simon [The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Urology, Amsterdam (Netherlands); Valdes Olmos, Renato A. [The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Nuclear Medicine, Amsterdam (Netherlands); Teertstra, Hendrik J. [The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Radiology, Amsterdam (Netherlands); Kerst, J.M.; Bergman, Andries M. [The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Amsterdam (Netherlands)

    2010-08-15

    The aim of this study was to explore the role of {sup 18}F-FDG PET/CT for monitoring treatment response in patients with primary inoperable (i.e. advanced) penile carcinoma treated with induction chemotherapy and to compare the metabolic tumour response with the radiological evaluation provided by CT imaging. Eight patients with advanced penile carcinoma were studied. All had undergone {sup 18}F-FDG PET/CT imaging at baseline and after two cycles of induction chemotherapy. The metabolic tumour response was evaluated according to European Organisation for Research and Treatment of Cancer (EORTC) criteria for therapy response. The radiologic tumour response was assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. Response evaluations were done separately and blinded for other patient data. For definition of the reference, all patients were rated as responders or non-responders by a multidisciplinary tumour board. PET/CT showed hypermetabolic uptake of FDG matching with malignancy in all eight patients. According to the reference, six patients were responders and two non-responders after two cycles of chemotherapy. The metabolic tumour response was considered accurate in all eight patients. In seven of the eight patients, the radiological tumour response was in agreement. In three patients correctly identified as responders, the radiological tumour response was deemed suboptimal compared with the metabolic assessment. Five of the six responders continued chemotherapy after response evaluation up to four cycles and were operated subsequently. Histopathological analysis confirmed the metabolic tumour response. {sup 18}F-FDG PET/CT imaging is feasible for monitoring response in patients with advanced penile carcinoma treated with induction chemotherapy. Our preliminary results suggest that PET/CT is potentially more reliable than CT alone. (orig.)

  13. Vismodegib in the treatment of advanced BCC.

    Science.gov (United States)

    O'Kane, G M; Lyons, T; McDonald, I; Mulligan, N; Moloney, F J; Murray, D; Kelly, C M

    2014-01-01

    Basal-cell carcinoma (BCC) is the most commonly diagnosed malignancy, comprising over 80 per thousand of non-melanoma skin cancers. Surgical excision is adequate treatment for most BCC's. Options are however limited for the minority of patients presenting with locally advanced inoperable or metastatic BCC. The Hedgehog signalling pathway is a critical driver in the pathogenesis of both sporadic and hereditary BCC. On 31st January 2012, based on a phase II clinical trial the US Food and Drug Administration approved Vismodegib (Erivedge, Roche) a first-in-class, small-molecule oral Hedgehog-inhibitor for the treatment of locally advanced inoperable and metastatic BCC. We present our experience treating the first Irish patient with this agent.

  14. Mucin phenotype of gastric cancer and clinicopathology of gastric-type differentiated adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Namikawa; Kazuhiro; Hanazaki

    2010-01-01

    Differentiated adenocarcinoma of the stomach is classified into gastric or intestinal phenotypes based on mucus expression. Recent advances in mucin histochemistry and immunohistochemistry have highlighted the importance of such a distinction, and it is important clinically to distinguish between gastricand intestinal-type differentiated adenocarcinoma. However, a clinical and pathological diagnosis of this type is often difficult in early gastric cancer because of histological similarities between a hyperp...

  15. Epidemiology of gastric cancer

    OpenAIRE

    Crew, Katherine D.; Neugut, Alfred I.

    2006-01-01

    The incidence and mortality of gastric cancer have fallen dramatically in US and elsewhere over the past several decades. Nonetheless, gastric cancer remains a major public health issue as the fourth most common cancer and the second leading cause of cancer death worldwide. Demographic trends differ by tumor location and histology. While there has been a marked decline in distal, intestinal type gastric cancers, the incidence of proximal, diffuse type adenocarcinomas of the gastric cardia has...

  16. Gastric lymphoma

    Directory of Open Access Journals (Sweden)

    Sravani Padala

    2016-06-01

    Full Text Available Gastrointestinal lymphomas represent 5-20% of extra nodal lymphomas and mainly occur in the stomach and small intestine. Clinical findings are not specific, thus often determining a delay in the diagnosis. Imaging features at conventional and cross-sectional imaging must be known by the radiologist since he/she plays a pivotal role in the diagnosis and disease assessment, thus assisting in the choice of the optimal treatment to patients. This review focuses on the wide variety of imaging presentation of esophageal, gastric, and small and large bowel lymphoma presenting their main imaging appearances at conventional and cross-sectional imaging, mainly focusing on computed tomography and magnetic resonance, helping in the choice of the best imaging technique for the disease characterization and assessment and the recognition of potential complications. Gastrointestinal tract is the most common extra nodal site involved by lymphoma. Although lymphoma can involve any part of the gastrointestinal tract .The most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. [Int J Res Med Sci 2016; 4(6.000: 2481-2486

  17. Stages of Gastric Cancer

    Science.gov (United States)

    ... liver cancer . The following stages are used for gastric cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells are ... check-ups. Treatment Options by Stage Stage 0 (Carcinoma in ... Stage I Gastric Cancer Treatment of stage I gastric cancer may ...

  18. 开腹与腹腔镜辅助下远端胃癌D2根治术对进展期胃癌的近期疗效分析%An analysis of short-term effects of open and laparoscopy-assisted the distal gastric D2 radical surgery for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    罗武凌

    2013-01-01

    Objective To investigate the clinical value of laparoscopy surgery conducted on advanced gastric cancer by the comparative analysis of short-term effect of open and laparoscopy-assisted the distal gastric D2 radical surgery.Methods The clinicopathologic features of 75 patients with advanced gastric cancer received laparoscopy(n=42) and open surgery(n=33) respectively from June 2009 to July 2012 in this hospital were collected,and the outcome result was analyzed.Results All of the patients were received successful distal gastric D2 radical surgery.The mean operation time,length of incision,blood loss,first flatus time,ground activity time,liquid diet intake time and hospital stay in laparoscopy group,which were definitely shorter than open surgery group,were (162.00±12.99)min,(5.99±0.77)cm,(149.14±26.87)mL,(4.15±0.80)d,(2.93±0.83)d,(4.23±0.78)d and (13.30± 2.78)d respectively(P<0.05) ;but there was no significant difference between laparoscopy and open surgery with number of lymph nodes removed and length of proximal and distal margin to the cancer(P>0.05),which were 29.13 ±17.87,(6.05 ± 1.12)cm and (7.13± 1.08)cm respectively.The probability of incision infection and lung infection in the open surgery group was much higher than the laparoscopy group(P<0.05),but there was no significant difference in the probability of leakage and bleeding of anastomotic stoma,and postoperative gastroparesis between two groups(P>0.05).Conclusion Compared with open surgery,laparoscopy-assisted the distal gastric D2 radical surgery used on advanced gastric cancer had similar radical effect.At the same time,it has the advantages of shorter time of operation,shorter incision,less bleeding,faster recovery,safety and reliability.%目的 通过对开腹与腹腔镜辅助下远端胃癌D2根治术对进展期胃癌的近期疗效进行对比分析,从而评价腹腔镜手术在进展期胃癌的临床应用价值.方法 收集2009年6月至2012年7月期间75例进展期

  19. Gastric Cancer: Current Status of Diagnosis and Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Tsunehiro; Saikawa, Yoshiro, E-mail: saiky@z8.keio.jp; Kitagawa, Yuko [Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo 1608582 (Japan)

    2013-01-16

    Gastric cancer is the second leading cause of death from malignant disease worldwide and most frequently discovered in advanced stages. Because curative surgery is regarded as the only option for cure, early detection of resectable gastric cancer is extremely important for good patient outcomes. Therefore, noninvasive diagnostic modalities such as evolutionary endoscopy and positron emission tomography are utilized as screening tools for gastric cancer. To date, early gastric cancer is being treated using minimally invasive methods such as endoscopic treatment and laparoscopic surgery, while in advanced cancer it is necessary to consider multimodality treatment including chemotherapy, radiotherapy, and surgery. Because of the results of large clinical trials, surgery with extended lymphadenectomy could not be recommended as a standard therapy for advanced gastric cancer. Recent clinical trials had shown survival benefits of adjuvant chemotherapy after curative resection compared with surgery alone. In addition, recent advances of molecular targeted agents would play an important role as one of the modalities for advanced gastric cancer. In this review, we summarize the current status of diagnostic technology and treatment for gastric cancer.

  20. Motivation and preferences of exercise programmes in patients with inoperable metastatic lung cancer: a need assessment.

    Science.gov (United States)

    Kartolo, Adi; Cheng, Susanna; Petrella, Teresa

    2016-01-01

    The aim of this study is to investigate the motivation, ability, preferences, and perceived potential facilitating factors/barriers of patients with inoperable metastatic lung cancer towards exercise programmes. This is a cross-sectional study using survey adopting the Theory of Planned Behaviour (TPB) to obtain patients' experience recruited through Odette Cancer Centre, Sunnybrook Health Sciences Complex. Results were expressed in percentages, P value, and Spearman's rho. Sixty patients were recruited from January 2014 to April 2014. Patients generally had a high level across TPB measures, with 63% of them indicating that they have the motivation to exercise. Significant association in relation to motivation was established on attitudes (importance, P = 0.005, rho = 0.326; helpfulness, P = 0.015, rho = 0.348; and easiness, P = 0.001, rho = 0.375) and subjective norm of close members (P = 0.0069, rho = 0.348) and healthcare professionals (P = 0.012, rho = 0.328). Being a non-smoker (P = 0.042, rho = 0.311), having a past exercise history prior to diagnosis (P = 0.000, rho = 0.563), and absence of COPD (P = 0.016, rho = -0.312) were also shown to have a significant association with motivation to exercise. Patients were motivated to participate in an exercise programme despite contrary belief; however, they might have limited ability and preferred light intensity type of exercise such as walking. Their motivation to exercise was driven by different factors when compared to other cancer patient populations. Thus, it is important for healthcare professionals to understand the factors influencing their motivation and increase their awareness (only 26% of patients indicated receiving advice regarding exercise) to better the care towards patients with metastatic lung cancer.

  1. Co-ordinated overexpression of SIRT1 and STAT3 is associated with poor survival outcome in gastric cancer patients.

    Science.gov (United States)

    Zhang, Shu; Huang, Shuling; Deng, Chao; Cao, Yu; Yang, Jun; Chen, Guangxia; Zhang, Bin; Duan, Chaoqin; Shi, Jiong; Kong, Bo; Friess, Helmut; Zhao, Nanyi; Huang, Chen; Huang, Xiaoli; Wang, Lei; Zou, Xiaoping

    2017-03-21

    In many gastric cancer patients, the disease is diagnosed in an advanced stage and therefore the mortality levels are high. Because there is a need to identify novel early diagnostic and prognostic biomarkers, we tested whether SIRT1 and STAT3 are good candidates. Towards this, we used patient tissues representing different stages of gastric cancer including gastric pre-cancerous lesions, early gastric cancer, and advanced gastric cancer, and probed SIRT1, STAT3 and phosphorylated STAT3 (pSTAT3) levels using immunohistochemistry. Our results revealed upregulated expression of SIRT1 in all stages of gastric cancer compared with noncancerous gastric mucosa, suggesting that high SIRT1 levels are likely involved in establishing gastric neoplasticity. However, STAT3 and pSTAT3 levels remained low until the gastric mucosa reached the tumor stage. Moreover, co-ordinated high expression of SIRT1 and STAT3 predicted poor overall survival for advanced gastric cancer patients. In addition, through analysis of gastric cancer patients from the TCGA dataset, we identified SIRT2 as an independent prognostic factor in gastric cancer patients. We postulate that SIRT1 and STAT3 are potential early diagnostic and prognostic markers of gastric cancer. Our study also shows that SIRT1 acts a gatekeeper during gastric tumorigenesis.

  2. Effects of Parenteral Nutrition During Chemotherapy on the Immune Functions of Advanced Gastric Cancer Patients%化疗期间肠外营养对中晚期胃癌患者免疫功能的影响

    Institute of Scientific and Technical Information of China (English)

    杨杰

    2012-01-01

    Objective: To observe the effects of parenteral nutrition during chemotherapy on the immune function of advanced gastric cancer patients. Methods: Sixty-three advanced gastric carcinoma patients were admitted to People's Hospital of Rugao City between March 2008 and September 2010. Thirty-six patients in the observation group received parenteral nutrition during chemotherapy, whereas 27 patients in the control group received chemotherapy without parenteral nutrition. The curative effects, average chemotherapy cycles, and progression-free survival were observed The nutritional states and lymphocyte subclusters of patients were also detected. Results: The near-future curative effects of the two groups were not significantly different However, the average chemotherapy cycle and progression-free survival of the observation group were significantly better than those of the control group. The nutritional states of the patients in the observation group were significantly better after chemotherapy, and their immune functions notably improved compared with those of the control group. Conclusion: For advanced gastric cancer patients, parenteral nutrition during chemotherapy can improve their nutrition status and immune functions, enable them more tolerant to chemotherapy and help for achieving better treatment effect%目的:观察化疗期间肠外营养对中晚期胃癌患者免疫功能的影响.方法:收集江苏省如皋市人民医院自2008年3月至2010年9月间收治的63例接受化疗的中晚期胃癌患者,随机分为观察组(化疗同时给予肠外营养)36例和对照组(化疗期间未给予肠外营养)27例.观察两组患者化疗疗效、平均化疗周期、无进展生存期,检测化疗前后两组患者营养状况和淋巴细胞亚群情况.结果:两组患者近期疗效无显著性差异;观察组平均化疗周期和无进展生存期显著优于对照组;化疗后观察组患者营养状况显著优于对照组;淋巴细胞亚群检测显

  3. Expression of the matrix metalloproteases 2, 14, 24, and 25 and tissue inhibitor 3 as potential molecular markers in advanced human gastric cancer.

    Science.gov (United States)

    de la Peña, Sol; Sampieri, Clara Luz; Ochoa-Lara, Mariana; León-Córdoba, Kenneth; Remes-Troche, José María

    2014-01-01

    During progression of gastric cancer (GC), degradation of the extracellular matrix is mediated by the matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs): changes in the expression of these have been related to unfavorable prognosis in GC. To analyze the expression of certain MMPs and TIMPs in chronic superficial gastritis (SG) and GC. The expression of MMPs and TIMPs was determined using qRT-PCR; the expression was classified, using threshold cycle (C(T)) values, as very high (C(T) ≤ 25), high (C(T) = 26-30), moderate (C(T) = 31-35), low (C(T) = 36-39), or not detected (C(T) = 40). Strength of association was estimated between the proteins, which were detected by Western blot, and the risk of developing GC. We found a high expression of MMP1, MMP2, MMP14, TIMP1, and TIMP3; moderate one of MMP9 and MMP25, and low one of MMP13 and MMP24 in both tissues. In absolute mRNA levels, significant differences were found in expression of MMP2, MMP24, and MMP25, which are overexpressed in GC compared with SG. The presence of the proteins MMP-14 and TIMP-3 was associated with the risk of developing GC. We consider that MMP2, MMP24, and MMP25 and the proteins MMP-14 and TIMP-3 could be candidates for prognostic molecular markers in GC.

  4. Expression of the Matrix Metalloproteases 2, 14, 24, and 25 and Tissue Inhibitor 3 as Potential Molecular Markers in Advanced Human Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Sol de la Peña

    2014-01-01

    Full Text Available Background. During progression of gastric cancer (GC, degradation of the extracellular matrix is mediated by the matrix metalloproteases (MMPs and their tissue inhibitors (TIMPs: changes in the expression of these have been related to unfavorable prognosis in GC. Objective. To analyze the expression of certain MMPs and TIMPs in chronic superficial gastritis (SG and GC. Methods. The expression of MMPs and TIMPs was determined using qRT-PCR; the expression was classified, using threshold cycle (CT values, as very high (CT≤25, high (CT=26–30, moderate (CT=31–35, low (CT=36–39, or not detected (CT=40. Strength of association was estimated between the proteins, which were detected by Western blot, and the risk of developing GC. Results. We found a high expression of MMP1, MMP2, MMP14, TIMP1, and TIMP3; moderate one of MMP9 and MMP25, and low one of MMP13 and MMP24 in both tissues. In absolute mRNA levels, significant differences were found in expression of MMP2, MMP24, and MMP25, which are overexpressed in GC compared with SG. The presence of the proteins MMP-14 and TIMP-3 was associated with the risk of developing GC. Conclusions. We consider that MMP2, MMP24, and MMP25 and the proteins MMP-14 and TIMP-3 could be candidates for prognostic molecular markers in GC.

  5. The tumor-stromal ratio as a strong prognosticator for advanced gastric cancer patients: proposal of a new TSNM staging system.

    Science.gov (United States)

    Peng, Chunwei; Liu, Jiuyang; Yang, Guifang; Li, Yan

    2017-08-16

    Insufficient attention is paid to the underlying tumor microenvironment (TME) evolution, that resulting in tumor heterogeneity and driving differences in cancer aggressiveness and treatment outcomes. The morphological evaluation of the proportion of the stroma at the most invasive part of primary tumor (tumor-stromal ratio, TSR) in cancer is gaining momentum as evidence strengthens for the clinical relevance. Tissue samples from the most invasive part of the primary gastric cancer (GC) of 494 patients were analyzed for their TSR, and a new TSNM (tumor-stromal node metastasis) staging system based on patho-biological behaviors was established and assessed. TSR is a new and strong independent prognostic factor for GC patients. The likelihood of tumor invasion is increased significantly for patients in the stromal-high subgroup compared to those in the stromal-low subgroup (P = 0.011). The discrimination ability of TSR was not less than the TNM staging system and was better in patients with stages I and II GC. We integrated the TSR parameter into the TNM staging system and proposed a new TSNM staging system creatively. There were three new subgroups (IC, IIC, IIID). There were four major groups and 10 subgroups in the TSNM system. The difference in overall survival (OS) was statistically significant among all TSNM system (P system has been established to optimize risk stratification for GC. The value of the TSNM staging system should be validated in further prospective study.

  6. Expression of the Matrix Metalloproteases 2, 14, 24, and 25 and Tissue Inhibitor 3 as Potential Molecular Markers in Advanced Human Gastric Cancer

    Science.gov (United States)

    de la Peña, Sol; Sampieri, Clara Luz; Ochoa-Lara, Mariana; León-Córdoba, Kenneth; Remes-Troche, José María

    2014-01-01

    Background. During progression of gastric cancer (GC), degradation of the extracellular matrix is mediated by the matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs): changes in the expression of these have been related to unfavorable prognosis in GC. Objective. To analyze the expression of certain MMPs and TIMPs in chronic superficial gastritis (SG) and GC. Methods. The expression of MMPs and TIMPs was determined using qRT-PCR; the expression was classified, using threshold cycle (CT) values, as very high (CT ≤ 25), high (CT = 26–30), moderate (CT = 31–35), low (CT = 36–39), or not detected (CT = 40). Strength of association was estimated between the proteins, which were detected by Western blot, and the risk of developing GC. Results. We found a high expression of MMP1, MMP2, MMP14, TIMP1, and TIMP3; moderate one of MMP9 and MMP25, and low one of MMP13 and MMP24 in both tissues. In absolute mRNA levels, significant differences were found in expression of MMP2, MMP24, and MMP25, which are overexpressed in GC compared with SG. The presence of the proteins MMP-14 and TIMP-3 was associated with the risk of developing GC. Conclusions. We consider that MMP2, MMP24, and MMP25 and the proteins MMP-14 and TIMP-3 could be candidates for prognostic molecular markers in GC. PMID:24669030

  7. Relationship between the expression of vascular endothelial growth factor and prognosis in elderly advanced gastric cancer%VEGF在老年进展期胃癌的表达及其与预后的关系

    Institute of Scientific and Technical Information of China (English)

    胡杰; 吴慧群; 张文发

    2011-01-01

    Objective To explore the relationship between the expression of vascular endothelial growth fac tor (VEGF) and prognostic evaluation in patients with elderly advanced gastric cancer. Methods Sixty patients of el derly advanced gastric cancer were selected as the study group, and 32 healthy individuals were enrolled as the control group. Immunohistochemical study was performed in the two groups to investigate the expression of VEGF and microvessel density (MVD). The relationship between the levels of VEGF and MVD and prognosis was analyzed. Results The positive rates of VEGF and MVD were much higher in the study group than the control group (P<0.01); There was statistically significant difference in the expression of MVD and VEGF in different TNM stages and lym phatic metastasis (P<0.05). The three-year survival rate and five-year survival rate were significantly lower in patients with positive expression of VEGF than patients with negative expression of VEGF. Conclusion The expression of VEGF is closely associated with angiogenesis, tumor growth and tumor metastasis. VEGF can be the prognostic dis criminators in prostate cancer.%目的 探讨血管内皮生长因子(VEGF)在老年进展期胃癌的表达及其与预后的关系.方法 选择60例老年进展期胃癌患者为观察组,同期32例健康体检者为对照组.应用免疫组织化学法检测胃癌组织与正常胃黏膜组织VEGF及微血管密度(MVD)的表达情况,并对MVD、VEGF表达水平与患者预后进行分析.结果 观察组胃癌组织VEGF及MVD阳性率显著高于对照组(P<0.01);观察组不同肿瘤TNM分期和有无淋巴结转移癌患者中VEGF及MVD表达差异有统计学意义(P<0.01);VEGF阳性者3年生存率和5年生存率显著低于VEGF阴性胃癌患者(P<0.01).结论 VEGF表达与血管生成和肿瘤进展、淋巴结转移密切相关,可作为判断老年进展胃癌预后的重要参考指标.

  8. 替吉奥联合顺铂治疗晚期胃癌临床疗效研究%Curative Effect Analysis of S-1 Combined with Cisplatin in the Treatment of Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    闫泽; 兆天欣; 邢影; 陈丹; 何璐璐

    2012-01-01

    目的:研究替吉奥联合顺铂治疗晚期胃癌的疗效和安全性.方法:42例晚期胃腺癌患者随机分为观察组(21例)与对照组(21例)两组,观察组采用替吉奥联合顺铂,对照组采用卡培他滨联合顺铂.结果:两组患者疗效间差异无统计学意义(P>0.05).两组的不良反应主要为骨髓抑制、消化道反应和乏力,观察组Ⅲ~Ⅳ度血小板减少发生率显著低于对照组(P<0.05),Ⅲ~Ⅳ度手足综合征的发生率亦显著低于对照组(P<0.05).结论:替吉奥联合顺铂治疗晚期胃癌疗效与卡培他滨联合顺铂相当,但其患者耐受性更好,值得临床进一步研究推广使用.%Objective: To investigate the safety and efficacy of S-l combined with cisplatin in the treatment for patients with advanced gastric cancer. Methods: Forty-two patients with advanced gastric cancer were randomly divided into two groups. Patients in observation group (n=21) received S-l and cisplatin; Patients in control group (n=21) received capecitabine and cisplatin. Results: The efficacy of the two groups showed no statistically significant difference (P>0.05). The main untoward effects were myelosuppression, gastroenteric reaction and weakness. Observation group showed a lower rate of untoward effects than control group. Observation group also showed a lower rate of Ⅲ~Ⅳ thrombocytopenia (P<0.05) and hand-foot syndrome (P<0.05) than control group. Conclusions: The treatment of the two groups were evidently effective, with observation group having better tolerance. The regimen could be clinically recommended.

  9. Current practice of gastric cancer treatment

    Institute of Scientific and Technical Information of China (English)

    Yoon Young Choi; Ji Yeong An; Hyung-Il Kim; Jae-Ho Cheong; Woo Jin Hyung; Sung Hoon Noh

    2014-01-01

    Objective The aim of this review was to overview the current practice of gastric cancer treatment including surgery and other adjuvant modalities.Data sources The review was based on data obtained from the published articles and main guidelines in the East and West.Study selection Articles with high level of evidence or current best evidence in each issue were selected to be reviewed.Results Although varied adjuvant modalities have been proved to be benefit for treating gastric cancer,surgery is still the most important treatment strategy against gastric cancer.Actively adapting to new technology is important but it should be balanced with an effort to establish sound scientific rationale that adheres to oncologic principles.Conclusions Future treatment of gastric cancer will be focused on tailored,personalized therapy.For achieving it,collaboration across disciplines is essential.Also the philosophy of caring for the patients with gastric cancer should be rooted in the realization of true patient benefit regardless of who is providing the care.With these philosophies,we can shift the scientific and technological advances toward triumph over gastric cancer.

  10. Combined cetuximab and reirradiation for locoregional recurrent and inoperable squamous cell carcinoma of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Balermpas, Panagiotis; Roedel, Claus; Weiss, Christian [Dept. of Radiation Therapy and Oncology, Goethe Univ., Frankfurt/Main (Germany); Hambek, Markus [Dept. of Otorhinolaryngology, Goethe Univ., Frankfurt/Main (Germany); Seitz, Oliver [Dept. of Oral Maxillofacial and Plastic Facial Surgery, Goethe Univ., Frankfurt/Main (Germany)

    2009-12-15

    Purpose: to investigate the feasibility, toxicity, and efficacy of external-beam reirradiation (Re-RT) combined with cetuximab for patients with inoperable and recurrent squamous cell carcinoma of the head and neck (SCCHN). Patients and methods: seven patients with inoperable recurrence of SCCHN after adjuvant or definitive radiotherapy (RT) and simultaneous or sequential cisplatin-based chemotherapy for primary SCCHN were treated between August and December 2008 with Re-RT (1.8 Gy/fraction to 50.4 Gy) and cetuximab (400 mg/m{sup 2} initial dose in the 1st week, and then 250 mg/m{sup 2} once weekly). Recurrence had to be located at least {>=} 50% in the preirradiated field. Long term toxicity from previous treatment was recorded before Re-RT as a baseline value. Acute and late toxicity derived from the experimental regimen were recorded every week during RT, and then every 3 months. Efficacy was assessed with repeated imaging using response evaluation criteria in solid tumors (RECIST) and clinical examinations 8-12 weeks after end of the treatment and every 3 months thereafter (Tables 1 and 2). Results: only mild localized mucositis occurred in all patients. Two patients developed a grade 3 acneiform rash related to cetuximab. After treatment one patient developed a grade 2 trismus, another showed grade 3 abacterial salivary gland inflammation with severe pain requiring opioid medication. Two patients achieved a complete response after 7 months, one remained stable, three progressed, and one died from pneumonia without having restaging magnetic resonance imaging. Conclusion: A second course of RT combined with cetuximab in patients with inoperable, recurrent HNSCC proved to be feasible with mild or moderate toxicity and encouraging response to treatment. (orig.)

  11. Gastric applications of electrical field stimulation.

    LENUS (Irish Health Repository)

    Hogan, Aisling M

    2012-02-01

    Advances in clinical applications of electricity have been vast since the launch of Hayman\\'s first cardiac pacemaker more than 70 years ago. Gastric electrical stimulation devices have been recently licensed for treatment of gastroparesis and preliminary studies examining their potential for use in refractory obesity yield promising results.

  12. Comparison of Two Docetaxel Based Regiments with ECF as First Line Systemic Treatment for Advanced Gastric Carcinoma%两个含多西紫杉醇的化疗方案与ECF方案在晚期胃癌一线治疗中的比较

    Institute of Scientific and Technical Information of China (English)

    马冬; 董秋美

    2008-01-01

    @@ 1 文献来源 Roth AD,Fazio N,Stupp R,et al.Docetaxel,Cisplatin,and Fluorouracil;Docetaxel and Cisplatin;and Epirubicin,Cisplatin,and Fluorouracil as systemic treatment for advanced gastric carcinoma:A randomized phase Ⅱ trial of the Swiss group for clinical cancer research[J].J Clin Oncol,2007,25(22):3217-3223.

  13. Advances in Effects of Selenium Against Chemotherapeutic Sensitivity for Gastric Cancer%硒对胃癌化疗敏感性影响的研究进展

    Institute of Scientific and Technical Information of China (English)

    陈晋; 陈家强; 罗斌; 王建洲; 刘长俊; 章顺悦

    2013-01-01

    An increasing attention is paid to gastric cancer in China for its high incidence and mortality rates.Chemotherapy is one of the main treatments due to the comparatively low cure surgery rate as well as easy relapse and transfer.Nevertheless,many patients can not accomplish the treatment for reason of adverse reaction of chemotherapy.With wide effects,the selenium is necessary for the body.The current researches about selenium mainly focus on agent-assisted in cancer chemotherapy,while selenium can significantly reduce the adverse reactions of chemotherapy,thus plays an important role against tumor collaborate with chemotherapy drugs.%胃癌因在我国各类恶性肿瘤中的高发病率及高死亡率而倍受关注.由于胃癌单纯的手术治愈率不高,且易出现复发或转移,因此,化疗是其主要的治疗手段之一.但化疗的不良反应太大,致使很多患者不能完成治疗.硒是人体所必需的营养元素,同时也是一种广泛的抗癌因子,目前人们对硒的研究,主要侧重于作为癌症化疗辅助剂的作用,硒能明显降低化疗药物的不良反应,并且在协同化疗药物抗肿瘤方向发挥着重要的作用.

  14. 联合脾切除治疗进展期胃上部癌的预后分析%Prognostic analysis of splenectomy in patients with advanced proximal gastric cancer

    Institute of Scientific and Technical Information of China (English)

    黄昌明; 王家镔; 卢辉山; 郑朝辉; 李平; 谢建伟; 张祥福

    2009-01-01

    Objective To evaluated the prognostic impact of splenectomy on patients with advanced proximal gastric cancer. Methods The clinical records of 237 patients with advanced proximal gastric cancer who underwent D2 curative resection combined with splenectomy from January 1980 to June 2003 were analyzed retrospectively. Seventy-five patients presented with No.10 lymph nodes metastasis, while 162 patients did not. Potential patient prognostic factors were evaluated by univariate and multivariate analysis.The independent prognostic factors of patients were performed subgroup analysis. Results The 5-year survival rate was 27.7% for patients with No.10 lymph nodes metastasis and 35.4% for patients without,the difference was statistically significant between the two groups (P0.05).For patients undergoing total gastrectomy, survival rates were 31.2% and 36.7%, respectively (P>0.05).Conclusions To improve patient prognosis, total gastrectomy with splenectomy should be recommended for patients with T3 proximal gastric cancer with No.10 lymph node metastasis.%目的 探讨联合脾切除对进展期胃上部癌患者预后的影响.方法 1980年1月至2003年6月对237例进展期胃上部癌患者施行了胃癌D2根治术联合脾切除,其中N0.10淋巴结转移患者75例,No.10淋巴结无转移患者162例.对影响患者的预后因素进行单因素及多因素分析;对影响患者预后的独立因素进行分层分析.结果 237例患者中No.10淋巴结转移和无转移患者术后5年生存率分别为27.7%和35.4%,二者差异有统计学意义(P0.05);全胃切除No.10淋巴结转移和无转移患者术后5年生存率分别为31.2%和36.7%,二者差异无统计学意义(P>0.05).结论 对于T3期胃上部癌No.10淋巴结转移的患者,施行全胃联合脾切除能够提高患者远期疗效.

  15. 胃癌靶向治疗的研究现状与进展%Research status quo and progression in targeted therapy for advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    冯睿; 张小田; 杨升

    2016-01-01

    随着对胃癌增殖生长与侵袭转移等恶性生物学行为机制研究深入,靶向治疗已成为胃癌领域研究热点。目前靶向药物研究的热门信号通路包括人类表皮生长因子受体(HER)家族信号通路、血管内皮生长因子(VEGF)信号通路、磷脂酰肌醇3激酶-蛋白激酶/哺乳动物雷帕霉素靶蛋白(PI3K/mTOR)信号通路和NF-κB信号通路等。HER家族信号通路相关靶向药物,包括针对HER-1的西妥昔单抗、尼妥珠单抗、马妥珠单抗、帕尼单抗和厄洛替尼,针对HER-2的曲妥珠单抗、帕妥珠单抗和 T-DM1,以及针对HER家族多靶点的拉帕替尼和阿法替尼。 VEGF信号通路相关靶向药物包括针对VEGF的贝伐珠单抗,抗VEGFR的雷莫芦单抗、阿帕替尼、索拉非尼、舒尼替尼及西地尼布,以及重组融合蛋白阿柏西普。此外,在胃癌治疗中具有潜力的PI3K/mTOR信号通路相关靶向药物包括LY294002、BEZ235和依维莫司,而硼替佐米为现有研究较多抑制NF-κB信号通路靶向药物。目前胃癌分子靶向治疗领域完成的Ⅲ期药物临床试验且成功的分子靶向药物主要有曲妥珠单抗、雷莫芦单抗及阿帕替尼。未来研究方向应关注针对多靶点的药物或应用针对不同靶点的药物联合治疗胃癌。本文收集国内外近期相关研究和临床试验报道,对胃癌靶向治疗的现状和进展做简要综述。%With the deeper research of the proliferation, invasion and metastasis mechanisms of the gastric cancer , targeted therapy has become a hot spot in this field. The exploration of targeted agents for gastric cancer is mainly concentrated upon the drugs that target human epidermal growth factor receptor (HER) family, the vascular endothelial growth factor (VEGF), the phosphatidylinositol 3-kinase-protein kinase/mammalian target of rapamycin (PI3K/mTOR) and the NF-κB signaling pathways. The targeted drugs relevant to

  16. Sequential FDG-PET and induction chemotherapy in locally advanced adenocarcinoma of the Oesophago-gastric junction (AEG: The Heidelberg Imaging program in Cancer of the oesophago-gastric junction during Neoadjuvant treatment: HICON trial

    Directory of Open Access Journals (Sweden)

    Weichert Wilko

    2011-06-01

    Full Text Available Abstract Background 18-Fluorodeoxyglucose-PET (18F-FDG-PET can be used for early response assessment in patients with locally advanced adenocarcinomas of the oesophagogastric junction (AEG undergoing neoadjuvant chemotherapy. It has been recently shown in the MUNICON trials that response-guided treatment algorithms based on early changes of the FDG tumor uptake detected by PET are feasible and that they can be implemented into clinical practice. Only 40%-50% of the patients respond metabolically to therapy. As metabolic non-response is known to be associated with a dismal prognosis, metabolic non-responders are increasingly treated with alternative neoadjuvant chemotherapies or chemoradiation in order to improve their clinical outcome. We plan to investigate whether PET can be used as response assessment during radiochemotherapy given as salvage treatment in early metabolic non-responders to standard chemotherapy. Methods/Design The HICON trial is a prospective, non-randomized, explorative imaging study evaluating the value of PET as a predictor of histopathological response in metabolic non-responders. Patients with resectable AEG type I and II according to Siewerts classification, staged cT3/4 and/or cN+ and cM0 by endoscopic ultrasound, spiral CT or MRI and FDG-PET are eligible. Tumors must be potentially R0 resectable and must have a sufficient FDG-baseline uptake. Only metabolic non-responders, showing a 18FDG-PET scans will be performed before ( = Baseline and after 14 days of standard neoadjuvant therapy as well as after the first cycle of salvage docetaxel/cisplatin chemotherapy (PET 1 and at the end of radiochemotherapy (PET2. Tracer uptake will be assessed semiquantitatively using standardized uptake values (SUV. The percentage difference ΔSUV = 100 (SUVBaseline - SUV PET1/SUVBaseline will be calculated and assessed as an early predictor of histopathological response. In a secondary analysis, the association between the difference

  17. Gastric Carcinogenesis and Underlying Molecular Mechanisms: Helicobacter pylori and Novel Targeted Therapy

    Directory of Open Access Journals (Sweden)

    Toshihiro Nishizawa

    2015-01-01

    Full Text Available The oxygen-derived free radicals that are released from activated neutrophils are one of the cytotoxic factors of Helicobacter pylori-induced gastric mucosal injury. Increased cytidine deaminase activity in H. pylori-infected gastric tissues promotes the accumulation of various mutations and might promote gastric carcinogenesis. Cytotoxin-associated gene A (CagA is delivered into gastric epithelial cells via bacterial type IV secretion system, and it causes inflammation and activation of oncogenic pathways. H. pylori infection induces epigenetic transformations, such as aberrant promoter methylation in tumor-suppressor genes. Aberrant expression of microRNAs is also reportedly linked to gastric tumorogenesis. Moreover, recent advances in molecular targeting therapies provided a new interesting weapon to treat advanced gastric cancer through anti-human epidermal growth factor receptor 2 (HER-2 therapies. This updated review article highlights possible mechanisms of gastric carcinogenesis including H. pylori-associated factors.

  18. NRS 2002和PG-SGA在晚期胃癌化疗患者中的应用%The application of NRS 2002 and PG-SGA in chemotherapy patients with advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    杨眉; 陈誉; 王晓杰; 陈境鸿; 郭增清

    2016-01-01

    Objective The aim of this study was to investigate the nutritional risk in patients with advanced gastric cancer received chemotherapy, using nutritional risk screening 2002 (NRS 2002) and patient-generated subjective global assessment (PG-SGA), and to determine the potential relationship between the nutritional statusand the chemotherapy-related toxicity. Methods A continuous approach was used to screen patients with advanced gastric cancer, the NRS2002, PG-SGA, laboratory test indicators and other methods were applied to evaluate the nutritional risk and malnutrition of patients, the differences between the two kinds of tools in the investigation results were compared, and the correlation between nutritional risks and traditional objective indicators were analyzed. Results A total of 71 patients completed the nutrition survey. NRS survey shows that the incidence of nutritional risk was 67.61%, the incidence of malnutrition in PG-SGA was 80.28%, there was statistical signiifcance between the two (P<0.05). When group according to the assessment results of NRS 2002, BMI was significantly different between the non-nutritional risk group and the nutritional risk group;when group by PG-SGA score results, prealbumin, albumin and CRP was signiifcantly different between the two kinds of groups, the related incidence of adverse reactions (neutrophils reduced I/II and weary I/II) of patients with the nutritional risk group after their chemotherapy is higher than that of the patients belonging to the non-nutritional risk group. Conclusions Both NRS 2002 and PG-SGA are applicable to the nutritional status investigation of patients with advanced gastric cancer, but the malnutrition detection rate of PG-SGA was higher, so it can assess the nutritional status of patients more effectively. The PG-SGA scale is recommended to carry out the comprehensive evaluation for advanced gastric cancer patients before chemotherapy, so as to better guide clinical nutrition therapy

  19. Advanced Gastric Cancer: Differentiation of Borrmann Type IV versus Borrmann Type III by Two-Phased Dynamic Multi-Detector Row CT with Use of the Water Filling Method

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dae Jung; Yu, Jeong Sik; Lee, Sang Min; Kim, Joo Hee; Chung, Jae Joon; Kim, Ki Whang [Dept. of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul (Korea, Republic of); Kang, Hae Youn [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

    2013-02-15

    To characterize Borrmann type IV from Borrmann type III advanced gastric cancer (AGC) by two-phased multi-detector row computed tomography (MDCT) using the water filling method. A total of 143 patients (pathologically confirmed Borrmann type III and IV - 100 and 43 patients), who underwent preoperative MDCT, were enrolled. Two radiologists, retrospectively and independently, determined tumor enhancement pattern using a 5-grade scale without clinical information. A weighted kappa test was applied for interobserver variability. The score of tumor enhancement pattern correlated with Borrmann type as determined by Spearman's correlation coefficient. The accuracy of differentiation of Borrmann type using MDCT was determined by receiver operating characteristic curves. Interobserver agreement (weighted kappa = 0.683) was substantial. The tumor enhancement pattern score showed a significant correlation with Borrmann type (reviewer 1, r = 0.591, p < 0.001; reviewer 2, r = 0.616, p < 0.001). The accuracy for differentiation of Borrmann type on MDCT was 0.86 (p < 0.001) in both reviewers. The sensitivity and specificity of the diagnosis of Borrmann type IV were 79% and 82% in reviewer 1, and 88% and 78% in reviewer 2, respectively. Dual-phased MDCT using the water filling method can differentiate between Borrmann type IV and III AGC with high accuracy.

  20. Definitive three-dimensional high-dose-rate brachytherapy for inoperable endometrial cancer

    Science.gov (United States)

    Draghini, Lorena; Casale, Michelina; Trippa, Fabio; Anselmo, Paola; Arcidiacono, Fabio; Fabiani, Stefania; Italiani, Marco; Chirico, Luigia; Muti, Marco

    2017-01-01

    Purpose To report our experience on high-dose-rate brachytherapy (HDR-BT) in patients with stage I-III endometrial cancer unfit to surgery. Material and methods Seventeen patients underwent HDR-BT as definitive treatment. Median age was 79 years (range, 60-95), median Karnofsky performance status 90% (range, 60-100). Histology was endometrial adenocarcinoma in 14 (82%), and non-endometrial in 3 (18%) patients. In 15 (88%) patients, clinical stage was I and in remaining 2 (12%) was III. All patients were evaluated with computed tomography (CT) and endometrial biopsy. Using the Fletcher applicator, a CT-based planning HDR-BT was delivered. Local control (LC) was obtained when there was an interruption of vaginal bleeding in absence of CT-imaging progression. Results Fourteen patients underwent HDR-BT alone and three external beam radiotherapy (EBRT) combined with HDR-BT. All patients had a clinical LC, after a median follow-up of 53 months (range, 6-131), 3 and 6 years LC rates were 86% and 69%, respectively. Cancer specific survival (CSS) at 1, 2, and 6 years was 93%, 85%, and 85%, respectively. Age, stage, dose, and type of radiotherapy did not result significant prognostic factors for LC and CSS. Only histology significantly influenced LC: for high-risk histology (i.e., non-endometrial carcinoma or grade [G] 3 endometrial adenocarcinoma) LC was 73% at 1 year and 36% at 6 years; for low-risk histology (i.e., G1-2 endometrial adenocarcinoma) was 100% at 1 and 6 years (p = 0.05). Two (12%) patients had G2 acute toxicity and two others (12%) G1 late toxicity. Conclusions Although some limitations of our analysis (relatively few number of patients recruited, retrospective evaluation, and consequent suboptimal patient selection), it confirms effectiveness and safety of definitive HDR-BT for medically inoperable stage I-III endometrial cancer. The best LC was obtained in stage I low-risk histology. PMID:28533799

  1. Definitive three-dimensional high-dose-rate brachytherapy for inoperable endometrial cancer

    Directory of Open Access Journals (Sweden)

    Lorena Draghini

    2017-04-01

    Full Text Available Purpose : To report our experience on high-dose-rate brachytherapy (HDR-BT in patients with stage I-III endometrial cancer unfit to surgery. Material and methods : Seventeen patients underwent HDR-BT as definitive treatment. Median age was 79 years (range, 60-95, median Karnofsky performance status 90% (range, 60-100. Histology was endometrial adenocarcinoma in 14 (82%, and non-endometrial in 3 (18% patients. In 15 (88% patients, clinical stage was I and in remaining 2 (12% was III. All patients were evaluated with computed tomography (CT and endometrial biopsy. Using the Fletcher applicator, a CT-based planning HDR-BT was delivered. Local control (LC was obtained when there was an interruption of vaginal bleeding in absence of CT-imaging progression. Results : Fourteen patients underwent HDR-BT alone and three external beam radiotherapy (EBRT combined with HDR-BT. All patients had a clinical LC, after a median follow-up of 53 months (range, 6-131, 3 and 6 years LC rates were 86% and 69%, respectively. Cancer specific survival (CSS at 1, 2, and 6 years was 93%, 85%, and 85%, respectively. Age, stage, dose, and type of radiotherapy did not result significant prognostic factors for LC and CSS. Only histology significantly influenced LC: for high-risk histology (i.e., non-endometrial carcinoma or grade [G] 3 endometrial adeno­carcinoma LC was 73% at 1 year and 36% at 6 years; for low-risk histology (i.e., G1-2 endometrial adenocarcinoma was 100% at 1 and 6 years (p = 0.05. Two (12% patients had G2 acute toxicity and two others (12% G1 late toxicity. Conclusions : Although some limitations of our analysis (relatively few number of patients recruited, retrospective evaluation, and consequent suboptimal patient selection, it confirms effectiveness and safety of definitive HDR-BT for medically inoperable stage I-III endometrial cancer. The best LC was obtained in stage I low-risk histology.

  2. Prognostic value of CXCL12 and CXCR4 in inoperable head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Rave-Fraenk, Margret; Tehrany, Narges; Leu, Martin; Weber, Hanne Elisabeth; Wolff, Hendrik Andreas [University Medical Center Goettingen, Department of Radiotherapy and Radiation Oncology, Goettingen (Germany); Kitz, Julia [University Medical Center Goettingen, Department of Pathology, Goettingen (Germany); Burfeind, Peter [University Medical Center Goettingen, Department of Human Genetics, Goettingen (Germany); Schliephake, Henning [University Medical Center Goettingen, Department of Oral and Maxillofacial Surgery, Goettingen (Germany); Canis, Martin [University Medical Center Goettingen, Department of Otorhinolaryngology, Head and Neck Surgery, Goettingen (Germany); Beissbarth, Tim [University Medical Center Goettingen, Institute of Medical Statistics, Goettingen (Germany); Reichardt, Holger Michael [University Medical Center Goettingen, Institute for Cellular and Molecular Immunology, Goettingen (Germany)

    2016-01-15

    The chemokine CXCL12 and its receptor CXCR4 can affect tumor growth, recurrence, and metastasis. We tested the hypothesis that the CXCL12 and CXCR4 expression influences the prognosis of patients with inoperable head and neck cancer treated with definite radiotherapy or chemoradiotherapy. Formalin-fixed paraffin-embedded pretreatment tumor tissue from 233 patients with known HPV/p16{sup INK4A} status was analyzed. CXCL12 and CXCR4 expressions were correlated with pretreatment parameters and survival data by univariate and multivariate Cox regression. CXCL12 was expressed in 43.3 % and CXCR4 in 66.1 % of the samples and both were correlated with HPV/p16{sup INK4A} positivity. A high CXCL12 expression was associated with increased overall survival (p = 0.036), while a high CXCR4 expression was associated with decreased metastasis-free survival (p = 0.034). A high CXCR4 expression could be regarded as a negative prognostic factor in head and neck cancer because it may foster metastatic spread. This may recommend CXCR4 as therapeutic target for combating head and neck cancer metastasis. (orig.) [German] Das Chemokin CXCL12 und sein Rezeptor CXCR4 beeinflussen Tumorwachstum, Auftreten von Rezidiven und Metastasierung. Es wurde die Hypothese geprueft, dass ein Zusammenhang der CXCL12- und CXCR4-Expression mit der Prognose von Patienten bestehe, die wegen eines inoperablen Kopf-Hals-Tumors eine primaere Radio- oder Radiochemotherapie erhielten. Dabei wurde auch der HPV-Status der Patienten beruecksichtigt. Formalinfixierte Proben aus unbehandelten Tumoren von 233 Patienten mit bekanntem HPV/p16{sup INK4A}-Status wurden ausgewertet. Die CXCL12- und CXCR4-Expression wurde mit klinischen Parametern und Ueberlebensdaten mittels uni- und multivariater Cox Regression analysiert. CXCL12 wurde von 43,3 %, CXCR4 von 66,1 % der Tumoren exprimiert, und beide Marker korrelierten mit einer HPV/p16{sup INK4A}-Expression. Eine hohe CXCL12-Expression war mit einem verbesserten

  3. Multidisciplinary approach to understand the pathogenesis of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Juan Shang; AS Pe(n)a

    2005-01-01

    Gastric carcinoma remains a common disease worldwide with a dismal prognosis. Therefore, it represents a very important health problem. It occurs with a high incidence in Asia and is one of the leading causes of cancer death in the world. Although the incidence and mortality of gastric carcinoma are decreasing in many countries,gastric cancer still represents the second most frequent malignancies in the world and the fourth in Europe. The 5-year survival rate of gastric carcinoma is low. The etiology and pathogenesis are not yet fully known. The study of gastric cancer is important in clinical medicine as well as in public health. Over the past 15 years,integrated research in molecular pathology has clarified the details of genetic and epigenetic abnormalities of cancer-related genes in the course of the development and progression of gastric cancer. Gastric cancer, as all cancers, is the end result of the interplay of many risk factors as well as protective factors. Although epidemiological evidence indicates that environmental factors play a major role in gastric carcinogenesis, the role of immunological, genetic, and immunogenetic factors are thought to contribute to the pathogenesis of gastric carcinoma. Among the environmental factors,diet and Helicobacter pylori are more amenable to intervention aimed at the prevention of gastric cancer.The aim of the present paper is to review and include the most recent published evidence to demonstrate that only a multidisciplinary approach will lead to the advancement of the pathogenesis and prevention of gastric cancer. On the immunogenetic research it is clear that evidence is accumulating to suggest that a genetic profile favoring the proinflammatory response increases the risk of gastric carcinoma.

  4. Detection and location of Helicobacter pylori in human gastric carcinomas

    Institute of Scientific and Technical Information of China (English)

    Yun-Lian Tang; Run-Liang Gan; Bi-Hua Dong; Ri-Chen Jiang; Rong-Jun Tang

    2005-01-01

    AIM: To define the infection status of Helicobacter pylori in 109 patients with gastric cancers and Hpylorilocalization in gastric carcinoma tissues in South China.METHODS: The incidence of Hpyloriinfection in gastric carcinomas was estimated by polymerase chain reaction (PCR), simultaneously; both morphological features and the localization of H pylori in gastric carcinomas were demonstrated by Warthin-Starry (WS) staining. The relationships between Hpylori infection and the clinicalpathologic factors of gastric carcinomas were analyzed by software SPSS10.0.RESULTS: Hpyloriwas found in 42 (39.03%) and 58(53.21%) cases of 109 patients with gastric carcinomas by PCRand WS, respectively. H pyloriinfection rate detected in gastric carcinomas by WS was higher than that by PCR (x2 = 9.735,P<0.005<0.01). WS stain showed that H pylori existed in the gastric antrum mucus, mucosal gland of normal tissues adjacent to gastric carcinomas and the gland, mucus pool of cancer tissues. The positive rate of H pyloriin normal tissues adjacent to carcinomas was higher than that in cancer tissues (x2 = 15.750, P<0.005<0.01). No significant differences in age, sex, site,histological types and lymph node metastasis were found between H pylorFpositive gastric carcinomas and H pylorinegative cases by both methods, but there were statistically significant differences of H pylori positive rate between early and advanced stage of gastric carcinomas (x2=4.548or 5.922, P = 0.033 or 0.015<0.05).CONCLUSION: These results suggested that H pylori infection might play a certain role in the early stage of carcinogenesis of human gastric mucosa epithelia.

  5. Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry.

    Science.gov (United States)

    Jiménez Fonseca, Paula; Carmona-Bayonas, Alberto; Hernández, Raquel; Custodio, Ana; Cano, Juana Maria; Lacalle, Alejandra; Echavarria, Isabel; Macias, Ismael; Mangas, Monserrat; Visa, Laura; Buxo, Elvira; Álvarez Manceñido, Felipe; Viudez, Antonio; Pericay, Carles; Azkarate, Aitor; Ramchandani, Avinash; López, Carlos; Martinez de Castro, Eva; Fernández Montes, Ana; Longo, Federico; Sánchez Bayona, Rodrigo; Limón, Maria Luisa; Diaz-Serrano, Asun; Martin Carnicero, Alfonso; Arias, David; Cerdà, Paula; Rivera, Fernando; Vieitez, Jose Maria; Sánchez Cánovas, Manuel; Garrido, M; Gallego, J

    2017-09-05

    The choice of chemotherapy in HER2-negative gastric cancer is based on centre's preferences and adverse effects profile. No schedule is currently accepted as standard, nor are there any factors to predict response, other than HER2 status. We seek to evaluate whether Lauren type influences the efficacy of various chemotherapies and on patient overall survival (OS). We have conducted a multicenter study in 31 hospitals. The eligibility criteria include diagnosis of stomach or gastroesophageal junction adenocarcinoma, HER2 negativity, and chemotherapy containing 2-3 drugs. Cox proportional hazards regression adjusted for confounding factors, with tests of 'treatment-by-histology' interaction, was used to estimate treatment effect. Our registry contains 1303 tumours analysable for OS end points and 730 evaluable for overall response rate (ORR). A decrease in ORR was detected in the presence of a diffuse component: odds ratio 0.719 (95% confidence interval (CI), 0.525-0.987), P=0.039. Anthracycline- or docetaxel-containing schedules increased ORR only in the intestinal type. The diffuse type displayed increased mortality with hazard ratio (HR) of 1.201 (95% CI, 1.054-1.368), P=0.0056. Patients receiving chemotherapy with docetaxel exhibited increased OS limited to the intestinal type: HR 0.65 (95% CI, 0.49-0.87), P=0.024, with no increment in OS for the subset having a diffuse component. With respect to progression-free survival (PFS), a significant interaction was seen in the effect of docetaxel-containing schedules, with better PFS limited to the intestinal type subgroup, in the comparison against any other schedule: HR 0.65 (95% CI, 0.50-0.85), P=0.015, and against anthracycline-based regimens: HR 0.64 (95% CI, 0.46-0.88), P=0.046. As a conclusion, in this registry, Lauren classification tumour subtypes predicted survival and responded differently to chemotherapy. Future clinical trials should stratify effect estimations based on histology.

  6. Gastric syphilis - Case report*

    Science.gov (United States)

    Guimarães, Tais Ferreira; Novis, Camila Freitas Lobo; Bottino, Caroline Bertolini; D'Acri, Antonio Macedo; Lima, Ricardo Barbosa; Martins, Carlos José

    2016-01-01

    Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described. PMID:27828649

  7. Triple gastric peptic ulcer perforation.

    Science.gov (United States)

    Radojkovic, Milan; Mihajlovic, Suncica; Stojanovic, Miroslav; Stanojevic, Goran; Damnjanovic, Zoran

    2016-03-01

    Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

  8. Review of docetaxel in the treatment of gastric cancer

    Directory of Open Access Journals (Sweden)

    Eric D Tetzlaff

    2008-09-01

    Full Text Available Eric D Tetzlaff1, Jonathan D Cheng1, Jaffer A Ajani21Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA; 2Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center, Houston, TX, USAAbstract: Gastric cancer is a global health problem accounting for 800,000 cancer related deaths annually. Often diagnosed at an advanced stage, the treatment of gastric cancer with chemotherapy is directed towards palliating cancer related symptoms with only modest improvements in survival. In addition, no regimen has emerged as a globally accepted standard. New therapeutic options are desperately needed for the treatment of gastric cancer. Docetaxel given in combination has recently emerged as a new option for patients with advanced gastric cancer. This review focuses on the treatment of advanced gastric cancer utilizing docetaxelbased therapy and the novel additions of biotherapy to the existing cytotoxic platforms. In addition, the current investigations of docetaxel for the treatment of potentially curable gastric cancer will be discussed.Keywords: docetaxel, gastric cancer, chemotherapy, biotherapy

  9. High levels of aromatic amino acids in gastric juice during the early stages of gastric cancer progression.

    Directory of Open Access Journals (Sweden)

    Kai Deng

    Full Text Available BACKGROUND: Early-stage gastric cancer is mostly asymptomatic and can easily be missed easily by conventional gastroscopy. Currently, there are no useful biomarkers for the early detection of gastric cancer, and their identification of biomarkers is urgently needed. METHODS: Gastric juice was obtained from 185 subjects that were divided into three groups: non-neoplastic gastric disease (NGD, advanced gastric cancer and early gastric cancer (EGC. The levels of aromatic amino acids in the gastric juice were quantitated using high-performance liquid chromatography. RESULTS: The median values (25th to 75th percentile of tyrosine, phenylalanine and tryptophan in the gastric juice were 3.8 (1.7-7.5 µg/ml, 5.3 (2.3-9.9 µg/ml and 1.0 (0.4-2.8 µg/ml in NGD; 19.4 (5.8-72.4 µg/ml, 24.6 (11.5-73.7 µg/ml and 8.3 (2.1-28.0 µg/ml in EGC. Higher levels of tyrosine, phenylalanine and tryptophan in the gastric juice were observed in individuals of EGC groups compared those of the NGD group (NGD vs. EGC, P<0.0001. For the detection of EGC, the areas under the receiver operating characteristic curves (AUCs of each biomarker were as follows: tyrosine, 0.790 [95% confidence interval (CI, 0.703-0.877]; phenylalanine, 0.831 (95% CI, 0.750-0.911; and tryptophan, 0.819 (95% CI, 0.739-0.900. The sensitivity and specificity of phenylalanine were 75.5% and 81.4%, respectively, for detection of EGC. A multiple logistic regression analysis showed that high levels of aromatic amino acids in the gastric juice were associated with gastric cancer (adjusted β coefficients ranged from 1.801 to 4.414, P<0.001. CONCLUSION: Increased levels of tyrosine, phenylalanine and tryptophan in the gastric juice samples were detected in the early phase of gastric carcinogenesis. Thus, tyrosine, phenylalanine and tryptophan in gastric juice could be used as biomarkers for the early detection of gastric cancer. A gastric juice analysis is an efficient, economical and convenient method for

  10. New method of lymph node tracing in gastrectomy for advanced gastric carcinoma%进展期胃癌根治术中淋巴结示踪新方法

    Institute of Scientific and Technical Information of China (English)

    Huaiwu Jiang; Zonglin Li; Jin Chen; Shiming Xiao; Liang Luo

    2012-01-01

    Objective: The aim of this study was to explore a new method of lymph node tracing in radical gastrectomy for advanced gastric carcinoma (AGC). Methods: Ninety-two patients who suffered from gastric angle carcinoma with metastasis in No. 3 group lymph nodes were carried out radical gastrectomy. During the operation methylene blue was injected inside or around the circum of the metastatic No. 3 group lymph nodes. Secondary sentinel lymph nodes (SSLNs) were the nearest blue lymph nodes to No. 3 group lymph nodes that were searched in 5 to 10 min after injecting methylene blue. These SSLNs were resected and carried out hematoxylin-eosin (HE) staining as well as immunohistochemistry (IHC) staining to demonstrate whether there were metastasis. Results: SSLNs were found successfully in 76 patients with a positive rate of 82.6% (76/92) by methylene blue staining, among which, 34 patients were demonstrated existing metastasis in SSLNs by HE staining, 26 patients were demonstrated existing metastasis in SSLNs by IHC staining which were not demonstrated existing metastasis by HE staining. Totally, 60 patients were demonstrated existing metastasis in SSLNs by HE staining and IHC staining with a positive rate of 78.9% (60/76). 136 SSLNs were found in total and 104 SSLNs were demonstrated existing metastasis with a positive rate of 76.4% (104/136). There were 14, 18, 10, 80, 6 and 8 SSLNs in No. 4, No. 5, No. 6, No. 7,No. 8 and No. 9 group lymph nodes respectively. And there were 10, 18, 8, 62, 2 and 4 SSLNs were demonstrated existing metastasis with a positive rate of 71.4%, 100%, 80.0%, 77.5%, 33.3% and 50.0% in No. 4, No. 5, No. 6, No. 7, No. 8 and No.9 group lymph nodes respectively. However, there were no significant correlations between the tumor's size and the positive rate of SSLN as well as the degree of tumor's differentiation and the positive rate of SSLN. Conclusion: The technique of SSLN tracing expands the application range of sentinel lymph node (SLN) tracing and

  11. Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center.

    Science.gov (United States)

    Laval, Guillemette; Arvieux, Catherine; Stefani, Laetitia; Villard, Marie-Laure; Mestrallet, Jean-Phillippe; Cardin, Nicolas

    2006-06-01

    A prospective protocol for treatment of malignant inoperable bowel obstruction was implemented at Grenoble University Hospital Center for 4 years. All 80 episodes of obstruction resulted from peritoneal carcinomatosis and none could expect another treatment cure. The protocol comprised three successive stages. Stage I included treatment for 5 days with a corticosteroid, antiemetic, anticholinergic, and analgesic. Stage II provided a somatostatin analogue if vomiting persisted. After 3 days, Stage III provided a venting gastrostomy. Obstruction relief with symptom control was obtained by medical treatment in 29 cases and symptom control occurred alone in an additional 32 cases. Ten patients were relieved by venting gastrostomy. Symptom control without permanent nasogastric tube (NGT) placement occurred in 72 episodes (90%). Eight patients with refractory vomiting were obliged to continue the NGT until death. Fifty-eight obstruction episodes (73%) were controlled in 10 days or less. Median time before gastrostomy was 17 days. Median survival was 31 days. This series suggests that a staged protocol for the treatment of inoperable malignant bowel obstruction is highly effective in relieving symptoms. A subgroup experiences relief of obstruction using this approach.

  12. Gastrin and Gastric Cancer

    Science.gov (United States)

    Waldum, Helge L.; Sagatun, Liv; Mjønes, Patricia

    2017-01-01

    Gastric cancer although occurring in reduced frequency is still an important disease, partly because of the bad prognosis when occurring in western countries. This decline in occurrence may mainly be due to the reduced prevalence of Helicobacter pylori (Hp) infection, which is the most important cause of gastric cancer. There exist many different pathological classifications of gastric carcinomas, but the most useful seems to be the one by Lauren into intestinal and diffuse types since these types seldom transform into the other and also have different epidemiology. During the nearly 30 years that have passed since the groundbreaking description of Hp as the cause of gastritis and gastric cancer, a continuous search for the mechanism by which Hp infection causes gastric cancer has been done. Interestingly, it is mainly atrophic gastritis of the oxyntic mucosa that predisposes to gastric cancer possibly by inducing hypoacidity and hypergastrinemia. There are many arguments in favor of an important role of gastrin and its target cell, the enterochromaffin-like cell, in gastric carcinogenesis. The role of gastrin in gastric carcinogenesis implies caution in the long-term treatment with inhibitors of gastric acid secretion inducing secondary hypergastrinemia, in a common disease like gastroesophageal reflux disease. PMID:28144230

  13. Medically inoperable endometrial cancer in patients with a high body mass index (BMI): Patterns of failure after 3-D image-based high dose rate (HDR) brachytherapy

    DEFF Research Database (Denmark)

    Acharya, Sahaja; Esthappan, Jacqueline; Badiyan, Shahed

    2016-01-01

    BACKGROUND AND PURPOSE: High BMI is a reason for medical inoperability in patients with endometrial cancer in the United States. Definitive radiation is an alternative therapy for these patients; however, data on patterns of failure after definitive radiotherapy are lacking. We describe...... the patterns of failure after definitive treatment with 3-D image-based high dose rate (HDR) brachytherapy for medically inoperable endometrial cancer. MATERIALS AND METHODS: Forty-three consecutive patients with endometrial cancer FIGO stages I-III were treated definitively with HDR brachytherapy...

  14. 腹腔镜辅助D2根治术治疗进展期胃癌的效果观察%Effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer

    Institute of Scientific and Technical Information of China (English)

    何平; 梁杰雄; 邵天松; 宋辉; 郭洋; 李洋

    2016-01-01

    Objective To investigate the clinical effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer.Methods Totally 78 cases with advanced gastric cancer from January 2008 to June 2013 were randomly divided into observation group (36 cases) receiving laparoscopic D2 radical gastrectomy and control group (40 patients) receiving laparotomy D2 radical gastrectomy.The incision length,operation duration,intraoperative blood loss,number of lymph nodes dissected,time of liquid diet intake,anal exhaust time,duration of hospitalization,complications and survival rate were compared between groups.Results The incision length,intraoperative blood loss,exhaust time,duration of hospitalization,incidence of complications in observation group were all significantly lower than those in control group [(5.7 ±0.4) cm vs (17.4 ± 1.5) cm,(164 ±35) ml vs (255 ± 87) ml,(2.8 ±1.6) d vs (4.9±2.5) d,(4.2±0.8) d vs (6.7±1.0) d,(12±3) d vs (15 ±4) d,13.9% (5/36) vs 32.5% (13/40)] (P <0.05);the operation duration,number of lymph nodes dissected,survival rate were not significantly different between two groups (P >0.05).Conclusion Laparoscopy-assisted distal gastric resection D2 is safe and feasible,it can achieve similar curative effect with laparotomy in treating advanced gastric cancer.%目的 探究腹腔镜辅助D2根治术治疗进展期胃癌的疗效.方法 对2008年1月至2013年6月于首都医科大学附属北京安贞医院接受手术治疗的76例进展期胃癌患者的临床资料进行回顾性分析,根据手术方式分为腹腔镜辅助手术组(观察组,36例)和开腹手术组(对照组,40例).比较2组患者切口长度、手术时间、术中出血量、清扫淋巴结个数、进食流质时间、肛门排气时间、术后住院时间、并发症发生情况以及术后存活率.结果 观察组患者切口长度、术中出血量、排气时间、进食流质时间、住院时间、术后并发症发

  15. Induction chemotherapy with carboplatin-paclitaxel followed by standard radiotherapy with concurrent daily low-dose cisplatin plus weekly paclitaxel for inoperable non-small-cell lung cancer.

    Science.gov (United States)

    Ardizzoni, Andrea; Scolaro, Tindaro; Mereu, Carlo; Cafferata, Mara Argenide; Tixi, Lucia; Bacigalupo, Almalina; Tiseo, Marcello; Monetti, Francesco; Rosso, Riccardo

    2005-02-01

    Both induction chemotherapy and concurrent platinating agents have been shown to improve results of thoracic irradiation in the treatment of locally advanced non-small-cell lung cancer (NSCLC). This phase II study investigated activity and feasibility of a novel chemoradiation regimen, including platinum and paclitaxel, both as induction chemotherapy and concurrently with thoracic radiotherapy. Previously untreated patients with histologically/cytologically proven unresectable stage I-III NSCLC were eligible. Induction chemotherapy consisted of 2 courses of 200 mg/m2 paclitaxel and carboplatin at AUC of 6 mg/mL/min every 3 weeks. From day 43, continuous thoracic irradiation (60 Gy in 30 fractions radiotherapy for 6 weeks) was given concurrently with daily cisplatin at a dose of 5 mg/m2 intravenously and weekly paclitaxel at a dose of 45 mg/m2 for 6 weeks. Fifteen patients were accrued in the first stage of the trial. According to the previous statistical considerations, accrual at the second stage of the study was halted as a result of the achievement an insufficient number of successes. Major toxicity of combined chemoradiation was grade III-IV esophagitis requiring hospitalization for artificial nutrition, which occurred in 58% of patients. Other toxicities included grade II-IV fatigue in 75% of patients and grade I-IV neuromuscular toxicity in 67%. Only 7 patients completed the treatment program as scheduled. Eight patients (53.3%; 95% confidence interval, 26.5-78.7%) had a major response (5 partial response, 3 complete response), 2 patients had disease progression, and 1 was stable at the end of treatment. Four patients died early. With a median follow up of 38 months, the median survival was 12 months. A combined chemoradiation program, including platinum and paclitaxel, appears difficult to deliver at full dose as a result of toxicity, mainly esophagitis. More active and less toxic combined modality treatments need to be developed for inoperable NSCLC.

  16. Molecular forms of trefoil factor 1 in normal gastric mucosa and its expression in normal and abnormal gastric tissues

    Institute of Scientific and Technical Information of China (English)

    Jian-Lin Ren; Jin-Yan Luo; Ya-Pi Lu; Lin Wang; Hua-Xiu Shi

    2006-01-01

    AIM: To study the molecular forms of trefoil factor 1 (TFF1) in normal gastric mucosa and its expression in normal and abnormal gastric tissues (gastric carcinoma, atypical hyperplasia and intestinalized gastric mucosa) and the role of TFF1 in the carcinogenesis and progression of gastric carcinoma and its molecular biological mechanism underlying gastric mucosa protection.METHODS: The molecular forms of TFF1 in normal gastric mucosa were observed by Western blot. The expression of TFF1 in normal and abnormal gastric tissues (gastric carcinoma, atypical hyperplasia and intestinalized gastric mucosa) was also assayed by immunohistochemical method. The average positive AO was estimated by Motic Images Advanced 3.0 software.RESULTS: Three patterns of TFF1 were found in normal gastric mucosa: monomer, dimmer, and TFF1 compound whose molecular weight is about 21 kDa.The concentration of TFF1 compound was the highest among these three patterns. TFF1 was expressed mainly in epithelial cytoplasm of the mucosa in gastric body and antrum, especially around the nuclei. The closer the TFF1 to the lumen, the higher the expression of TFF1.The expression of TFF1 in peripheral tissue of gastric carcinoma (0.51 ± 0.07) was higher than that in normal gastric mucosa (0.44 ± 0.06, P < 0.001). The expression of TFF1 in gastric adenocarcinoma was positively related to the differentiation of adenocarcinoma. The lower the differentiation of adenocarcinoma was, the weaker the expression of TFF1. No TFF1 was expressed in poorly-differentiated adenocarcinoma. The expression of TFF1 in moderately-well differentiated adenocarcinoma (0.45± 0.07) was a little lower than that in normal mucosa (P > 0.05). The expression of TFF1 in gastric mucosa with atypical hyperplasia (0.57 ± 0.03) was significantly higher than that in normal gastric mucosa (P < 0.001).No TFF1 was expressed in intestinalized gastric mucosa.There was no statistically significant difference between the expressions of

  17. Research on 128-slice CT perfusion imaging of perigastric lymph node metastases of advanced gastric cancer%进展期胃癌胃周淋巴结的128层CT灌注成像研究

    Institute of Scientific and Technical Information of China (English)

    左晓娜; 曲红光; 王治民

    2016-01-01

    Objective:By studying the 128-slice spiral CT perfusion imaging of gastric cancer, this study aimed to investigate the per⁃fusion curves and perfusion imaging features of metastatic perigastric lymph nodes, reactive lymphoid hyperplasia (RLH) in the active stage and RLH in the quiescent stage;to find out the differences of the perfusion indexes including blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface (PS) of the different types of lymph nodes in advanced gastric cancer. Methods:From the 30 patients with gastric cancer diagnosed by surgery and pathological examination admitted in Gansu Provincial Hospital, 35 metastatic lymph nodes (Group A), 53 lymph nodes with reactive lymphoid hyperplasia (RLH) in the active stage (Group B) and 27 RLH lymph nodes in the quiescent stage were selected, and the time-density curves (TDC) of the three groups were compared, then the differences of the perfusion indexes were com⁃pared and analyzed by one-way analysis of variance (one-way ANOVA). Results:①The 128-slice spiral CT perfusion imaging of gastric can⁃cer could demonstrate the perfusion information inside the different types of perigastric lymph nodes, and could reflect the physiological func⁃tions of the lymph nodes precisely;②The results of BF, BV, MTT and PS of metastatic perigastric lymph nodes, RLH lymph nodes in the reac⁃tive stage and RLH lymph nodes in the quiescent stage were statistically different. Conclusion: The 128-slice spiral CT perfusion imaging of gastric cancer can reflect the changes of the perfusion indexes of perigastric lymph nodes visually, and can provide the objective and quantita⁃tive information of thehemodynamic changes of the lymph nodes. Combined with enhanced imaging and various post-processing technologies, the 128-slice spiral CT perfusion imaging can provide more valuable information for thelocating and the qualitative diagnosis of the perigastric lymph nodes and the preoperative staging

  18. Decreased expression of DICER1 in gastric cancer

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhi-hong; SUN Xiu-ju; FU Wei-neng; GUAN Yi; GAO Feng; WANG Ying; SUN Kai-lai

    2007-01-01

    Background The role of epigenetics in gene expression regulation and development significantly enhances our understanding of carcinogenesis.All the tumor related genes may be the target of epigenetical or genetic regulation.We selected some epigenetically regulated genes for cDNA array analysis and observed variability in the expression of the DICER1 gene in distinct stages of gastric cancer.The aim of this study was to assess the correlation between the expression of DICER1,an epigenetically regulated gene,and gastric cancer.Methods To detect the expression of 506 tumor-associated genes,including DICER1,in the matched cancerous mucosa,pre-malignant lesion (adjacent mucosa),non-cancerous gastric mucosa and distant lymphocyte metastatic lesion in 3 cases of gastric cancers using cDNA array.DICER1 mRNA expression and DICER1 protein expression were further analyzed by Real-time PCR and Western blot in 32 cases of progressive gastric cancer.DICER1 protein expression was also detected in 33 early and 30 progressive gastric cancers by the immunohistochemistry (IHC) method.Results In 3 cases of gastric cancer cDNA array showed dramatically decreased expression of DICER1 in pre-malignant Iesion,cancerous mucosa and distant lymphocyte metastatic lesions compared with matched noncancerous gastric mucosa,pre-malignant lesion and cancerous mucosa.Real-time PCR results showed that the expression level of DICER1 mRNA in gastric cancer was significantly down-regulated compared to normal gastric tissue (P<0.05).The IHC assay also showed that the expression of DICER1 was significantly decreased in progressive gastric cancer.Among the 63 cases of gastric cancers,13/33 early(39.4%)and 19/30(63.3%)progressive cancers showed negative expression of DICER1(50.8%).The difference in expression of DICER1 between early and progressive gastric cancers was significant(P<0.01).The result of Western blotting showed that DICER1 protein was down-regulated significantly in advanced gastric cancer

  19. Hedgehog signaling pathway and gastric cancer.

    Science.gov (United States)

    Katoh, Yuriko; Katoh, Masaru

    2005-10-01

    Hedgehog, WNT, FGF and BMP signaling pathways network together during embryogenesis, tissue regeneration, and carcinogenesis. Aberrant activation of Hedgehog signaling pathway leads to pathological consequences in a variety of human tumors, such as gastric cancer and pancreatic cancer. Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), surgical gastrectomy and chemotherapy are therapeutic options for gastric cancer; however, prognosis of advanced gastric cancer patient is still poor. Here, Hedgehog signaling pathway in human gastric cancer and its clinical applications will be reviewed. Human SHH, IHH, DHH (Hedgehog homologs), HHAT (Hedgehog acyltransferase), HHIP (Hedgehog-interacting protein), DISP1, DISP2, DISP3 (Dispatched homologs), PTCH1, PTCH2 (Patched homologs), SMO (Smoothened homolog), KIF27, KIF7 (Costal-2 homologs), STK36 (Fused homolog), SUFU (SuFu homolog), DZIP1 (Iguana homolog), GLI1, GLI2 and GLI3 (Cubitus interruptus homologs) are implicated in the Hedgehog signaling. PTCH1, FOXM1 and CCND2 are direct transcriptional targets of Hedgehog signaling. Hedgehog signaling activation leads to cell proliferation through cell cycle regulation. SHH regulates growth and differentiation within gastric mucosa through autocrine loop and FOXL1-mediated epithelial-mesenchymal interaction. SHH is implicated in stem/progenitor cell restitution of damaged gastric mucosa during chronic infection with Helicobacter pylori. SHH up-regulation, IHH upregulation and HHIP down-regulation lead to aberrant activation of Hedgehog signaling through PTCH1 to GLI1 in gastric cancer. Small molecule compounds targeted to SMO (KADD-cyclopamine, SANT1-4, Cur61414) as well as humanized anti-SHH antibodies are potent anti-cancer drugs for gastric cancer. Cocktail of Hedgehog inhibitors would be developed as novel therapeutics for gastric cancer. Single nucleotide polymorphism (SNP) and copy number polymorphism (CNP) of Hedgehog signaling genes would be utilized

  20. Improving the outcomes in gastric cancer surgery.

    Science.gov (United States)

    Tegels, Juul J W; De Maat, Michiel F G; Hulsewé, Karel W E; Hoofwijk, Anton G M; Stoot, Jan H M B

    2014-10-14

    Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and five-year survival rates are poor, therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately, in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-, intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index (e.g., Charlson comorbidity index), assessment of nutritional status (e.g., short nutritional assessment questionnaire, nutritional risk screening - 2002) and frailty assessment (Groningen frailty indicator, Edmonton frail scale, Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential. Implementation of fast-track or enhanced recovery after surgery programs is showing promising results, although future studies have to determine what the exact optimal strategy is. Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection. Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far. Advances in postoperative care include optimal timing of oral diet, which has been shown to reduce hospital stay. In general, hospital volume, i.e., centralization, and clinical audits might further improve the outcome in gastric cancer surgery. In conclusion, progress has been made in improving the surgical treatment of gastric cancer. However, gastric cancer treatment is high risk surgery and many areas for future research remain.

  1. The role of leptin in gastric cancer: Clinicopathologic features and molecular mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Nyeong [Department of Internal Medicine, Hanyang University College of Medicine, Seoul (Korea, Republic of); Choi, Ho Soon, E-mail: hschoi96@hanyang.ac.kr [Department of Internal Medicine, Hanyang University College of Medicine, Seoul (Korea, Republic of); Yang, Sun Young [Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul (Korea, Republic of); Park, Hyun Ki; Lee, Young Yiul; Lee, Oh Young; Yoon, Byung Chul; Hahm, Joon Soo [Department of Internal Medicine, Hanyang University College of Medicine, Seoul (Korea, Republic of); Paik, Seung Sam [Pathology, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2014-04-18

    Highlights: • Leptin and Ob-R are expressed in gastric adenoma and early and advanced cancer. • Leptin is more likely associated with differentiated gastric cancer or cardia cancer. • Leptin proliferates gastric cancer cells via activating the STAT3 and ERK1/2 pathways. - Abstract: Obesity is associated with certain types of cancer, including gastric cancer. However, it is still unclear whether obesity-related cytokine, leptin, is implicated in gastric cancer. Therefore, we aimed to investigate the role of leptin in gastric cancer. The expression of leptin and its receptor, Ob-R, was assessed by immunohistochemical staining and was compared in patients with gastric adenoma (n = 38), early gastric cancer (EGC) (n = 38), and advanced gastric cancer (AGC) (n = 38), as a function of their clinicopathological characteristics. Gastric cancer cell lines were studied to investigate the effects of leptin on the signal transducer and activator of transcription-3 (STAT3) and extracellular receptor kinase 1/2 (ERK1/2) signaling pathways using MTT assays, immunoblotting, and inhibition studies. Leptin was expressed in gastric adenomas (42.1%), EGCs (47.4%), and AGCs (43.4%). Ob-R expression tended to increase from gastric adenoma (2%), through EGC (8%), to AGC (18%). Leptin induced the proliferation of gastric cancer cells by activating STAT3 and ERK1/2 and up-regulating the expression of vascular endothelial growth factor (VEGF). Blocking Ob-R with pharmacological inhibitors and by RNAi decreased both the leptin-induced activation of STAT3 and ERK1/2 and the leptin-induced expression of VEGF. Leptin plays a role in gastric cancer by stimulating the proliferation of gastric cancer cells via activating the STAT3 and ERK1/2 pathways.

  2. 胃超声助显剂胃充盈检查在进展期胃癌诊断的临床应用探讨%Clinical Value of Stomach Ultrasonography with the Gastroenterultrasound Developer in the Diagnosis of Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    袁帆; 陆文明; 傅绢; 陈华

    2013-01-01

    目的 探讨超声助显剂造影在进展期胃癌诊断的临床应用价值.方法 85例进展期胃癌患者,采用胃超声助显剂充盈胃腔后进行检查,并进行Borrmann分型,全部病例均经手术病理证实,且和胃镜进行对照.结果 超声对进展期胃癌诊断符合率92.94% (79/85),病变部位符合率97.65% (83/85),浸润深度符合率88.24% (75/85),淋巴结转移符合率70.51% (55/78),肝转移符合率90.91% (10/11)和卵巢转移符合率100% (4/4).结论 胃超声助显剂造影检查对进展期胃癌具有较高的临床价值,适合对胃癌高危人群进行初步筛查和健康体检.%Objective To explore the clinical value of ultrasonography with the gastroenterultrasound developer in the diagnosis of advanced gastric cancer.Methods 85 cases of advanced gastric cancer patients,using the gastroenterultrasound developer filling the stomach,than ultrasonography and diagnosis it for Borrmann type.All cases were confirmed by pathology,and gastroscopy control.Results Diagnose accordance rate of advanced gastric cancer with ultrasonography of 92.94 % (79/85),location accordance rate of 97.65 % (83/85),depth of infiltration ccordance rate of 88.24% (75/85),lymph node metastasis ccordance rate of 70.51% (55/78),liver metastases accordance rate of 90.91%(10/11),ovarian metastasis accordance rate of 100%(4/4).Conclusions Stomach ultrasonography with the gastroenterultrasound developer have high clinical value of advanced gastric cancer.It is benefit for preliminary screening of gastric cancer high-risk groups and Health examination.

  3. Stomach (Gastric) Cancer Screening

    Science.gov (United States)

    ... Gastric Cancer Treatment Stomach Cancer Prevention Stomach Cancer Screening Research Stomach (Gastric) Cancer Screening (PDQ®)–Patient Version What is ... from the . There is no standard or routine screening test for stomach cancer. Several types of screening tests have been ...

  4. Epidemiology of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Katherine D Crew; Alfred I Neugut

    2006-01-01

    The incidence and mortality of gastric cancer have fallen dramatically in US and elsewhere over the past several decades. Nonetheless, gastric cancer remains a major public health issue as the fourth most common cancer and the second leading cause of cancer death worldwide. Demographic trends differ by tumor location and histology. While there has been a marked decline in distal, intestinal type gastric cancers, the incidence of proximal, diffuse type adenocarcinomas of the gastric cardia has been increasing, particularly in the Western countries. Incidence by tumor sub-site also varies widely based on geographic location, race, and socioeconomic status. Distal gastric cancer predominates in developing countries, among blacks, and in lower socioeconomic groups, whereas proximal tumors are more common in developed countries, among whites, and in higher socio-economic classes. Diverging trends in the incidence of gastric cancer by tumor location suggest that they may represent two diseases with different etiologies. The main risk factors for distal gastric cancer include Helicobacter pylori (H pylori) infection and dietary factors, whereas gastroesophageal reflux disease and obesity play important roles in the development of proximal stomach cancer. The purpose of this review is to examine the epidemiology and risk factors of gastric cancer, and to discuss strategies for primary prevention.

  5. Gastric bypass surgery

    Science.gov (United States)

    ... Roux-en-Y; Weight-loss surgery - gastric bypass; Obesity surgery - gastric bypass ... bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of ...

  6. Obesity and gastric cancer.

    Science.gov (United States)

    Li, Qiang; Zhang, Jun; Zhou, Yongning; Qiao, Liang

    2012-06-01

    Obesity is an important public health problem worldwide. It increases the risk of many chronic diseases such as diabetes and cardiovascular diseases. Meanwhile, obesity is a major risk factor for several types of cancer including gastric cancer. Possible mechanisms linking obesity with gastric cancer may include obesity associated gastro-oesophageal reflux, insulin resistance, altered levels of adiponectin, leptin, ghrelin, and an abnormally increased blood level of insulin-like growth factor (IGF). Helicobacter pylori (H. pylori) infection is a well-recognized risk factor for peptic ulcer and gastric cancer. Recent studies have revealed an increased prevalence of H. pylori infection in obese patients, providing another clue for the increased incidence of gastric cancer in obese population. If this connection can be confirmed in animal models and a large cohort of patients, then eradicating H. pylori together with life style modification in obese individuals may help prevent the development of gastric cancer in the increasingly obese population.

  7. Elevated risk for gastric adenocarcinoma can be predicted from histomorphology

    Institute of Scientific and Technical Information of China (English)

    Michael Vieth; Mandred Stolte

    2006-01-01

    The number of patients with gastric cancer has more than doubled since 1985 in developing countries.Thus, the questions of whether it can be predicted from gastritis morphology, who is at risk and who has a lower risk of developing gastric carcinoma are raised. H pylori-infection leads to erosions, ulcerations,carcinoma, rnucosa associated lymphoid tissue (MALT)-lymphoma and extragastric diseases only in some individuals. The frequency of ulcerations among H pylori-infected individuals is estimated to be 13%,gastric cancer about 1% and MALT lymphoma around 0.1%. In the literature a multistep model from chronic active H pylori-infection through multifocal atrophy,intestinal metaplasia, dysplasia (intraepithelial neoplasia)and carcinoma has been described. But this model cannot be applied to all routine cases. Since risk factors such as metaplasia and atrophy are paracancerous rather than precancerous conditions, this raises the question whether there is a better morphological marker. Differences in topography, grade and activity of Helicobacter gastritis in the antrum and corpus might be good markers for identifying those who are at risk of developing gastric cancer. It is known that the so-called corpus dominant H pylori gastritis is found more frequently among individuals with early and advanced gastric cancer and within high risk populations. This is valid both for firstdegree relatives of gastric cancer patients and for patients with gastric adenoma and hyperplastic polyps.In conclusion, corpus-dominant H pylori gestritis is significantly more common in patients with advanced and early gastric cancer, first-degree relatives of patients with gastric cancer, patients with gastric adenoma and gastric hyperplastic polyps. Therefore, all these patients are at risk of developing gastric cancer. Next, the question of who is at risk of developing corpus-dominant gastritis is raised. It appears that patients with a low acid output more frequently develop gastric cancer

  8. 华蟾素胶囊联合化疗对中晚期胃癌的疗效观察%Efficacy Observation of Huachansu Capsule combined with Chemotherapy in Treating Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    徐咏梅; 刘声

    2016-01-01

    目的::观察华蟾素胶囊联合化疗治疗中晚期胃癌疗效及对患者生活质量、不良反应的影响。方法:将符合入选标准的60例患者随机分为治疗组和对照组,对照组采用FOLFOX4方案化疗和对症支持治疗,治疗组在上述治疗的基础上加用华蟾素胶囊,比较2组患者近期客观有效率、稳定率、生活质量和不良反应。结果:治疗组近期客观有效率明显高于对照组,差异有统计学意义(P<0.05),治疗组治疗后生活质量及不良反应指标明显优于对照组,差异有统计学意义(P<0.05)。结论:华蟾素胶囊联合化疗药物和单纯化疗药物对中晚期胃癌患者均有疗效,并可提高患者生活质量,减轻化疗不良反应,但前者明显优于后者。%Objective:To observe the effects of Huachansu capsule combined with chemotherapy in the treatment of advanced gas-tric cancer, as well as its effect on patients′life quality and its adverse reaction. Methods:Sixty cases meeting the inclusion criteria were randomly divided into the treatment group and control group. The control group was treated by FOLFOX4 regimen chemother-apy and supportive treatment, and the treatment group by those plus Huachansu capsule. Short-term objective efficiency, stable rate, quality of life and adverse reaction were compared between the two groups. Results:After treatment, short-term objective ef-fective rate of the treatment group was significantly higher than that of the control group ( P<0. 05 ) . The quality of life and ad-verse reaction index of the treatment group were obviously superior to that of the control group (P<0. 05). Conclusion:Both Hua-chansu capsule combined with chemotherapy and the single chemotherapy therapy have curative effects in treating advanced gastric cancer. However, Huachansu capsule combined with chemotherapy could better improve patients′ quality of life, and reduce ad-verse reaction of chemotherapy.

  9. Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

    Institute of Scientific and Technical Information of China (English)

    Caigang Liu; Ping Lu; Jinsong Gu; Junqing Chen

    2007-01-01

    OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations.METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who under went a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients (P=0.000) In gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%,16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection (P=0.132). Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases (P=0.135). There was no statistically significant difference in survival between the cases with or without peritoneal metastasis (P=0.152).CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.

  10. Isolated limb infusion with fotemustine after dacarbazine chemosensitisation for inoperable loco-regional melanoma recurrence.

    NARCIS (Netherlands)

    Bonenkamp, J.J.; Thompson, J.; Wilt, J.H.W. de; Doubrovsky, A.; Faria Lima, R. de; Kam, P.C.

    2004-01-01

    BACKGROUND: Isolated limb infusion (ILI) is a simple yet effective alternative to conventional isolated limb perfusion for the treatment of advanced melanoma of the extremities. PATIENTS AND METHODS: The study group comprised 13 patients with very advanced limb disease who had failed to achieve a sa

  11. Correlation between Fas and FasL proteins expression in normal gastric mucosa and gastric cancer

    Directory of Open Access Journals (Sweden)

    Jolanta Czyżewska

    2011-04-01

    Full Text Available The study’s objective was to assess the expressions of Fas and FasL proteins in gastric cancer in correlation with chosen clinicohistological parameters. Fas and FasL expression was analyzed in 68 patients with gastric cancer, using the immunohistochemical method. The expression of Fas was found to be lower in gastric cancer cells than in healthy mucosa, both in the lining epithelium and in glandular tubes (28% vs. 48% and 44%; p < 0.001. The expression of FasL was also markedly lower in cancer cells than in glandular tubes, yet higher than in the lining epithelium (51% vs. 73% and 14%; p < 0.01. Positive expressions of FasL and Fas were lower in less advanced gastric cancer cells (T1, T2, than in more advanced tumors (T3, T4, but only in the case of FasL was this difference statistically significant (p < 0.05. Our findings seem to confirm the theory of the impact of apoptotic disorders at the level of Fas receptor and FasL protein in the process of gastric cancer formation and growth, which is manifested in the varied expressions of these proteins in gastric cancer and in the normal lining and glandular epithelium of the stomach. However, the lack of significant differences in the expressions of Fas and FasL in correlation to other clinicohistological parameters indicates the existence of mechanisms that have a greater impact on the process of differentiation of gastric cancers. This in our opinion eliminates these proteins as prognostic factors. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 1, pp. 142–147

  12. Endoscopic surveillance strategy after endoscopic resection for early gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Nishida; Masahiko; Tsujii; Motohiko; Kato; Yoshito; Hayashi; Tomofumi; Akasaka; Hideki; Iijima; Tetsuo; Takehara

    2014-01-01

    Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.

  13. CONTINUOUS CARBOPLATIN INFUSION DURING 6 WEEKS RADIOTHERAPY IN LOCALLY INOPERABLE NON-SMALL-CELL LUNG-CANCER - A PHASE-I AND PHARMACOKINETIC STUDY

    NARCIS (Netherlands)

    GROEN, HJM; VANDERLEEST, AHD; DEVRIES, EGE; UGES, DRA; SZABO, BG; MULDER, NH

    1995-01-01

    A phase I study was performed in 21 patients with previously untreated, locally inoperable, non-small-cell lung cancer (NSCLC) with ambulatory continuous carboplatin infusion together with continuous thoracic irradiation over 6 weeks. A dose range for carboplatin of 15 mg m(-2) day(-1) during the la

  14. Gastric cancer:The times they are a-changin’

    Institute of Scientific and Technical Information of China (English)

    Maria; Antonietta; Satolli; Lucio; Buffoni; Rosella; Spadi; Ilaria; Roato

    2015-01-01

    Gastric cancer is the third leading cause of cancer death worldwide.Even though during these last decades gastric cancer incidence decreased in Western countries,it remains endemic and with a high incidence in Eastern countries.The survival in advanced and metastatic stage of gastric cancer is still very poor.Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients.Indeed,the key point is still the selection of patients for the right treatment,on basis of molecular tumor characterization.Since chemotherapy reached a plateau of efficacy for gastric cancer,the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity.Currently,Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erb B2 positive patients,whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer.New perspectives for an effective treatment derived from the immunotherapeutic strategies.Here,we report an overview on gastric cancer treatments,with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.

  15. Gastric cancer: The times they are a-changin'.

    Science.gov (United States)

    Satolli, Maria Antonietta; Buffoni, Lucio; Spadi, Rosella; Roato, Ilaria

    2015-11-15

    Gastric cancer is the third leading cause of cancer death worldwide. Even though during these last decades gastric cancer incidence decreased in Western countries, it remains endemic and with a high incidence in Eastern countries. The survival in advanced and metastatic stage of gastric cancer is still very poor. Recently the Cancer Genoma Atlas Research Network identified four subtypes with different molecular profiles to classify gastric cancer in order to offer the optimal targeted therapies for pre-selected patients. Indeed, the key point is still the selection of patients for the right treatment, on basis of molecular tumor characterization. Since chemotherapy reached a plateau of efficacy for gastric cancer, the combination between cytotoxic therapy and biological agents gets a better prognosis and decreases chemotherapeutic toxicity. Currently, Trastuzumab in combination with platinum and fluorouracil is the only approved targeted therapy in the first line for c-erbB2 positive patients, whereas Ramucirumab is the only approved targeted agent for patients with metastatic gastric cancer. New perspectives for an effective treatment derived from the immunotherapeutic strategies. Here, we report an overview on gastric cancer treatments, with particular attention to recent advances in targeted therapies and in immunotherapeutic approach.

  16. 化疗联合局部热疗治疗晚期胃癌疗效与安全性的Meta分析%Chemotherapy combined with hyperthermia for advanced gastric cancer:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    冯莉; 刘巍; 洪雷; 吕雅蕾; 王玉栋; 左静; 王龙; 韩晶; 单玉洁

    2014-01-01

    Objective To assess the effectiveness and safety of hyperthermia combined with chemotherapy for advanced gastric cancer.Methods We searched English databases as Cochrane Library,PubMed,EMBASE and Chinese ones as CBM,CNKI,VIP and Wangfang data with com-puter and also retrieved other sources as supplying,such as tracing related references,besides we al-so communicated with authors to obtain some certain information that has not been found.All relevant randomized controlled trials (RCTs)were collected to compare hyperthermia combined with chemo-therapy and chemotherapy alone.The quality of included trials were assessed by Cochrane Handbook 5.0 for systematic reviews.Meta-analyses were conducted by STATA SE 12.0 software.Results Five RCTs involving 35 1 patients with advanced gastric cancer were included.The results of meta-analysis showed that:a)as for effectiveness,the hyperthermia combined with chemotherapy group was supe-rior to the chemotherapy group in the complete response (CR)rate (OR=2.13,95%CI 1.17 to 3.86,P =0.013)and the total efficiency rate(OR=1.37,95%CI 1.09 to 1.73,P=0.006),with significant differences;b )as for safety,the hyperthermia combined with chemotherapy group was similar to the chemotherapy group in the incidence of adverse reactions.Conclusion Compared with chemotherapy,hyperthermia combined with chemotherapy in the treatment of advanced gastric cancer can significantly improve the complete response rate and the total efficiency rate,and mean-while not increased the incidence of adverse reactions.Due to the limitation of the included studies, large sample size,multicenter,high quality studies are needed to verify the above conclusion.We recommend that chemotherapy combined with hyperthermia therapy could be applied to clinic combi-ning individual conditions of patients.%目的:系统评价热疗联合化疗(热化)与单纯化疗(单化)比较治疗晚期胃癌的疗效和安全性。方法计算机检索Cochrane Library、PubMed

  17. DCF方案与ECF方案治疗进展期胃癌的临床研究%A clinical study of DCF scheme and ECF scheme in the treatment of advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    刘军

    2013-01-01

    目的 探讨DCF方案(多西紫杉醇+顺铂+5-氟尿嘧啶)与ECF方案(表柔比星+顺铂+ 5-氟尿嘧啶)治疗进展期胃癌的临床疗效及不良反应.方法 选择进展期胃癌患者62例,按数字表格法随机分为DCF组和ECF组,每组31例.DCF组给予DCF方案化疗,ECF组给予ECF方案化疗,至少完成2个化疗周期后进行疗效评价.结果 DCF组完全缓解2例、部分缓解10例、病情稳定11例、病情进展8例,治疗有效率为38.71%(12/31);ECF组完全缓解1例、部分缓解9例、病情稳定10例、病情进展11例,治疗有效率为32.26%(10/31),两组治疗有效率比较差异无统计学意义(x2=0.28,P> 0.05).DCF组中位无进展时间为5.9个月,ECF组为5.7个月.两组化疗期间不良反应主要以骨髓抑制、消化道反应及周围神经炎多见,以1、2度为主,两组血红蛋白下降、白细胞下降、血小板下降、口腔炎、恶心呕吐、腹泻发生率比较差异均无统计学意义(P>0.05),DCF组周围神经炎发生率明显高于ECF组[77.42%(24/31)比9.68%(3/31),P<0.05].结论 DCF方案与ECF方案治疗进展期胃癌疗效均较为满意,不良反应以1、2度为主,DCF方案患者周围神经炎发生率高,但均可耐受.%Objective To investigate the clinical effect and adverse reactions of DCF scheme (docetaxel + cisplatin + 5-fluorouracil) and ECF scheme (epirubicin + cisplatin + 5-fluorouracil) in the treatment of advanced gastric cancer.Methods Sixty-two patients with advanced gastric cancer were randomly divided into two groups with 31 cases each,DCF group was given DCF scheme therapy,ECF group was given ECF scheme therapy.After completing at least 2 cycles of chemotherapy the curative effect was evaluated.Results DCF group complete response in 2 patients,partial response in 10 patients,stable condition in 11 patients,disease progression in 8 cases,the effective rate was 38.71% (12/31),ECF group complete response in 1 patient,partial response in 9

  18. 伊立替康联合亚甲蓝示踪进展期胃癌淋巴结的研究%Study on lymph node tracing of advanced gastric cancer using irinotecan coupled with methylene blue

    Institute of Scientific and Technical Information of China (English)

    陈晓鹏; 王东; 王冠男; 胡明华; 张卫东; 张国政; 张帆

    2011-01-01

    目的:探讨伊立替康联合亚甲蓝在进展期胃癌根治术中淋巴结示踪的效率及其机制.方法:90例进展期胃癌随机分为非示踪组(31例)、亚甲蓝示踪组(30例)和伊立替康联合亚甲蓝示踪组(29例,简称联合示踪组),其中亚甲蓝示踪组术中用亚甲蓝2 mL分4点于瘤周浆膜下注射,联合示踪组用40 mg伊立替康与2 mL亚甲蓝耦合后分4点注射.3组均用多功能手术解剖器进行刮吸法胃癌根治淋巴结清扫.分别统计各组手术时间、出血量、输血量、清除淋巴结数和术后随访情况.结果:非示踪组、亚甲蓝示踪组和联合示踪组平均手术时间分别为(218±67)、(192±31)和(205±36)min(P>0.05);平均出血量分别为(248±116)、(164±88)和(173±98)mL(P0.05);平均每例清除淋巴结数分别为(22±9)、(22±10)和(30±9)枚(P0.05),3年存活率分别为62.1%(18/29)、57.1%(16/28)和78.6 9,6(22/28)(P>0.05).结论:瘤周浆膜下注射伊立替康与亚甲蓝耦合液可明显提高进展期胃癌患者淋巴结清除效率,且安全简便.其机制可能是耦合液显著延长淋巴结染色和褪色时间,始终存在色觉导向刺激,激发术者进行准确而彻底的淋巴结清扫.%AIM: To explore the effectiveness and mechanism of lymph node tracing using irinotecan coupled with methylene blue in radical resection of advanced gastric cancer. METHODS: 90 patients with advanced gastric cancer were randomly divided into the non-tracing group (n=31), methylene blue tracing group (n =30) and the combination tracing group (n =29). During operation, 2 mL of methylene blue was injected into the peritumoral subserosa at 4 points with microacupuncture needle in methylene blue tracing group, and the couplant of 40 mg of irinotecan and 2 mL methylene blue was injected in combination tracing group. The D2/D2+ lymphadenectomy was finished by curettage-aspiration dissection with Peng's multifunction operative dissector (PMOD) in all three groups. The

  19. Clinical Research of Combination of Chinese and Western Medicine Treatment of Middle and Advanced Gastric Cancer%中西医结合治疗中晚期胃癌临床研究

    Institute of Scientific and Technical Information of China (English)

    吕明

    2013-01-01

    Objective:To explore the clinical curative effect of combined traditional Chinese and western medicine treatment of middle and advanced gastric cancer.Methods:120 patients with middle and advanced gastric cancer were randomly divided into the control group and the observation group.Two groups were given conventional treatment such as chemotherapy,nutritional support,correcting water,electrolyte and acid base balance,anti-nausea and so on.The treatment group was additionally treated with strengthening spleen,dispelling blood stasis and reducing phlegm method,composition:codonopsis pilosula 15 g,radix astragali preparata15 g,akebiae fructus15 g,roasted atractylodis macrccephala 12 g,salviae miltiorrhizae 12 g,curcuma zedoary 10 g,lucid ganoderma 10 g,pericarpium citri reticulatae 10 g,origin liquorice 10 g,oldenlandia diffusa 30 g,raw semen coicis 30 g,rhizome dioscorea 30 g.A dose one day,decoction with water and taking decoction for twice.30 days for a course of treatment.Effective rate,quality of life,clinical symptoms and adverse reactions of the two groups were observed.Results:In the observation group,the effective rate was 53.33 %,quality of life was increased by 53.33%,and clinical symptoms improvement rate was 80.00%.In the control group,the effective rate was 43.33%,quality of life was increased by 30.00%,and clinical symptoms improvement rate was 60.00%.Comparison those of the two groups showed that the differences were statistically significant(P <0.05).Comparison of adverse reaction of the two groups showed that the difference was statistical sign ificance (P < 0.05).Conclusion:Combination of traditional Chinese and western medicine treatment of locally middle and advanced gastric cancer has definitely curative effect,which can improve the patients' quality of life and clinical symptoms,and reduce the adverse reaction of chemotherapy.%目的:探讨中西医结合治疗中晚期胃癌的临床疗效.方法:将120例中晚期胃癌患者

  20. Influence of chemoradiotherapy on the quality life and complications for advanced gastric carcinoma%同步放化疗对局部晚期胃癌患者生活质量及并发症的影响

    Institute of Scientific and Technical Information of China (English)

    刘瑜; 姚俊涛; 刘秋芳; 张蕊; 庞宏涛; 胡玉琴

    2015-01-01

    Objective:To investigate the influence of chemoradiotherapy on patients quality of life and complica-tions of locally advanced gastric carcinoma patients (Ⅱ -Ⅲc ).Methods:All 55 cases of locally advanced gastric cancer patients who can not accepted operation were randomly divided into two groups.After treated with XELOX scheme 1 cycle of chemotherapy,28 patients were accepted 3 -dimensional conformal radiation therapy.In the second day of the next cycle of chemotherapy and chemotherapy cycle XELOX regimen for 3,4 cycle.27 patients received XELOX scheme chemotherapy for 4 cycle.Results:The progress free survival (PFS)of chemoradiotherapy group was 7.1 months while the chemotherapy group was 5.1 months(P 0.05,the PF,RF,EF,CF,SF were almost the same.P >0.05.The Ⅲ/Ⅳ incidence of hematological and gastrointestinal of the chemoradiotherapy were higher than the chemotherapy(25.0% vs 18.5%;28.6% vs 18.5%),but P >0.05.Conclusion:The chemoradiotherapy can improve the efficacy of locally advanced gastric carcinoma patients (Ⅱ -Ⅲc )without operation.Compared with simple chemotherapy,chemoradiotherapy could improve the symptoms of pain,sleep and physical function.The gastrointestinal and hematological toxicity could be tolerated.%目的:观察同步放化疗对局部晚期胃癌患者的近期疗效,患者生活质量的影响及并发症分析。方法:将55例不能手术的局部晚期胃癌患者随机分为2组,28例进行同步放化疗治疗,先行 XELOX 方案化疗1周期,于2周期化疗第2天同时进行适形放疗,并按化疗周期进行3、4周期 XELOX 方案治疗。27例患者进行4周期 XELOX 方案化疗。结果:无进展生存期(PFS)同步放化疗组为7.1个月,化疗组为5.1个月(P <0.05);肿瘤客观缓解率(ORR)同步放化疗组67.8%,化疗组40.7%(P <0.05);1年生存率同步放化疗组60%高于化疗组51%,两者比较无统计学意义(P >0.05);QLQ

  1. Gastric electromechanical dysfunction in Parkinson's disease.

    Science.gov (United States)

    Krygowska-Wajs, A; Lorens, K; Thor, P; Szczudlik, A; Konturek, S

    2000-01-01

    This study was designed to evaluate gastric myoelectrical and mechanical activities in idiopathic Parkinson's disease (IPD) patients. Twenty patients with IPD (14 male and 6 female, mean age 42 +/- 9 years) were studied. Patients were divided into two groups: group A--early stage of disease (no. = 6) and group B--advanced IPD (no. = 14). Electrogastrography (EGG) was performed in fasting and postprandial conditions (Synectics system). The cross-sectional area of the gastric antrum was measured by sonography (Hitachi EUB-240). The antral area in fasting conditions was 2.1 +/- 0.4 and 4.2 +/- 1.2 cm2 and gastric emptying was 75 +/- 5 and 125 +/- 12 min in groups A and B respectively. EGG showed dysrhythmias (range 1-6 cycles per minute) in about 75% of both groups of IPD patients without increase in signal amplitude after a meal. Our results suggest that gastric motility is particularly impaired in patients with advanced IPD. It may be caused by the primary degenerative process in the autonomic nervous system of the gut.

  2. Intracisternal ziconotide infusion. Clinical case of an inoperable pharynx cancer patient with severe cervico-facial pain syndrome

    Directory of Open Access Journals (Sweden)

    Sergio Mameli

    2015-03-01

    Full Text Available The authors describe the clinical case of a patient suffering from severe cervico-facial pain syndrome with great incident component from inoperable pharynx cancer. The patient that was poorly responding to systemic therapy with high doses of opioids, benefi ted from intrathecal administration of ziconotide in combination with morphine and bupivacaine. After a long period of effectiveness (16 months, the patient complained of pain recurrence.The increase of ziconotide dose caused a serious adverse effect (psychosis, which led to the suspension of the drug. After four weeks washout, lower doses of the drug (1/4 administered at cervical segmental level; the patient achieved again a good pain relief.

  3. A Case of Inoperable Malignant Insulinoma with Resistant Hypoglycemia Who Experienced the Most Significant Clinical Improvement with Everolimus

    Directory of Open Access Journals (Sweden)

    Emre Bozkirli

    2013-01-01

    Full Text Available Metastatic insulinomas may sometimes present with recurrent life-threatening hypoglycemia episodes. Such patients usually fail to respond to various therapeutic agents which causes constant dextrose infusion requirement. Herein, we present a resistant case of inoperable malignant insulinoma who was treated with many therapeutic agents and interventions including somatostatin analogues, Yttrium-90 radioembolization, everolimus, radiotherapy, and chemoembolization. Close blood sugar monitorization during these therapies showed the most favourable response with everolimus. Everolimus treatment resulted in rapid improvement of hypoglycemia episodes, letting us discontinue dextrose infusion and discharge the patient. However, experience with everolimus in such patients is still limited, and more precise data can be obtained with the increasing use of this agent for neuroendocrine tumours.

  4. When operable patients become inoperable: conversion of a surgical aortic valve replacement into transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Arendrup, Henrik; Engstrøm, Thomas

    2009-01-01

    Transcatheter aortic valve implantation (TAVI) is a relatively new treatment option for inoperable patients with severe aortic stenosis (AS). This case describes how a planned conventional surgical aortic valve replacement (AVR) on a 73-year-old woman was successfully converted to a TAVI procedure....... On extracorporal circulation it was reconized that the aortic annulus, the coronary ostiae and the proximal part of the ascending aorta were severely calcified making valve implantation impossible. Surgical closure without valve substitution was estimated to be associated with a high risk of mortality due......, and the prosthesis was sutured to the ascending aorta. With some manipulation of the prosthesis it was possible to suture the aorta circumferentially around the fully expanded upper part of the prosthesis. Post-procedurally the patient recovered successfully, with improved function capacity, aortic valve area...

  5. Genomic dysregulation in gastric tumors.

    Science.gov (United States)

    Janjigian, Yelena Y; Kelsen, David P

    2013-03-01

    Gastric cancer is among the most common human malignancies and the second leading cause of cancer-related death. The different epidemiologic and histopathology of subtypes of gastric cancer are associated with different genomic patterns. Data suggests that gene expression patterns of proximal, distal gastric cancers-intestinal type, and diffuse/signet cell are well separated. This review summarizes the genetic and epigenetic changes thought to drive gastric cancer and the emerging paradigm of gastric cancer as three unique disease subtypes.

  6. Gastric conduit perforation.

    Science.gov (United States)

    Patil, Nilesh; Kaushal, Arvind; Jain, Amit; Saluja, Sundeep Singh; Mishra, Pramod Kumar

    2014-08-16

    As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.

  7. Familial gastric cancer

    Directory of Open Access Journals (Sweden)

    Bresciani Cláudio

    2003-01-01

    Full Text Available BACKGROUND: Familial aggregation of gastric cancer has pointed out to a possible hereditary and genetic factor involved in the carcinogenesis of this disease. The diffuse type gastric cancer patients are frequently younger and the tumor has locally infiltrative growth pattern early in its development. Observation of families with frequent early onset gastric cancer has led to the identification of a novel gene implicated in gastric cancer susceptibility: CDH1/E-cadherin. Diffuse familiar gastric cancer is defined as any family presenting: two first-degree relatives with diffuse gastric cancer, one of them with age under 50 years or at least 3 first-degree relatives irrespective age of onset. CASE REPORT: The family reported by us does not fit in any of the classification proposed. The precise identification of these families by clinical and molecular tools is of great importance. The case reported is an example of a family that probably is a form of hereditary gastric cancer not yet fully understood. CONCLUSION: Soon there will be new criteria, possibly including genetic and molecular characteristics.

  8. Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Vuong Te

    2006-11-01

    Full Text Available Abstract Purpose Hypofractionated radiotherapy may overcome repopulation in rapidly proliferating tumors such as lung cancer. It is more convenient for the patients and reduces health care costs. This study reports our results on patients with medically inoperable, early stage, non-small cell lung cancer (NSCLC treated with hypofractionation. Materials and methods Stage T1-2N0 NSCLC patients were treated with hypofractionation alone, 52.5 Gy/15 fractions, in 3 weeks, with 3-dimensional conformal planning. T1-2N1 patients with the hilar lymphnode close to the primary tumor were also eligible for this treatment. We did not use any approach to reduce respiratory motion, but it was monitored in all patients. Elective nodal radiotherapy was not performed. Routine follow up included assessment for acute and late toxicity and radiological tumor response. Median follow up time was 29 months for the surviving patients. Results Thirty-two patients with a median age of 76 years, T1 = 15 and T2 = 17, were treated. Median planning target volume (PTV volume was 150cc and median V16 of both lungs was 13%. The most important finding of this study is that toxicity was minimal. Two patients had grade ≤ 2 acute pneumonitis and 3 had mild (grade 1 acute esophagitis. There was no late toxicity. Actuarial 1 and 2-year overall survival rates are 78% and 56%, cancer specific survival rates (CSS are 90% and 74%, and local relapse free survival rates are 93% and 76% respectively. Conclusion 3-D planning, involved field hypofractionation at a dose of 52.5 Gy in 15 daily fractions is safe, well tolerated and easy radiation treatment for medically inoperable lung cancer patients. It shortens by half the traditional treatment. Results compare favorably with previously published studies. Further studies are needed to compare similar technique with other treatments such as surgery and stereotactic radiotherapy.

  9. Accelerated hyperfractionated radiotherapy combined with induction and concomitant chemotherapy for inoperable non-small-cell lung cancer. Impact of total treatment time

    Energy Technology Data Exchange (ETDEWEB)

    Nyman, J.; Mercke, C. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Oncology; Bergman, B. [Sahlgrenska Univ. Hospital, Gothenburg (Sweden). Dept. of Respiratory Medicine

    1998-12-31

    Tumour cell proliferation during conventionally fractionated radiotherapy (RT) can negatively influence the treatment outcome in patients with unresectable non-small-cell lung cancer (NSCLC). Accelerated and hyperfractionated RT may therefore have an advantage over conventional RT. Moreover, earlier studies have suggested improved survival with addition of cisplatin-based chemotherapy (CT). We present here the results of combined treatment with induction and concomitant CT and accelerated hyperfractionated RT in a retrospective series of patients with advanced NSCLS. Between August 1990 and August 1995, 90 consecutive patients, aged 42-77 years (median 63 years), with locally advanced unresectable or medically inoperable NSCLC and good performance status were referred for treatment: stage: I 23%, IIIa 37%, IIIb 40%. Patient histologies included: squamous cell carcinoma 52%, adenocarcinoma 34% and large cell carcinoma 13%. The treatment consisted of two courses of CT (cisplatin 100 mg/m{sup 2} day 1 and etoposide 100 mg/m{sup 2} day 1-3 i.v.), the second course given concomitantly with RT. The total RT dose was 61.2-64.6 Gy, with two daily fractions of 1.7 Gy. A one-week interval was introduced after 40.8 Gy to reduce acute toxicity, making the total treatment time 4.5 weeks. Concerning toxicity, 33 patients had febrile neutropenia, 10 patients suffered from grade III oesophagitis and 7 patients had grade III pneumonitis. There were two possible treatment-related deaths, one due to myocardial infarction and the other due to a pneumocystis carinii infection. The 1-, 2- and 3-year overall survival rates were 72%, 46% and 34%, respectively; median survival was 21.3 months. Fifty-nine patients had progressive disease: 21 failed locoregionally, 29 had distant metastases and 9 patients had a combination of these. Pretreatment weight loss was the only prognostic factor found, except for stage. However, the results for stage IIIb were no different from those for stage IIIa

  10. Gastric Duplication Cyst Causing Gastric Outlet Obstruction

    Directory of Open Access Journals (Sweden)

    Muna Al Shehi

    2012-07-01

    Full Text Available This is a case report of a newborn baby with gastric duplication cyst presented with non-bilious vomiting and upper abdominal distension. The diagnosis was suspected clinically and established by ultrasonography and computed tomography. The cyst was completely excised with uneventful recovery.

  11. Identification of differentially expressed serum proteins in gastric adenocarcinoma☆

    Science.gov (United States)

    Subbannayya, Yashwanth; Mir, Sartaj Ahmad; Renuse, Santosh; Manda, Srikanth S.; Pinto, Sneha M.; Puttamallesh, Vinuth N.; Solanki, Hitendra Singh; Manju, H.C.; Syed, Nazia; Sharma, Rakesh; Christopher, Rita; Vijayakumar, M.; Kumar, K.V. Veerendra; Prasad, T.S. Keshava; Ramaswamy, Girija; Kumar, Rekha V.; Chatterjee, Aditi; Pandey, Akhilesh; Gowda, Harsha

    2015-01-01

    Gastric adenocarcinoma is an aggressive cancer with poor prognosis. Blood based biomarkers of gastric cancer have the potential to improve diagnosis and monitoring of these tumors. Proteins that show altered levels in the circulation of gastric cancer patients could prove useful as putative biomarkers. We used an iTRAQ-based quantitative proteomic approach to identify proteins that show altered levels in the sera of patients with gastric cancer. Our study resulted in identification of 643 proteins, of which 48 proteins showed increased levels and 11 proteins showed decreased levels in serum from gastric cancer patients compared to age and sex matched healthy controls. Proteins that showed increased expression in gastric cancer included inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4), Mannose-binding protein C (MBL2), sex hormone-binding globulin (SHBG), insulin-like growth factor-binding protein 2 (IGFBP2), serum amyloid A protein (SAA1), Orosomucoid 1 (ORM1) and extracellular superoxide dismutase [Cu–Zn] (SOD3). We used multiple reaction monitoring assays and validated elevated levels of ITIH4 and SAA1 proteins in serum from gastric cancer patients. Biological significance Gastric cancer is a highly aggressive cancer associated with high mortality. Serum-based biomarkers are of considerable interest in diagnosis and monitoring of various diseases including cancers. Gastric cancer is often diagnosed at advanced stages resulting in poor prognosis and high mortality. Pathological diagnosis using biopsy specimens remains the gold standard for diagnosis of gastric cancer. Serum-based biomarkers are of considerable importance as they are minimally invasive. In this study, we carried out quantitative proteomic profiling of serum from gastric cancer patients to identify proteins that show altered levels in gastric cancer patients. We identified more than 50 proteins that showed altered levels in gastric cancer patient sera. Validation in a large cohort of well

  12. Helicobacter pyloriand gastric cancer

    African Journals Online (AJOL)

    2009-05-12

    May 12, 2009 ... This process may result in sloughing off of epithelial cells and compensatory cell ... Nardone G, Rocco A, Malfertheiner P. Review article: Helicobacter pylori and molecular events in precancerous gastric lesions. Aliment.

  13. Diet after gastric banding

    Science.gov (United States)

    ... helps people who have a gastric band stay satisfied longer. This includes things like salad with grilled ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  14. History, Pathogenesis, and Management of Familial Gastric Cancer: Original Study of John XXIII's Family

    Directory of Open Access Journals (Sweden)

    Giovanni Corso

    2013-01-01

    Full Text Available Background. Hereditary diffuse gastric cancer is associated with the E-cadherin germline mutations, but genetic determinants have not been identified for familial intestinal gastric carcinoma. The guidelines for hereditary diffuse gastric cancer are clearly established; however, there are no defined recommendations for the management of familial intestinal gastric carcinoma. Methods. In this study we describe Pope John XXIII's pedigree that harboured gastric cancer as well as six other family members. Family history was analysed according to the International Gastric Cancer Linkage Consortium criteria, and gastric tumours were classified in accord with the last Japanese guidelines. Results. Seven out of 109 members in this pedigree harboured gastric cancer, affecting two consecutive generations. John XXIII's clinical tumour (cTN was classified as cT4bN3a (IV stage. In two other cases, gastric carcinomas were classified as intestinal histotype and staged as pT1bN0 and pT2N2, respectively. Conclusions. Pope John XXIII's family presents a strong aggregation for gastric cancer affecting almost seven members; it spreads through two consecutive generations. In absence of defined genetic causes and considering the increased risk of gastric cancer’s development in these families, as well as the high mortality rates and advanced stages, we propose an intensive surveillance protocol for asymptomatic members.

  15. Gastric volvulus in childhood.

    Directory of Open Access Journals (Sweden)

    Karande T

    1997-04-01

    Full Text Available Gastric volvulus is an uncommon condition more so in the paediatric age group. The cause of gastric volvulus may be idiopathic or secondary to various congenital or acquired conditions. In this short series of three patients, one had volvulus which was due to ligamentous laxity and mobile spleen, second had congenital postero-lateral diaphragmatic defect and the third had hiatus hernia.

  16. Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Aiko eOgawa

    2015-02-01

    Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

  17. CT of Gastric Emergencies.

    Science.gov (United States)

    Guniganti, Preethi; Bradenham, Courtney H; Raptis, Constantine; Menias, Christine O; Mellnick, Vincent M

    2015-01-01

    Abdominal pain, nausea, and vomiting are common presenting symptoms among adult patients seeking care in the emergency department, and, with the increased use of computed tomography (CT) to image patients with these complaints, radiologists will more frequently encounter a variety of emergent gastric pathologic conditions on CT studies. Familiarity with the CT appearance of emergent gastric conditions is important, as the clinical presentation is often nonspecific and the radiologist may be the first to recognize gastric disease as the cause of a patient's symptoms. Although endoscopy and barium fluoroscopy remain important tools for evaluating patients with suspected gastric disease in the outpatient setting, compared with CT these modalities enable less comprehensive evaluation of patients with nonspecific complaints and are less readily available in the acute setting. Endoscopy is also more invasive than CT and has greater potential risks. Although the mucosal detail of CT is relatively poor compared with barium fluoroscopy or endoscopy, CT can be used with the appropriate imaging protocols to identify inflammatory conditions of the stomach ranging from gastritis to peptic ulcer disease. In addition, CT can readily demonstrate the various complications of gastric disease, including perforation, obstruction, and hemorrhage, which may direct further clinical, endoscopic, or surgical management. We will review the normal anatomy of the stomach and discuss emergent gastric disease with a focus on the usual clinical presentation, typical imaging appearance, and differentiating features, as well as potential imaging pitfalls.

  18. Familial Gastric Cancers

    Science.gov (United States)

    Setia, Namrata; Clark, Jeffrey W.; Duda, Dan G.; Hong, Theodore S.; Kwak, Eunice L.; Mullen, John T.

    2015-01-01

    Although the majority of gastric carcinomas are sporadic, approximately 10% show familial aggregation, and a hereditary cause is determined in 1%–3% cases. Of these, hereditary diffuse gastric cancer is the most recognized predisposition syndrome. Although rare, the less commonly known syndromes also confer a markedly increased risk for development of gastric cancer. Identification and characterization of these syndromes require a multidisciplinary effort involving oncologists, surgeons, genetic counselors, biologists, and pathologists. This article reviews the molecular genetics, clinical and pathologic features, surveillance guidelines, and preventive measures of common and less common hereditary gastric cancer predisposition syndromes. Implications for Practice: Although the majority of gastric adenocarcinomas are sporadic with many of those related to chronic Helicobacter pylori infection, approximately 10% of the cases show familial aggregation, and a specific hereditary cause is determined in 1%–3% cases. This review describes the molecular genetics, clinical and pathologic features, surveillance guidelines, and preventive measures of common and less common hereditary gastric cancer predisposition syndromes. Ultimately, a better understanding of the biology of these conditions should allow early identification and intervention as part of a multidisciplinary approach involving oncologists, surgeons, genetic counselors, and pathologists. PMID:26424758

  19. Relationship between trefoil factor 1 expression and gastric rnucosa injuries and gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Jian-Lin Ren; Jin-Yan Luo; Ya-Pi Lu; Lin Wang; Hua-Xiu Shi

    2005-01-01

    AIM: To determine whether trefoil factor 1 (TFF1) is associated with mucosa healing and carcinoma suppression, we assess the expression of trefoil factor 1 in normal and pathologic gastric mucosa.METHODS: TFF1 in normal and pathologic gastric mucosa was assessed by immunohistochemical method, and the average positive A was estimated by Motic Images Advanced 3.0 software.RESULTS: Increased TFF1 was detected in gastritis, gastric ulcer and duodenal ulcer compared with normal mucosa. The same result could be seen in multiple and compound ulcer compared with simple ulcer. There was no significant difference between gastric ulcer and duodenal ulcer, gastritis and simple ulcer respectively. Increased TFF1 was detected in the peripheral mucosa of the gastric adenocarcinoma compared with normalmucosa. The expression of TFF1 in gastric adenocarcinoma was related to the differentiation of adenocarcinoma. The lower the differentiation of adenocarcinoma, the weaker the expression of TFF1. There was no TFF1 expressed in low-differentiated adenocarcinoma. The expression of TFF1 in middle and highly differentiated adenocarcinoma was a little lower than that in normal mucosa. But there was no significant difference. No TFF1 was assessed in esophageal squamous carcinoma and peripheral tissue. There was no significant difference between male and female.CONCLUSION: The expression of TFF1 was higher in gastritis and peptic ulcer than that in normal mucosa, and was also higher in multiple and compound ulcer than in simple ulcer. It seems that TFF1 plays a role in gastric mucosa protection and epithelial restitution. Increased expression of TFF1 in peripheral tissue suggests that TFFLis associated with mechanism of carcinoma suppression and differentiation. Decreased expression of TFF1 in carcinoma and its relativity to the differentiation suggests that TFF1 is related to gland and cell destruction of carcinoma.

  20. 铜绿假单胞菌注射液预防胃癌术后腹腔复发与转移的研究%Evaluation of PA-MSHA vaccine on the prophylaxis of post-operative intraperitoneal recurrence and metastasis in advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    凌伟; 刘骅; 曹晖; 郁丰荣; 徐佳

    2009-01-01

    Objective To evaluate the killing effect by PA-MSHA vaccine on gastric cancer cells in vitro and its effect on the prophylaxis of post-operative intraperitoneal recurrence and metastasis in advanced gastric cancer. Methods MTT method was used to observe the inhibition and killing effect by PA-MSHA vaccine on gastric cancer cell strain MKN45 between January 2005 and December 2007 at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Specific combination and inhibition of cell proliferation were observed by transmission electron microscopy. Sixty cases of advanced gastric cancer T3M0 were selected into the study which were randomly separated into two groups: PA-MSHA group and control group. It observed side effects, effect on the patients' immune function and intraperitoneal recurrence or metastasis. Results PA-MSHA vaccine could specifically combine and penetrate into the gastric cancer cell strain MKN45 so as to inhibit its proliferation and the killing effect was in direct proportion to its dose. The side effect of PA-MSHA vaccine was comparatively limited. In PA-MSHA group, the cellular immune function was strengthened and intraperitoneal recurrence or metastasis decreased significantly. Conclusion PA-MSHA vaccine has dose-dependent killing effect on gastric cancer cell strain MKN45 by specific combination. It is safe and feasible which can strengthen the cellular immune function and reduce intraperitoneal recurrence or metastasis in advanced gastric cancer.%目的 探讨铜绿假单胞菌注射液在体外对胃癌细胞杀伤作用,并观察其在进展期胃癌围手术期应用对预防术后腹腔复发与转移的作用.方法 2005年1月至2007年12月上海交通大学医学院附属仁济医院普外科采用四甲基偶氮唑盐(MTT)法观察铜绿假单胞菌注射液抑制胃癌瘤株MKN45细胞增殖和杀伤作用的剂量依赖性;采用扫描电镜观察对胃癌瘤株MKN45的特异性结合.在此基础上选择T3MO

  1. Effect of Cachexia and Bacterial Translocation on Locally Advanced Gastric Cancer%恶液质与肠道细菌移位对局限型进展期胃癌患者临床结局的影响

    Institute of Scientific and Technical Information of China (English)

    王永红

    2014-01-01

    Objective To investigate the relationship between bacterial translocation and gastric cancer patients with ca -chexia.Methods 120 patients with locally advanced gastric cancer were divided into patients with cachexia (group A,60 cases) and patients without cachexia (group B,60 cases).Then the patients were divided into cachexia bacterial translocation positive group(group C),cachexia bacterial translocation negative group (group D),non-cachexia bacterial translocation positive group (group E)and non-cachexia bacterial translocation negative group (group F)according to the result of cultured peripheral blood . 60 healthy volunteers were the control group (group G).The intestinal bacteria were cultivated by peripheral blood;serum tumor necrosis factor α(TNF-α),and interleukin 1(IL-1)were tested;and the 2-year survival rate was calculated .Results ①The bac-terial translocation incidence rates of group A and group B were 26.67% and 6.67%;the bacterial culture results of group G were negative.The bacterial translocation rate in group A was significantly higher than that of group B (P<0.05).②The TNF-αand IL-1αlevel in group C were significantly higher than those of group D ,E,F and G(P<0.05).③The 2-year survival rates in group C,D,E,and F were 12.50%,22.73%, 50.00%,and 46.43%.Conclusion Intestinal bacterial translocation plays an important part in the occurrence and development of cachexia in gastric cancer .%目的:探讨肠道细菌移位与胃癌恶液质患者的关系。方法选择原发性局限型进展期胃癌患者120例,根据有无恶液质表现分为胃癌恶液质组( A组,60例)和胃癌无恶液质组( B组,60例)。外周血培养后,根据结果再分为恶液质细菌移位阳性组(C组)、恶液质细菌移位阴性组(D组),非恶液质细菌移位阳性组(E组)及非恶液质细菌移位阴性组( F组)。选择60例健康体检者作为对照组( G组)。外周血培养肠道细菌;检测

  2. Treatment of gastric outlet obstruction that results fromunresectable gastric cancer: Current evidence

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Malignant gastric outlet obstruction (GOO) is a commoncondition that results from locally advanced malignanciesin the upper gastrointestinal tract, such aspancreatic, gastric, and other carcinomas. Two typesof procedures for malignant GOO, namely, gastrojejunostomy(GJ) with laparotomy or a laparoscopicapproach and endoscopic stenting (ES), are currentlyavailable. Although numerous previous reports haveclarified the benefits and drawbacks of each procedure,whether GJ or ES should be used in patients with GOOthat results from gastric cancer who may have a longerlife expectancy than patients with other malignancieshas not been determined. In this review, which focuseson gastric cancer-induced GOO, we analyzed the twosystematic reviews and a meta-analysis that comparedGJ and ES and outlined the current status of GOOtreatment. We also provide an updated review thatincludes laparoscopic GJ. Various data from 13 studiesin one review and 6 studies in another review wereanalyzed. Although the main results of the presentreview indicated that both GJ and ES were efficacioustreatments in patients with GOO that resulted fromgastric cancer, current evidence suggests that GJ maybe the preferable procedure given its good performancestatus and improved prognosis in gastric cancer patients.

  3. Incidence trends and mortality rates of gastric cancer in Israel.

    Science.gov (United States)

    Lavy, Ron; Kapiev, Andronik; Poluksht, Natan; Halevy, Ariel; Keinan-Boker, Lital

    2013-04-01

    Gastric cancer is the fourth most common malignancy worldwide. The incidence trends and mortality rates of gastric cancer in Israel have not been studied in depth. The aim of our study was to try and investigate the aforementioned issues in Israel in different ethnic groups. This retrospective study is based on the data of The Israel National Cancer Registry and The Central Bureau of Statistics. Published data from these two institutes were collected, summarized, and analyzed in this study. Around 650 new cases of gastric cancer are diagnosed yearly in Israel. While we noticed a decline during the period 1990-2007 in the incidence in the Jewish population (13.6-8.9 and 6.75-5.42 cases per 100,000 in Jewish men and women, respectively), an increase in the Arab population was noticed (7.7-10.2 and 3.7-4.2 cases per 100,000 in men and women, respectively). Age-adjusted mortality rates per 10,000 cases of gastric cancer decreased significantly, from 7.21 in 1990 to 5.46 in 2007, in the total population. The 5-year relative survival showed a slight increase for both men and women. There is a difference in the incidence and outcome of gastric cancer between the Jewish and Arab populations in Israel. The grim prognosis of gastric cancer patients in Israel is probably due to the advanced stage at which gastric cancer is diagnosed in Israel.

  4. Research advances of K-ras mutation in the prognosis and targeted therapy of gastric cancer%K-ras 突变在胃癌预后及靶向治疗中的研究进展

    Institute of Scientific and Technical Information of China (English)

    黄荧; 魏嘉; 刘宝瑞

    2016-01-01

    约30%的人类肿瘤均可发生 K-ras 突变,其中在胰腺癌、结直肠癌和肺癌中尤其常见。近年的研究表明,胃癌中也存在一定的 K-ras 突变,人们还对 K-ras 突变展开了一系列的功能研究。文章介绍了 K-ras 突变在胃癌中的研究现状,尤其是 K-ras 突变在胃癌中的发生情况、K-ras 突变与胃癌临床病理特点及预后的相关性、靶向 K-ras 突变的小分子抑制剂、K-ras 信号通路上相关靶点的靶向药物治疗,提出了未来有潜力的研究方向。%K-ras mutations have been described in 30% of human cancers with significantly different mutation frequencies.High K-ras mutation frequency is found in many cancers such as pancreas and lung cancers, whereas, gastric cancer has a relatively low K-ras mutation frequency.In recent years, numerous researches have focused on the K-ras mutation in gastric cancer.This review summarizes the K-ras mutation frequency in gastric cancer, the relationship of K-ras mutation with clinicopathologic features and prognosis of gastric cancer patients, targeted therapy for K-ras mutated gastric cancer, some small-molecular inhibitors of K-ras, and development of targeted therapy drugs for K-ras signaling pathway in gastric cancer.

  5. 奥沙利铂联合卡培他滨治疗晚期胃癌的21例临床探讨%Combination of oxaliplatin and capecitabine in treatment of twenty-one advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    徐满珍; 李小兵

    2013-01-01

    Objective: To observe the efficacy and side efferts of oxalipatin plus capecitabine for the treatment of ad-vanced gastric cancer Methods: Twenty-one cases of patients . Oxaliplatin was given at a dose of 130mg/m2 by intravenous injection at day 1; Cape citabine was orally given at a dose of 2500 mg/m2, twice a day for two weeks. Twenty-one days was one cycle.Results: Among 21 patients , the response rate (CR+PR) was 57.1% with 2CR, 10PR, 3SD,6PD. MST was 9 months, mttp was 7 months. The major side effects were hand-foot syn-drome in 7(33.3%), newel toxity 12(57.1%), diarrhea 14 .conclusion: oxaplatin cornbined with capecitabine is a good chernother-appy with high clinical remission rate and could signiticartly improve life quality .And side effects could be tolerable.%目的观察奥沙利铂联合卡培他滨治疗晚期胃癌的疗效和安全性。方法21例晚期胃癌患者,静脉滴注奥沙利铂130mg/m2,d1;卡培他滨2500 mg/m2,分早晚2次口服,d1-14,21天为1周期。结果21例患者中,CR 2例,PR10例,SD3例,PD6例,近期有效率(CR+PR)为57.1%,中位生存期9个月,中位疾病进展时间为7个月。不良反应为手足综合征、神经毒性,多为Ⅰ-Ⅱ度。结论奥沙利铂联合卡培他滨化疗方案,缓解率高,能提高生活质量,毒副反应小,患者易耐受。

  6. Serum Levels of Leptin As Marker For Patients At High Risk of Gastric Cancer

    NARCIS (Netherlands)

    Capelle, Lisette G.; de Vries, Annemarie C.; Haringsma, Jelle; Steyerberg, Ewout W.; Looman, Caspar W. N.; Nagtzaam, Nicole M. A.; van Dekken, Herman; ter Borg, Frank; de Vries, Richard A.; Kuipers, Ernst J.

    2009-01-01

    Background: Serological screening for gastric cancer (GC) may reduce mortality. However, optimal serum markers for advanced gastric precursor lesions are lacking. Aim: To evaluate in a case-control study whether serum leptin levels correlate with intestinal metaplasia (IM) and can serve as a tool to

  7. RULE OF CARCINOGENETIC DEVELOPMENT OF GASTRIC CARDIA OBSERVED BY ENDOSCOPY

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To study the rule of development of early cancer of gastric cardiac in vivo. Methods: A prospective cohort was held in the high incidence area of cancer of esophagus and stomach in china. One hundred and six persons were examined regularly by endoscopy to observe the change of pro-cancer lesions of gastric cardiac by taking biopsy specimen. All specimens were diagnosed through normal pathological process. Results: The 106 subjects were examined twice in 1998 and 2002. Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 with mild atypical hyperplasia, and 2 with highly atypical hyperplasia. Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, 3 turned to atypical hyperplasia. Conclusion: 1. The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. 2. The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.

  8. HER2 testing in gastric and gastroesophageal adenocarcinomas.

    Science.gov (United States)

    Vakiani, Efsevia

    2015-05-01

    The human epidermal growth factor receptor 2 (HER2) is overexpressed in 10% to 35% of gastric and gastroesophageal junction (GEJ) adenocarcinomas. In 2010, the phase III Trastuzumab for Gastric Cancer (ToGA) trial showed that addition of the anti-HER2 monoclonal antibody trastuzumab to chemotherapy significantly improved survival of patients with advanced or metastatic tumors that were positive for HER2 overexpression. As a result, HER2 testing is now recommended for all patients with advanced or metastatic disease, although there is still some debate as to the optimal methods of assessment. HER2 expression in gastric and GEJ tumors shows several differences compared with breast tumors and, for this reason, the proposed criteria for scoring HER2 expression in biopsies and resections of gastric and GEJ carcinomas differ from those used in breast carcinomas. This review discusses what is currently known about the patterns of HER2 expression in gastric and GEJ adenocarcinomas, summarizes the findings of the ToGA trial and its clinical implications, and provides an overview of the recommended guidelines for the most accurate evaluation of HER2 status in gastric and GEJ cancer.

  9. Cellular and molecular aspects of gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Malcolm G Smith; Georgina L Hold; Eiichi Tahara; Emad M El-Omar

    2006-01-01

    Gastric cancer remains a global killer with a shifting burden from the developed to the developing world.The cancer develops along a multistage process that is defined by distinct histological and pathophysiological phases. Several genetic and epigenetic alterations mediate the transition from one stage to another and these include mutations in oncogenes, tumour suppressor genes and cell cycle and mismatch repair genes. The most significant advance in the fight against gastric caner came with the recognition of the role of Helicobacter pylori (H pylori) as the most important acquired aetiological agent for this cancer. Recent work has focussed on elucidating the complex host/microbial interactions that underlie the neoplastic process. There is now considerable insight into the pathogenesis of this cancer and the prospect of preventing and eradicating the disease has become a reality. Perhaps more importantly, the study of H pylori-induced gastric carcinogenesis offers a paradigm for understanding more complex human cancers. In this review, we examine the molecular and cellular events that underlie H pyloriinduced gastric cancer.

  10. Complication of Intraoperative Radiation Therapy (IORT) in Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myung Se; Kim, Sung Kyu; Song, Sung Kyo; Kim, Hong Jin; Kwan, Koing Bo; Kim, Heung Dae [Yeungnam University College of Medicine, Taegu (Korea, Republic of)

    1992-12-15

    Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increase distant metastasis free survival. IORT is the modality which could increase local control without increasing complication, combined with curative operation. Even though we could achieve significant decreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988, and performed 53 IORT in patients with gastric cancer. No local failure has been report? by regular follow up so far. Nine cases(17%) of treatment related complication were reported including intestinal obstruction, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo 25.2% (chemotherapy + operation), Kim 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500 cGy), external irradiation(--4500 cGy) and extensive chemotherapy (FAM, 5FU+MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.

  11. Older patients with inoperable non-small cell lung cancer. Long-term survival after concurrent chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Semrau, Sabine; Fietkau, Rainer [Friedrich-Alexander-University Erlangen-Nuernberg, Department of Radiation Oncology, Erlangen (Germany); Zettl, Heike [Rostock Cancer Registry University of Rostock, Rostock (Germany); Hildebrandt, Guido [University of Rostock, Department of Radiation Therapy, Rostock (Germany); Klautke, Gunther [Klinikum Chemnitz, Department of Radiation Therapy, Chemnitz (Germany)

    2014-12-15

    Considering the various comorbidities associated with aging, the feasibility and usefulness of concurrent chemoradiotherapy (CRT) in older patients with inoperable non-small cell lung cancer (NSCLC) is a controversial issue. Here, we compared the feasibility of CRT and the effects of various comorbidities on the prognosis of a minimally selected population of inoperable NSCLC patients aged 60-77 years. The study comprised 161 patients with inoperable NSCLC who received CRT with a target radiation dose greater than 60 Gy and platinum-based chemotherapy from 1998 to 2007. The total population included 69 patients aged 60-69 years and 53 aged 70-77 years. These two age cohorts were included in the study with a follow-up of a median 14.5 months. The two groups showed no differences in long-term survival, as reflected by the 5-year survival rates of 13.0 ± 4.1 % (60- to 69-year-olds) and 14.4 ± 4.9 % (70- to 77-year-olds). During the treatment phase, the groups were comparable in terms of toxicity and the feasibility of chemotherapy. Compared to patients in their 60s, the septuagenarians had more pulmonary comorbidities (p = 0.02), diabetes mellitus (p = 0.04), cardiac comorbidities (p = 0.08), and previous cancer disease (p = 0.08) that exerted a negative effect on survival. In patients without comorbidities, there were no differences between the age groups. Age is not a contraindication for concurrent CRT per se, because elderly patients do not have a worse long-term prognosis than younger seniors. However, ''elderly patients'' (≥ 70-77 years) have more concomitant diseases associated with shorter survival than ''moderately aged patients'' (≥ 60-69 years). (orig.) [German] Hinsichtlich der verschiedenen altersbedingten Komorbiditaeten werden die Durchfuehrbarkeit und der Nutzen einer simultanen Chemoradiotherapie (''concurrent chemoradiotherapy'', CRT) bei alten Patienten mit einem inoperablen nicht

  12. Clinicopathological characteristics and computed tomography features of mucinous gastric carcinoma.

    Science.gov (United States)

    Yan, C; Zhu, Z-G; Yan, M; Zhang, H; Pan, Z-L; Chen, J; Xiang, M; Chen, M-M; Liu, B-Y; Lin, Y-Z

    2011-01-01

    This study investigated the clinicopathological characteristics of mucinous gastric carcinoma (MGC) and assessed whether multidetector-row computed tomography (MDCT) could differentiate MGC from non-mucinous gastric carcinoma (NGC). Clinicopathological data from 542 patients with gastric carcinoma (23 MGC, 519 NGC), who underwent pre-operative MDCT examination and curative or palliative gastrectomy, were analysed. Only seven of the 23 patients with MGC were correctly diagnosed pre-operatively by endoscopic biopsy. The MGC patients had larger tumours, a higher frequency of lymph node metastases, were more likely to have tumours of tumour, node, metastasis stages III and IV, and were less likely to have a curative resection than NGC patients. In addition, five MGC patients had calcifications in the thickened gastric wall. In conclusion, MGC is rare and is detected mostly at an advanced stage. The diagnostic sensitivity of MGC by endoscopic biopsy was relatively low, whereas MDCT was helpful in distinguishing MGC from NGC.

  13. Immunotherapy of gastric cancer with levamisole

    Directory of Open Access Journals (Sweden)

    Miwa,Hiroaki

    1978-10-01

    Full Text Available Ninety-nine gastric cancer patients initially received levamisole at a daily dose of 150 mg for three consecutive days before operation. This therapy was repeated fortnightly (3-day administration followed by 11-day withdrawal period for more than one month as long as possible and the survival rate up to 18 months was compared with thas of control patients. The 18 month survival rate of advanced Stage IV patients was significantly higher in patients receiving levamisole than that of control patients. The effects of levamisole in cases of advanced cancer have been discussed in relation to the literature available.

  14. Adjuvant chemotherapy (Nedaplatin/UFT) after radiotherapy for locallu advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kubota, Akira; Furukawa, Madoka; Kawano, Toshiro; Yamashita, Kohsuke; Sugiyama, Masato [Kanagawa Cancer Center (Japan)

    2003-03-01

    To evaluate the toxicity and efficacy of adjuvant chemotherapy after radiotherapy for patients with locally advanced head and neck squamous cancer, 40 patients, previously untreated (6 with stage III and 34 with stage IV; 26 with resectable, 10 with unresectable and 4 patients with inoperable) were treated with radiotherapy followed by adjuvant chemotherapy (Nedaplatin /tegafur-uracil (UFT)) at our outpatient clinic. The primary site was identified in the larynx or hypopharynx in 15, oral cavity or oropharynx in 11, sinuses in 6, nasopharynx in 4, unknown primary in 3, and parotis in 1 patient. Treatment consisted of 6 courses of Nedaplatin 80 mg/m{sup 2} repeated at 4 weeks intervals, and one-year oral administration of UFTE 400mg/day, after radiotherapy. Toxicities included leukopenia (grade 3, 20.5%, grade 4, 2.6%), thrombocytopenia (grade 3, 7.7%). There was one death due to gastric ulcer. Twenty-five patients (62.5%) received 6 courses of adjuvant chemotherapy. Two-year overall survival rate was 100% for stage III and 61.1% for stage IV. Over the same period, the progression-free survival rate was 83.3% for stage III and 46.1% for stage IV. 85.7% of complete response (CR) (12/14 patients) and 63.6% of partial response (PR) (14/22 patients) to radiotherapy showed that the effect of radiotherapy was maintained during adjuvant chemotherapy. If the effect of radiotherapy was maintained during adjuvant chemotherapy, the two-year progression free survival rate was not different between 81.8% for CR to radiotherapy and 81.3% for PR. The rate of distant failure was 2.5%, which was lower than that citedin previous reports. This adjuvant chemotherapy regimen is tolerable at outpatient clinics and might suppress distant metastasis after radiotherapy. (author)

  15. Survival and Quality of Life After Stereotactic or 3D-Conformal Radiotherapy for Inoperable Early-Stage Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Widder, Joachim, E-mail: j.widder@rt.umcg.nl [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Postmus, Douwe [Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Ubbels, Jan F.; Wiegman, Erwin M.; Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

    2011-11-15

    Purpose: To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment. Methods and Materials: Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate. Results: Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5-4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7-14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR (p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0-5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8-14.7; p < 0.01) after 3D-CRT compared with SABR. Conclusion: In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.

  16. Robotic stereotactic body radiation therapy for elderly medically inoperable early-stage non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Karam SD

    2013-08-01

    Full Text Available Sana D Karam,1 Zachary D Horne,1 Robert L Hong,1,2 Nimrah Baig,1 Gregory J Gagnon,4 Don McRae,2 David Duhamel,3 Nadim M Nasr1,21Department of Radiation Oncology, Georgetown University Hospital, Washington, DC, USA; 2Department of Radiation Oncology, Virginia Hospital Center, Arlington, VA, USA; 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA; 4Department of Radiation Oncology, Frederick Memorial Hospital, Frederick, MD, USAIntroduction: Stereotactic body radiation therapy (SBRT is being increasingly applied in the treatment of non-small cell lung cancer (NSCLC because of its high local efficacy. This study aims to examine survival outcomes in elderly patients with inoperable stage I NSCLC treated with SBRT.Methods: A total of 31 patients with single lesions treated with fractionated SBRT from 2008 to 2011 were retrospectively analyzed. A median prescribed dose of 48 Gy was delivered to the prescription isodose line, over a median of four treatments. The median biologically effective dose (BED was 105.6 (range 37.50–180, and the median age was 73 (65–90 years. No patient received concurrent chemotherapy.Results: With a median follow up of 13 months (range, 4–40 months, the actuarial median overall survival (OS and progression-free survival (PFS were 32 months, and 19 months, respectively. The actuarial median local control (LC time was not reached. The survival outcomes at median follow up of 13 months were 80%, 68%, and 70% for LC, PFS, and OS, respectively. Univariate analysis revealed a BED of >100 Gy was associated with improved LC rates (P = 0.02, while squamous cell histology predicted for worse LC outcome at median follow up time of 13 months (P = 0.04. Increased tumor volume was a worse prognostic indicator of both LC and OS outcomes (P < 0.05. Finally, female gender was a better prognostic factor for OS than male gender (P = 0.006. There were no prognostic indicators of PFS that reached

  17. 西妥昔单抗联合FOLFIRI方案治疗晚期胃癌的疗效观察%Effects of Cetuximab Combined with Modified FOLFIRI on Advanced Gastric Cancer in Second-line Treatment

    Institute of Scientific and Technical Information of China (English)

    邓清明; 李登进; 张林

    2012-01-01

    To observe the effects of Cetuximab combined with modified FOLFIRI on advanced gastric cancer in second-line treatment and evaluate its efficacy and adverse reactions,and to investigate the relationship between its efficacy and prognosis.Methods:Tumor lesions and adverse reactions were observed every 2 cycles of treatment,and the progress of tumor and survival were followed up.Tumor remission assessment were performed in accordance with Response Evaluation Criteria in solid Tumors (RECIST) and the adverse event were classified according to the Common adverse events evaluation criteria version 3.0 (NCI a CTCAE3.0) by National Cancer Institute.Calculate the tumor remission rate,median time to progression and median overall survival.Results:Among the 38 patients who completed at least 2 cycles of treatment and received efficacy evaluation,one case was observed in complete remission (CR),accounting for 0.03%; 13 cases were in partial remission (PR),accounting for 34.00%; the overall remission rate (ORR =CR + PR) was 37.00%.20 cases were in status of stable disease (SD),accounting for 53.00%; disease control rate (Disease Control Rate,DCR =CR + PR + SD) was 89.00%.Disease progression (PD) was occurred in 4 cases,accounting for 11.00%.The overall safety is good,for no case of treatment-related death occurred.The Ⅲ / Ⅳ neutropenia incidence was 52.5%,incidence of febrile due to particle missing 13.1%,incidence ofⅢ / Ⅳ degree severe anemia 29.5%,incidence ofⅢ / Ⅳ degree ofthrombocytopenia decline 8.2%.Ⅲ / Ⅳ degree of non-hematologic toxicity included nausea (8.2%),vomiting (6.6%),stomatitis (1.6%),diarrhea (6.6%),infection (4.9%),fatigue (4.9%),ileus (6.6 %),elevated aminotransferases (1.6%),allergic reactions (1.6%) and rash (9.8%).Conclusion:This study showed that Cetuximab combined with modified FOLFIRI is a safe and effective program in second-line treatment of advanced gastric cancer patients.It is required to

  18. Gastric cancer: basic aspects.

    Science.gov (United States)

    Resende, Carlos; Thiel, Alexandra; Machado, José C; Ristimäki, Ari

    2011-09-01

    Gastric cancer (GC) is a world health burden, ranging as the second cause of cancer death worldwide. Etiologically, GC arises not only from the combined effects of environmental factors and susceptible genetic variants but also from the accumulation of genetic and epigenetic alterations. In the last years, molecular oncobiology studies brought to light a number of genes that are implicated in gastric carcinogenesis. This review is intended to focus on the recently described basic aspects that play key roles in the process of gastric carcinogenesis. Genetic variants of the genes IL-10, IL-17, MUC1, MUC6, DNMT3B, SMAD4, and SERPINE1 have been reported to modify the risk of developing GC. Several genes have been newly associated with gastric carcinogenesis, both through oncogenic activation (GSK3β, CD133, DSC2, P-Cadherin, CDH17, CD168, CD44, metalloproteinases MMP7 and MMP11, and a subset of miRNAs) and through tumor suppressor gene inactivation mechanisms (TFF1, PDX1, BCL2L10, XRCC, psiTPTE-HERV, HAI-2, GRIK2, and RUNX3). It also addressed the role of the inflammatory mediator cyclooxygenase-2 (COX-2) in the process of gastric carcinogenesis and its importance as a potential molecular target for therapy.

  19. GASTRIC OUTLET OBSTRUCTION IN PROTON PUMP INHIBITOR ERA: A PROSPECTIVE STUDY OF FIFTY CASES IN TERTIARY HOSPITAL IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2016-01-01

    ulcer with gastric outlet obstruction, males are 8 in number (67% and females are 4 in numbers (33%. A total of 184 patients were studied and only 50 were included for the study. More than two-third of patients were males. Patients with malignant gastric outlet obstruction were older than those of benign type. This difference was statistically significant (p<0.001. Gastric cancer was the commonest malignant cause of gastric outlet obstruction, whereas peptic ulcer disease was the commonest benign cause. Commonest age group for cancer antrum with gastric outlet obstruction is 51-60 years and that of chronic DU with gastric outlet obstruction is 41-50 years. For antral carcinoma, Subtotal gastrectomy with Billroth II anastomosis was done for operable patients. Palliative anterior gastrojejunostomy for inoperable patients. For chronic DU, Truncal vagotomy with short loop posterior gastrojejunostomy was done in 12 patients. CONCLUSION So with the advent of recent antiulcer drugs the commonest cause of gastric outlet obstruction is carcinoma antrum of stomach, which has compared well with other center studies. Commonest age group for carcinoma antrum with gastric outlet obstruction is 51-60 years and that of chronic DU with gastric outlet obstruction is 41-50 years. Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant. The majority of patients present late with poor general condition. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided.

  20. Treatment Option Overview (Gastric Cancer)

    Science.gov (United States)

    ... liver cancer . The following stages are used for gastric cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells are ... check-ups. Treatment Options by Stage Stage 0 (Carcinoma in ... Stage I Gastric Cancer Treatment of stage I gastric cancer may ...

  1. General Information about Gastric Cancer

    Science.gov (United States)

    ... liver cancer . The following stages are used for gastric cancer: Stage 0 (Carcinoma in Situ) In stage 0 , abnormal cells are ... check-ups. Treatment Options by Stage Stage 0 (Carcinoma in ... Stage I Gastric Cancer Treatment of stage I gastric cancer may ...

  2. Post-marketing safety evaluation of S-1 in patients with inoperable or recurrent breast cancer: especially in patients treated with S-1 + trastuzumab.

    Science.gov (United States)

    Saito, Yuki; Oshitanai, Risa; Terao, Mayako; Terada, Mizuho; Tsuda, Banri; Okamura, Takuho; Suzuki, Yasuhiro; Tokuda, Yutaka

    2011-09-01

    The purpose of this study was to assess the safety of S-1 in Japanese in inoperable or recurrent breast cancer patients. A prospective post-marketing surveillance was performed at 313 sites in Japan in patients with inoperable or recurrent breast cancer treated with S-1. We examined 1361 patients between January 2006 and December 2007 with regard to the incidence of adverse drug reactions graded by the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. At least one adverse drug reaction was encountered by 858 patients, with an overall incidence of 63.0% (858/1361). The incidence of Grade 3 or higher adverse drug reactions in a descending order was 14.7% (200/1361). In this study, the most common combination drug was trastuzumab. The overall incidence of adverse drug reactions was 63.5% (431/679 patients) in patients treated with S-1 alone, and 55.9% (66/118 patients) in patients treated with S-1 + trastuzumab. Monotherapy with S-1 or combination therapy with S-1 + trastuzumab was well tolerated for inoperable or recurrent breast cancer patients.

  3. FGF19 Contributes to Tumor Progression in Gastric Cancer by Promoting Migration and Invasion.

    Science.gov (United States)

    Wang, Shuang; Zhao, Daqi; Tian, Ruihua; Shi, Hailong; Chen, Xiangming; Liu, Wenzhi; Wei, Lin

    2016-01-01

    Gastric cancer is the fourth most common type of cancer and second leading cause of cancer-related death in the world. Since patients are often diagnosed at a late stage, very few effective therapies are left in the arsenal. FGF19, as a hormone, has been reported to promote tumor growth in various types of cancer; however, its function in gastric cancer remains unknown. In the current study, we showed that FGF19 is overexpressed in gastric cancer and is associated with depth of invasion, lymph node metastasis, and TNM stage. In addition, in vitro experiments demonstrated that FGF19 is able to enhance migration and invasion abilities of gastric cancer cells. Given its great potency in gastric cancer progression, FGF19 may be an effective target of treatment for advanced gastric cancer patients.

  4. ANTIGEN MG7 IN GASTRIC CANCER AND GASTRIC PRECANCEROUS LESIONS

    Institute of Scientific and Technical Information of China (English)

    郭冬丽; 宁佩芳; 袁媛

    2004-01-01

    Objective: To study the dynamic change and its diagnostic significance of MG7 expression in the process of gastric cancer development. Methods: The expression level of antigen MG7 was determined by immunohistochemistry method in 406 cases of gastric mucosa. The classification of intestinal metaplasia of gastric mucosa was determined by histochemistry method in 82 cases. Results: The positive rate of MG7 expression in normal gastric mucosa, intestinal metaplasia and dysplasia of gastric mucosa and gastric cancer were increased gradually (P<0.01). The positive rate of MG7 expression in superficial gastritis, atrophic gastritis and gastric cancer were increased on sequence (P<0.01). The positive rate of antigen MG7 expression in type Ⅲ intestinal metaplasia of gastric mucosa had significant difference,compared with that in type Ⅰ an Ⅱ intestinal metaplasia (P<0.05). Conclusion: MG7 antigen had close relationship with gastric cancer. Type Ⅲ intestinal metaplasia, atrophic gastritis and dysplasia should be followed up in order to improve the early detection of gastric cancer. MG7 antigen had great clinical value in the dynamic follow-up of gastric precursors.

  5. Modulation of toxicity following external beam irradiation preceded by high-dose rate brachytherapy in inoperable oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Taal, B.G.; Aleman, B.M.P.; Koning, C.C.E.; Boot, H. [Nederlands Kanker Inst. `Antoni van Leeuwenhoekhuis`, Amsterdam (Netherlands)

    1996-09-01

    To induce fast relief of dysphagia in inoperable oesephageal cancer, we applied high-dose rate (HDR) intraluminal irradiation followed by external irradiation (EBRT) in a phase II study. 15 patients (group A: n = 15; 10 men, 5 women; median age 66 years) were treated with 10 Gy HDR brachytherapy plus 40 Gy EBRT (15 fractions of 2.67 Gy). Severe side-effects were encountered in 60% of patients: 3 late ulceration, 2 pending fistula and 2 patients with fatal haemorrhage after an interval of 6 months. Overall response was excellent: 9 complete remissions (60%) and 6 partial responses (40%). Because of the high toxicity rate, in a subsequent study (group B: n = 30; 23 mean, 7 women; median age 66 years) the EBRT scheme was changed using smaller fractions (2.0 Gy) to reach the same total dose of 40 Gy. The complication rate (17%) was significantly reduced, while the overall response remained excellent (83%): 17 complete and 8 partial responses. The impressive change in complication rate of HDR brachytherapy and EBRT stresses the impact of the fraction per dose and illustrates the small therapeutic margins. (author).

  6. Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer.

    Science.gov (United States)

    Bye, Asta; Wesseltoft-Rao, Nima; Iversen, Per Ole; Skjegstad, Grete; Holven, Kirsten B; Ulven, Stine; Hjermstad, Marianne J

    2016-06-01

    Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35-79) years, 5 females, were followed for median 5.5 (1-12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI 2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p cachexia.

  7. Activity and safety of pegylated liposomal doxorubicin,5-fluorouracil and folinic acid in inoperable hepatocellular carcinoma: A phase Ⅱ study

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To improve the results of New therapeutic strategies in hepatocellular carcinoma (HCC). We have conducted a phase Ⅱ study with pegylated liposomal doxorubicin (PLD), 5-fluorouracil (5FU) and folinic acid (FA).METHODS: Thirty-one patients with hystologically-confirmed, inoperable HCC, received combination chemotherapy with PLD 25 mg/mq on d 1, 5FU 1200 mg/mq in 48 h continuous infusion, and oral FA 30 mg on d 1 and 2 every 3 wk until disease progression or intolerable toxicity.RESULTS: The median age was 65 years (range 41-82) and 28 patients were hepatitis C virus seropositive (90%).The majority of patients were Child-Pugh Class B (55%).Two patients showed a partial response (PR), and 16 had stable disease (SD). With a median follow-up of 14 mo, the median time to progression of all evaluable patients was 4 mo (95% CI 1.7-7). Median overall survival was 9 mo (95% CI 3-24 mo). After 1 year, 9 of 18 PR/SD patients were alive. Chemotherapy was well tolerated.CONCLUSION: PLD/FU/FA combination seems capable of achieving durable stabilization of HCC. The manageable toxicity supports a role for combination with other anticancer agents.

  8. The use of imatinib in the treatment of inoperable dermatofibrosarcoma protuberans in the area of the shoulder joint

    Directory of Open Access Journals (Sweden)

    Joanna Huszno

    2014-06-01

    Full Text Available Introduction. Dermatofibrosarcoma protuberans (DFSP is a rare sarcoma of the skin and subcutaneous tissue. The most common clinical problem is its local recurrence. The therapeutic procedure of choice is radical surgery. In the case of inoperable disease, targeted therapy with imatinib, a tyrosine kinase inhibitor, may cause significant reduction of tumor volume and even enable radical surgery. Objective. We present the effectiveness of imatinib for the treatment of unresectable DFSP localized in the area of the shoulder joint of a 62-year-old woman. Case report. The patient met the criteria for inclusion in treatment with imatinib. After 3 cycles of treatment, partial regression of the lesions (above 50% was observed. Therapy was complicated by hepatological side effects during the sixth cycle. Treatment was continued with a reduced dose when transaminase levels normalized. In a physical examination and imaging studies, further regression was observed. The patient has regained considerable mobility of the shoulder joint. A decision to continue the treatment has been made. Conclusions. The use of imatinib allowed a clinical benefit to be gained in the form of significant regression of lesions. A very good treatment response and significant improvement in quality of life of the patient were achieved. The patient has been treated with imatinib for 30 months.

  9. The genomics and therapeutics of HER2-positive gastric cancer—from trastuzumab and beyond

    Science.gov (United States)

    Kelly, Ciara M.

    2016-01-01

    Gastric cancer is a biologically heterogeneous tumor. The identification of human epidermal growth factor receptor-2 (HER2) biomarker overexpression in gastric cancer represented a significant step towards unraveling the molecular complexity of this disease. Trastuzumab in combination with chemotherapy, in the first-line setting of patients with metastatic, HER2-positive gastric and gastroesophageal, represents the first targeted therapeutic to demonstrate improvement in response rate and survival in gastric cancer. However, not all patients with HER2-positive gastric cancer respond to trastuzumab and the majority of patients who do initially benefit from trastuzumab develop resistance to it. Advances in molecular oncology and cancer genomics have helped to classify gastric cancer into molecularly distinct subtypes. This information informs research efforts investigating the etiology of mechanisms of resistance to HER2-directed therapy and guides clinical investigation in methods to overcome this resistance. This article reviews anti-HER2-therapies that are currently used as standard of care in advanced, HER2-positive, breast cancer and are now under investigation as monotherapy and in combination with chemotherapy and/or a second HER2-directed agent in advanced HER2-positive gastric cancer. The future directions of clinical investigation in HER2-positive gastric cancer are also discussed including: novel HER2-directed therapies, the pharmacokinetics and pharmacodynamics of anti-HER2-therapies, the role of functional imaging, the potential of patient derived xenograft preclinical models and the importance of tumor genomic sequencing. PMID:27747089

  10. MYC and gastric adenocarcinoma carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    Danielle Queiroz Calcagno; Mariana Ferreira Leal; Paulo Pimentel Assumpcao; Marilia de Arruda Cardoso Smith; Rommel Rodriguez Burbano

    2008-01-01

    MYC is an oncogene involved in cell cycle regulation, cell growth arrest, cell adhesion, metabolism, ribosome biogenesis, protein synthesis, and mitochondrial function. It has been described as a key element of several carcinogenesis processes in humans. Many studies have shown an association between MYC deregulation and gastric cancer. MYC deregulation is also seen in gastric preneoplastic lesions and thus it may have a role in early gastric carcinogenesis. Several studies have suggested that amplification is the main mechanism of MYC deregulation in gastric cancer. In the present review, we focus on the deregulation of the MYC oncogene in gastric adenocarcinoma carcinogenesis, including its association with Helicobacter pylori (H pylori) and clinical applications.

  11. [Surgical treatment of gastric carcinoma: lymphadenectomy].

    Science.gov (United States)

    Crucitti, F; Pacelli, F; Doglietto, G B; Crucitti, P; Alfieri, S; Caprino, P

    1997-01-01

    The review of the literature shows the improvement of outcome of patients with gastric cancer after resection and extended lymphadenectomy. Lymphadenectomy D2/D3 was performed in 206 out of 639 patients with gastric cancer: 5-year survival was 66.3% versus 41.5% of the 121 patients that underwent D1 resection (p < 0.0001). Univariate and multivariate analyses show that proximal location of the cancer, advanced stage and lymphadenectomy limited to perigastric stations are negative prognostic factors. Although there are still different opinions regarding D2 or D3 lymphadenectomies for the operative risks, pancreatic resection (preferring pancreas sparing techniques) and splenectomy is subtotal gastrectomy for antral carcinoma, extended lymphadenectomy remains an important point to improve survival.

  12. Prognostic factorsin inoperable adenocarcinoma of the lung: A multivariate regression analysis of 259 patiens

    DEFF Research Database (Denmark)

    Sørensen, Jens Benn; Badsberg, Jens Henrik; Olsen, Jens

    1989-01-01

    The prognostic factors for survival in advanced adenocarcinoma of the lung were investigated in a consecutive series of 259 patients treated with chemotherapy. Twenty-eight pretreatment variables were investigated by use of Cox's multivariate regression model, including histological subtypes...... and degree of differentiation, the new international staging system for lung cancer, and seven laboratory parameters. Staging of the patients included bone marrow examination but were otherwise nonextensive without routine bone, liver, and brain scans. Factors predicting poor survival were low performance...... status, stage IV disease, no prior nonradical resection, liver metastases, high values of white blood cell count, and lactate dehydrogenase, and low values of aspartate aminotransaminase. The nonradical resection may not be a prognostic factor because of the resection itself but may rather serve...

  13. Identification and validation of genes involved in gastric tumorigenesis

    Directory of Open Access Journals (Sweden)

    Shirley Sundersingh

    2010-11-01

    Full Text Available Abstract Background Gastric cancer is one of the common cancers seen in south India. Unfortunately more than 90% are advanced by the time they report to a tertiary centre in the country. There is an urgent need to characterize these cancers and try to identify potential biomarkers and novel therapeutic targets. Materials and methods We used 24 gastric cancers, 20 Paired normal (PN and 5 apparently normal gastric tissues obtained from patients with non-gastric cancers (Apparently normal - AN for the microarray study followed by validation of the significant genes (n = 63 by relative quantitation using Taqman Low Density Array Real Time PCR. We then used a custom made Quantibody protein array to validate the expression of 15 proteins in gastric tissues (4 AN, 9 PN and 9 gastric cancers. The same array format was used to study the plasma levels of these proteins in 58 patients with gastric cancers and 18 from patients with normal/non-malignant gastric conditions. Results Seventeen genes (ASPN, CCL15/MIP-1δ, MMP3, SPON2, PRSS2, CCL3, TMEPAI/PMEPAI, SIX3, MFNG, SOSTDC1, SGNE1, SST, IGHA1, AKR1B10, FCGBP, ATP4B, NCAPH2 were shown to be differentially expressed between the tumours and the paired normal, for the first time. EpCAM (p = 0.0001, IL8 (p = 0.0003, CCL4/MIP-1β (p = 0.0026, CCL20/MIP-3α (p = 0.039 and TIMP1 (p = 0.0017 tissue protein levels were significantly different (Mann Whitney U test between tumours versus AN & PN. In addition, median plasma levels of IL8, CXCL9/MIG, CCL3/MIP-1α, CCL20/MIP-3α, PDGFR-B and TIMP1 proteins were significantly different between the non-malignant group and the gastric cancer group. The post-surgical levels of EpCAM, IGFBP3, IL8, CXCL10/IP10, CXCL9/MIG, CCL3/MIP-1α, CCL20/MIP-3α, SPP1/OPN and PDGFR-B showed a uniform drop in all the samples studied. Conclusions Our study has identified several genes differentially expressed in gastric cancers, some for the first time. Some of these have been confirmed at

  14. Gastric microbiota and carcinogenesis: the role of non-Helicobacter pylori bacteria: a systematic review

    Directory of Open Access Journals (Sweden)

    Emanuel Dias-Jácome

    Full Text Available Background and aim: Helicobacter pylori is the strongest risk factor for gastric cancer. However, recent advances in DNA sequencing technology have revealed a complex microbial community in the stomach that could also contribute to the development of gastric cancer. The aim of this study was to present recent scientific evidence regarding the role of non-Helicobacter pylori bacteria in gastric carcinogenesis. Methods: A systematic review of original articles published in PubMed in the last ten years related to gastric microbiota and gastric cancer in humans was performed. Results: Thirteen original articles were included. The constitution of gastric microbiota appears to be significantly affected by gastric cancer and premalignant lesions. In fact, differences in gastric microbiota have been documented, depending on Helicobacter pylori status and gastric conditions, such as non-atrophic gastritis, intestinal metaplasia and cancer. Gastric carcinogenesis can be associated with an increase in many bacteria (such as Lactobacillus coleohominis, Klebsiella pneumoniae or Acinetobacter baumannii as well as decrease in others (such as Porphyromonas spp, Neisseria spp, Prevotella pallens or Streptococcus sinensis. However, there is no conclusive data that confirms if these changes in microbiota are a cause or consequence of the process of carcinogenesis. Conclusions: Even though there is limited evidence in humans, microbiota differences between normal individuals, pre-malignant lesions and gastric cancer could suggest a progressive shift in the constitution of gastric microbiota in carcinogenesis, possibly resulting from a complex cross-talk between gastric microbiota and Helicobacter pylori. However, further studies are needed to elucidate the specific role (if any of different microorganisms.

  15. Ion Chromatography Based Urine Amino Acid Profiling Applied for Diagnosis of Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Jing Fan

    2012-01-01

    Full Text Available Aim. Amino acid metabolism in cancer patients differs from that in healthy people. In the study, we performed urine-free amino acid profile of gastric cancer at different stages and health subjects to explore potential biomarkers for diagnosing or screening gastric cancer. Methods. Forty three urine samples were collected from inpatients and healthy adults who were divided into 4 groups. Healthy adults were in group A (n=15, early gastric cancer inpatients in group B (n=7, and advanced gastric cancer inpatients in group C (n=16; in addition, two healthy adults and three advanced gastric cancer inpatients were in group D (n=5 to test models. We performed urine amino acids profile of each group by applying ion chromatography (IC technique and analyzed urine amino acids according to chromatogram of amino acids standard solution. The data we obtained were processed with statistical analysis. A diagnostic model was constructed to discriminate gastric cancer from healthy individuals and another diagnostic model for clinical staging by principal component analysis. Differentiation performance was validated by the area under the curve (AUC of receiver-operating characteristic (ROC curves. Results. The urine-free amino acid profile of gastric cancer patients changed to a certain degree compared with that of healthy adults. Compared with healthy adult group, the levels of valine, isoleucine, and leucine increased (P<0.05, but the levels of histidine and methionine decreased (P<0.05, and aspartate decreased significantly (P<0.01. The urine amino acid profile was also different between early and advanced gastric cancer groups. Compared with early gastric cancer, the levels of isoleucine and valine decreased in advanced gastric cancer (P<0.05. A diagnosis model constructed for gastric cancer with AUC value of 0.936 tested by group D showed that 4 samples could coincide with it. Another diagnosis model for clinical staging with an AUC value of 0.902 tested by

  16. Effects of gastric pacing on gastric emptying and plasma motilin

    Institute of Scientific and Technical Information of China (English)

    Min Yang; Dian-Chun Fang; Qian-Wei Li; Nian-Xu Sun; Qing-Lin Long; Jian-Feng Sui; Lu Gan

    2004-01-01

    AIM: To invertigate the effects of gastric pacing on gastric emptying and plasma motilin level in a canine model of gastric motility disorders and the correlation between gastric emptying and plasma motilin level.METHODS: Ten healthy Mongrel dogs were divided into:experimental group of six dogs and control group of four dogs. A model of gastric motility disorders was established in the experimental group undergone truncal vagotomy combined with injection of glucagon. Gastric half-emptying time (GEt1/2) was monitored with single photon emission computerized tomography (SPECT), and the half-solid test meal was labeled with an isotope-99m Tc sulfur colloid. Plasma motilin concentration was measured with radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2 times the intrinsic slow-wave frequency and a superimposed series of high frequency pulses (10-30 Hz) was performed for 45 min daily for a month in conscious dogs.RESULTS: After surgery, GEt1/2 in dogs undergone truncal vagotomy was increased significantly from 56.35±2.99 min to 79.42±l.91 min (P<0.001), but surface gastric pacing markedly accelerated gastric emptying and significantly decreased GEt1/2 to 64,94±l.75 min (P<0.001) in animals undergone vagotomy. There was a significant increase of plasma level of motilin at the phase of IMCⅢ (interdigertive myoelectrical complex, IMCⅢ) in the dogs undergone bilateral truncal vagotomy (baseline vs vagotomy, 184.29±9.81 pg/ml vs 242.09±17,22 pg/ml; P<0.01). But plasma motilin concentration (212.55±11.20 pg/ml; P<0.02) was decreased significantly after a long-term treatment with gastric pacing.Before gastric pacing, GEt1/2 and plasma motilin concentration of the dogs undergone vagotomy showed a positive correlation (r=0.867, P<0.01), but after a long-term gastric pacing, GEt1/2 and motilin level showed a negative correlation (r=-0.733, P<0,04).CONCLUSION: Surface gastric pacing with optimal pacing parameters can improve gastric emptying

  17. Robot-assisted laparoscopic gastrectomy for gastric cancer

    Science.gov (United States)

    Caruso, Stefano; Franceschini, Franco; Patriti, Alberto; Roviello, Franco; Annecchiarico, Mario; Ceccarelli, Graziano; Coratti, Andrea

    2017-01-01

    Phase III evidence in the shape of a series of randomized controlled trials and meta-analyses has shown that laparoscopic gastrectomy is safe and gives better short-term results with respect to the traditional open technique for early-stage gastric cancer. In fact, in the East laparoscopic gastrectomy has become routine for early-stage gastric cancer. In contrast, the treatment of advanced gastric cancer through a minimally invasive way is still a debated issue, mostly due to worries about its oncological efficacy and the difficulty of carrying out an extended lymphadenectomy and intestinal reconstruction after total gastrectomy laparoscopically. Over the last ten years the introduction of robotic surgery has implied overcoming some intrinsic drawbacks found to be present in the conventional laparoscopic procedure. Robot-assisted gastrectomy with D2 lymphadenectomy has been shown to be safe and feasible for the treatment of gastric cancer patients. But unfortunately, most available studies investigating the robotic gastrectomy for gastric cancer compared to laparoscopic and open technique are so far retrospective and there have not been phase III trials. In the present review we looked at scientific evidence available today regarding the new high-tech surgical robotic approach, and we attempted to bring to light the real advantages of robot-assisted gastrectomy compared to the traditional laparoscopic and open technique for the treatment of gastric cancer. PMID:28101302

  18. [Laparoscopic distal gastrectomy for gastric cancer: initial experience].

    Science.gov (United States)

    Berrospi, Francisco; Celis, Juan; Ruíz, Eloy; Payet, Eduardo; Chávez, Iván; Young, Frank

    2008-01-01

    To report the initial experience with the laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Between May 2006 and May 2007, 29 consecutive GC patients with gastric cancer underwent LADG with D2 lymphadenectomy. The operation consisted in a laparoscopic time to perform lymphadenectomy and mobilization of the distal stomach, followed by a minilaparotomy for exteriorization of the specimen and construction of a hand sewn anastomosis. Twenty-nine patients underwent LADG with D2 lymphadenectomy for gastric cancer. Mean age was 58.2 years. Mean operative time was 287.4 min. Mean number of lymph nodes resected was 42.6. Twelve patients were early gastric cancer, and seventeen were advanced gastric cancer. Mean proximal and distal resection margin were 5.8 cm and 3.5 cm, respectively. Resection margins were negative in all cases. Mean number of lymph nodes resected was 42.6. Thirty-day morbidity rate was 10.3 %. There were no postoperative deaths.CONCLUSION. The short-term results of our LADG with D2 lymphadenectomy for the treatment of gastric cancer shows that a radical surgery, in terms of resection margins and lymphadenectomy, can be done with low morbidity.

  19. Mitochondrial microsatellite instability in gastric cancer and its precancerous lesions

    Institute of Scientific and Technical Information of China (English)

    Xian-Long Ling; Dian-Chun Fang; Rong-Quan Wang; Shi-Ming Yang; Li Fang

    2004-01-01

    AIM: To evaluate the role of mitochondrial microsatelliteinstability (mtMSI) in gastric carcinogenesis. METHODS: MtMSI was measured with PCR-single strand conformation polymophism (PCR-SSCP) in 68 cases of advanced gastric cancer, 40 cases of chronic gastritis, 30 cases of intestinal metaplasia and 20 cases of dysplasia.RESULTS: MtMSI was observed in 12.5% (5 of 40) of chronic gastritis, 20.0% (6 of 30) of intestinal metaplasia, 25.0% (5 of 20) of dysplasia and 38.2% (26 of 68) of gastric cancer. These findings showed a sequential accumulation of mtMSI in the histological progression from chonic gastritis to gastric cancer. An association of mtMSI with intestinal histological type and distal location was found (P=0.001 and P=0.002), whereas no significant correlation was found between mtMSI and age at diagnosis, sex, tumor size, depthof invasion, lymph node spread and clinical stages (P>0.05).CONCLUSION: MtMSI may play an early and importantrole in the gastric carcinogenesis pathway, especially in the intestinal type and distal gastric cancer.

  20. Gastric and non-gastric signals in electrogastrography.

    Science.gov (United States)

    Kaiho, T; Shimoyama, I; Nakajima, Y; Ochiai, T

    2000-02-14

    Electrogastrography (EGG) is the cutaneous recording of gastric myoelectrical activity, and the dominant frequency reflects the rhythm of the gastric slow wave. Ambulatory EGG is contaminated with a large amount of motion artifacts, and it is unclear how much of the signals comprising the dominant frequency originates from non-gastric sources. The aim of the present study was to evaluate the pattern of gastric and non-gastric signals in the dominant frequency histogram (DFH) obtained from long-term ambulatory EGG recordings. Ten normal controls and five post-gastrectomy patients participated in the present study. Twenty-four hour ambulatory EGG was recorded under normal daily conditions. The DFH of normal controls showed two distinctive peaks, and that of the post-gastrectomy patients, a single peak. The common peak at approximately 1.5 cpm was seen in both DFHs, and the peak at 3 cpm was seen only in the DFH of normal controls. Thus, the common peak was thought to be a product of non-gastric origin. In conclusion, the dominant frequency consists of gastric and non-gastric components which have a specific distribution pattern in the DFH. These findings quantified the contribution of gastric and non-gastric signals to the dominant frequencies in long-term ambulatory EGG.

  1. Gastric Calcifying Fibrous Tumour

    Directory of Open Access Journals (Sweden)

    Tan Attila

    2006-01-01

    Full Text Available Intramucosal gastric tumours are most commonly found to be gastrointestinal stromal tumours or leiomyomas (smooth muscle tumours; however, a variety of other uncommon mesenchymal tumours can occur in the stomach wall. A rare benign calcifying fibrous tumour is reported and the endoscopic appearance, ultrasound findings and morphology are documented. A review of the literature found only two similar cases.

  2. 胃转流手术治疗2型糖尿病机制的研究进展%Advanced in mechanism research about the gastric bypass operation for the treatment of type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    侯亚勃; 高寅生; 杨晓军; 高鹏

    2014-01-01

    胃转流手术治疗2型糖尿病的疗效已经得到明确的肯定,但其确切的治疗机制尚不清楚,目前,临床认为可能是由于术后胃肠道正常解剖结构的改变,引起与血糖代谢有关的胃肠道激素的变化,使糖尿病病情得到缓解,本文就近年来有关胃转流手术治疗2型糖尿病的机制研究作一综述.%It has been confirmed clearly that gastric bypass operation could be used for tbe treatment of type 2 diabetes mellitus.However,the curative mechanism underlying this therapy remain unclear up to now.Referencing the curative mechanisms research progress from domestic and abroad,the possible mechanism is considered as the secretion of gastrointestinal hormones can be changed after gastric by~ss operation,which has altered the normal anatomy structure of the gastrointestinal,and so as to the situation of type 2 diabetes mellitus can be controlled.This review will summarize recent papers related to mechanism research about the gastric bypass operatiou for the treatment of type 2 diabetes mellitus.

  3. Epirubicin, oxaliplatin, and capectabine is just as "MAGIC"al as epirubicin, cisplatin, and fluorouracil perioperative chemotherapy for resectable locally advanced gastro-oesophageal cancer

    Directory of Open Access Journals (Sweden)

    Bhawna Sirohi

    2014-01-01

    Full Text Available Background: The perioperative use of epirubicin, cisplatin, and fluorouracil (ECF significantly improves outcomes in patients with gastric and gastro-oesophageal (GO cancers but is cumbersome to administer. Given the equivalence of epirubicin, oxaliplatin, and capectabine (EOX with ECF in advanced setting, we analyzed the compliance, efficacy, and toxicity of perioperative EOX in resectable but locally advanced cancers. Methods: This is a retrospective analysis of prospectively maintained database of patients treated between January 2012 and September 2013 at Tata Memorial Centre. Patients were planned to receive 3# of neoadjuvant (NA and 3# of adjuvant EOX (intravenous epirubicin 50 mg/m 2 D1, oxaliplatin 130 mg/m 2 , on D1, capecitabiine 1250 mg/m 2 D1-21 every 21 days. On completion of NA therapy, patients were planned to undergo gastrectomy and D2 lymphadenectomy. Results: A total of 99 patients (76% males, median age 51 years were treated with perioperative EOX. Preoperatively, 93% patients completed EOX. Post-NA chemotherapy, 4 patients progressed, 1 patient died and 94 were taken up for surgery. Of these, 9 were inoperable and 85 patients underwent radical surgery. Of these, 71% (60/85 were able to complete three cycles of adjuvant EOX. The compliance to complete all 6 cycles of perioperative chemotherapy was 64%. Grade 3 and 4 toxicities were comparable to the MAGIC dataset apart from higher number of diarrhea in our patients. Conclusions: In patients with resectable GO adenocarcinoma, it is possible to deliver the MAGIC-type perioperative chemotherapy with EOX with better compliance, toxicity, and efficacy rates.

  4. Gastric Cancer Regional Detection System.

    Science.gov (United States)

    Ural, Berkan; Hardalaç, Fırat; Serhatlioğlu, Selami; İlhan, Mustafa Necmi

    2016-01-01

    In this study, a novel system was created to localize cancerous regions for stomach images which were taken with computed tomography(CT). The aim was to determine the coordinates of cancerous regions which spread in the stomach area in the color space with using this system. Also, to limit these areas with a high accuracy ratio and to feedback to the user of this system were the other objectives. This integration was performed with using energy mapping, analysis methods and multiple image processing methods and the system which was consisted from these advanced algorithms was appeared. For this work, in the range of 25-40 years and when gender discrimination was insignificant, 30 volunteer patients were chosen. During the formation of the system, to exalt the accuracy to the maximum level, 2 main stages were followed up. First, in the system, advanced image processing methods were processed between each other and obtained data were studied. Second, in the system, FFT and Log transformations were used respectively for the first two cases, then these transformations were used together for the third case. For totally three cases, energy distribution and DC energy intensity analysis were done and the performance of this system was investigated. Finally, with using the system's unique algorithms, a non-invasive method was achieved to detect the gastric cancer and when FFT and Log transformation were used together, the maximum success rate was obtained and this rate was calculated as 83,3119 %.

  5. Engagement of Patients With Advanced Cancer

    Science.gov (United States)

    2016-11-15

    End of Life; Advanced Cancer; Lung Neoplasm; Gastric Cancer; Colon Cancer; Glioblastoma Multiforme; Head and Neck Neoplasms; Rectum Cancer; Melanoma; Kidney Cancer; Prostate Cancer; Testicular Neoplasms; Liver Cancer; Cancer of Unknown Origin

  6. Clinical management of gastric cancer: results of a multicentre survey

    Directory of Open Access Journals (Sweden)

    Xu Feng

    2011-08-01

    Full Text Available Abstract Background The National Comprehensive Cancer Network clinical practice guidelines in oncology-gastric cancer guidelines have been widely used to provide appropriate recommendations for the treatment of patients with gastric cancer. The aim of this study was to examine the adherence of surgical oncologists, medical oncologists, and radiation oncologists' to the recommended guidelines. Methods A questionnaire asking the treatment options for gastric cancer cases was sent to 394 Chinese oncology specialists, including surgical oncologists, medical oncologists, and radiation oncologists working in hospitals joined in The Western Cooperative Gastrointestinal Oncology Group of China. The questionnaire involved a series of clinical scenarios regarding the interpretation of surgery, neoadjuvant, adjuvant, and advanced treatment planning of gastric cancer. Results Analysis of 358 respondents (91% showed variations between each specialization and from the recommended guidelines in the management approaches to specific clinical scenarios. The majority of specialists admitted that less than 50% of patients received multidisciplinary evaluation before treatment. The participants gave different responses to questions involving adjuvant, neoadjuvant, and advanced settings, compared to the recommended guidelines. Conclusions These results highlight the heterogeneity of the treatment of gastric cancer. Surgical oncologists, medical oncologists, and radiation oncologists are not adhering to the recommended guidelines.

  7. The Relationship between Apoptosis and the Expression of Proliferating Cell Nuclear Antigen and the Clinical Stages in Gastric Carcinoma

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The relationship between the apoptosis and the expression of proliferating cell nuclear antigen (PCNA) and the clinical stages in gastric cancers was studied. By using terminal deoxynucleotidyl transferase-mediated nick end labelling (TUNEL) technique and PCNA immunohistochemical staining, the apoptosis and the expression of PCNA in tissue of gastric carcinoma were assayed in situ, the index of apoptosis (AI), index of PCNA (PI) and the rate of AI/PI were calculated. AI and PI in gastric cancer tissues were (6.5±3.7) % and (49.8±15.9) % respectively, and the rate of AI/PI was 0.13±0.05, which were obviously different from those of normal gastric mucosa in paragastric cancer (P<0.01). With the advanced TNM stages of gastric carcinoma, the AI was decreased, PI was increased and the rate of AI/PI decreased in gastric carcinoma. There was significant difference in them between the gastric cancer tissues and normal gastric mucosa in pericarcinoma in TNM stage Ⅱ to Ⅳ (P<0.05). It was suggested that the decreased apoptotic cells and the increased proliferating cells were obviously related to the tumor genesis and tumor progression in gastric carcinoma. The AI, PI and the rate of AI/PI would become the prognostic factors in advanced gastric carcinoma.

  8. Inter-application displacement of brachytherapy dose received by the bladder and rectum of the patients with inoperable cervical cancer

    Science.gov (United States)

    Marosevic, Goran; Ljuca, Dzenita; Osmic, Hasan; Fazlic, Semir; Arsovski, Oliver; Mileusnic, Dusan

    2014-01-01

    Background The aim of the study was to examine on the CT basis the inter-application displacement of the positions D0.1cc, D1cc and D2cc of the brachytherapy dose applied to the bladder and rectum of the patients with inoperable cervical cancer. Patients and methods This prospective study included 30 patients with cervical cancer who were treated by concomitant chemo-radiotherapy. HDR intracavitary brachytherapy was made by the applicators type Fletcher tandem and ovoids. For each brachytherapy application the position D0.1cc was determined of the bladder and rectum that receive a brachytherapty dose. Then, based on the X, Y, and Z axis displacement, inter-application mean X, Y, and Z axis displacements were calculated as well as their displacement vectors (R). It has been analyzed whether there is statistically significant difference in inter-application displacement of the position of the brachytherapy dose D0.1cc, D1cc and D2cc of the bladder and rectum. The ANOVA test and post-hoc analysis by Tukey method were used for testing statistical importance of differences among the groups analyzed. The difference among the groups analyzed was considered significant if p < 0.05. Results There are significant inter-application displacements of the position of the brachytherapy dose D0,1cc, D1cc and D2cc of the bladder and rectum. Conclusions When we calculate the cumulative brachytherapy dose by summing up D0,1cc, D1cc and D2cc of the organs at risk for all the applications, we must bear in mind their inter-application displacement, and the fact that it is less likely that the worst scenario would indeed happen. PMID:24991211

  9. A randomized phase II trial of concurrent chemoradiation with two doses of radiotherapy, 60Gy and 66Gy, concomitant with a fixed dose of oral vinorelbine in locally advanced NSCLC

    DEFF Research Database (Denmark)

    Hansen, Olfred; Knap, Marianne; Khalil, Azza Ahmed

    2017-01-01

    Introduction: In order to test the best performing radiation dose with a convenient chemotherapy schedule of an oral formulation of radio-sensitizing vinorelbine in inoperable locally advanced non-small cell lung cancer (NSCLC), we performed a randomized phase II trial based on a "pick the winner...

  10. HOTTIP and HOXA13 are oncogenes associated with gastric cancer progression.

    Science.gov (United States)

    Chang, Shuai; Liu, Junsong; Guo, Shaochun; He, Shicai; Qiu, Guanglin; Lu, Jing; Wang, Jin; Fan, Lin; Zhao, Wei; Che, Xiangming

    2016-06-01

    A long non-coding RNA named HOTTIP (HOXA transcript at the distal tip) coordinates the activation of various 5' HOXA genes which encode master regulators of development through targeting the WDR5/MLL complex. HOTTIP acts as an oncogene in several types of cancers, whereas its biological function in gastric cancer has never been studied. In the present study, we investigated the role of HOTTIP in gastric cancer. We found that HOTTIP was upregulated in gastric cancer cell lines. Knockdown of HOTTIP in gastric cancer cells inhibited cell proliferation, migration and invasion. Moreover, downregulation of HOTTIP led to decreased expression of homeobox protein Hox-A13 (HOXA13) in gastric cancer cell lines. HOXA13 was involved in HOTTIP‑induced malignant phenotypes of gastric cancer cells. Our data showed that the levels of HOTTIP and HOXA13 were both markedly upregulated in gastric cancer tissues compared with their counterparts in non-tumorous tissues. Furthermore, the expression levels of HOTTIP and HOXA13 were both higher in gastric cancer which was poorly differentiated, at advanced TNM stages and exhibited lymph node-metastasis. Spearman analyses indicated that HOTTIP and HOXA13 had a highly positive correlation both in non-tumor mucosae and cancer lesions. Collectively, these findings suggest that HOTTIP and HOXA13 play important roles in gastric cancer progression and provide a new insight into therapeutic treatment for the disease.

  11. Slit2 expression and its correlation with subcellular localization of β-catenin in gastric cancer.

    Science.gov (United States)

    Shi, Rongliang; Liu, Weiyan; Liu, Bingya; Xu, Ziping; Chen, Liping; Zhang, Ziping

    2013-10-01

    Gastric cancer is the fourth most common cancer worldwide. Several signaling pathways are involved in gastric cancer development and progression. Slit2 was recently found to be involved in cancer; however, its expression pattern in gastric cancer has not been discovered yet. In the present study, we investigated the expression of Slit2 in human gastric cancer and its correlation with the expression and subcellular localization of β-catenin. Immunohistochemistry (IHC) staining revealed that Slit2 was highly expressed in human gastric cancer tissues, while it was low or weakly expressed in normal gastric tissues. The differences in clinicopathological features between different groups were determined using Pearson's χ2 test. Slit2 levels were significantly associated with differentiation, Lauren's classification, lymph node metastasis and TNM staging. Slit2 levels were positively correlated with β-catenin level in gastric cancer tissues and cell lines. High levels of Slit2 were correlated with the membrane localization of β-catenin, and low levels of Slit2 were correlated with nuclear translocation of β-catenin in both gastric cancer tissues and cell lines assayed by IHC and immunofluorescence staining, respectively. Our data suggest that Slit2 was highly expressed in gastric cancer patients with less advanced clinicopathological features. Slit2 levels were correlated with β-catenin level and subcellular localization.

  12. Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction.

    Science.gov (United States)

    Kosai, Nik Ritza; Gendeh, Hardip Singh; Norfaezan, Abdul Rashid; Razman, Jamin; Sutton, Paul Anthony; Das, Srijit

    2015-06-01

    Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

  13. Genetics Home Reference: hereditary diffuse gastric cancer

    Science.gov (United States)

    ... Health Conditions hereditary diffuse gastric cancer hereditary diffuse gastric cancer Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Hereditary diffuse gastric cancer (HDGC) is an inherited disorder that greatly increases ...

  14. The role of leptin in gastric cancer: clinicopathologic features and molecular mechanisms.

    Science.gov (United States)

    Lee, Kang Nyeong; Choi, Ho Soon; Yang, Sun Young; Park, Hyun Ki; Lee, Young Yiul; Lee, Oh Young; Yoon, Byung Chul; Hahm, Joon Soo; Paik, Seung Sam

    2014-04-18

    Obesity is associated with certain types of cancer, including gastric cancer. However, it is still unclear whether obesity-related cytokine, leptin, is implicated in gastric cancer. Therefore, we aimed to investigate the role of leptin in gastric cancer. The expression of leptin and its receptor, Ob-R, was assessed by immunohistochemical staining and was compared in patients with gastric adenoma (n=38), early gastric cancer (EGC) (n=38), and advanced gastric cancer (AGC) (n=38), as a function of their clinicopathological characteristics. Gastric cancer cell lines were studied to investigate the effects of leptin on the signal transducer and activator of transcription-3 (STAT3) and extracellular receptor kinase 1/2 (ERK1/2) signaling pathways using MTT assays, immunoblotting, and inhibition studies. Leptin was expressed in gastric adenomas (42.1%), EGCs (47.4%), and AGCs (43.4%). Ob-R expression tended to increase from gastric adenoma (2%), through EGC (8%), to AGC (18%). Leptin induced the proliferation of gastric cancer cells by activating STAT3 and ERK1/2 and up-regulating the expression of vascular endothelial growth factor (VEGF). Blocking Ob-R with pharmacological inhibitors and by RNAi decreased both the leptin-induced activation of STAT3 and ERK1/2 and the leptin-induced expression of VEGF. Leptin plays a role in gastric cancer by stimulating the proliferation of gastric cancer cells via activating the STAT3 and ERK1/2 pathways. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk.

    Science.gov (United States)

    Masuyama, Hironori; Yoshitake, Naoto; Sasai, Takako; Nakamura, Tetsuya; Masuyama, Atsushi; Zuiki, Toru; Kurashina, Kentaro; Mieda, Mitsuyo; Sunada, Keijiro; Yamamoto, Hironori; Togashi, Kazutomo; Terano, Akira; Hiraishi, Hideyuki

    2015-01-01

    The relationship between Helicobacter pylori infection and gastric cancer has been demonstrated, and the risk of gastric cancer occurrence is known to increase with the progression of atrophic changes associated with chronic gastritis. Endoscopic evaluation of the degree and extent of atrophy of the gastric mucosa is a simple and very important means of identifying a group at high risk for gastric cancer. This study aimed to clarify the carcinogenic risk in relation to the degree of atrophy. A total of 27,777 patients (272 with early gastric cancer and 135 with advanced gastric cancer) were included in this study. Endoscopically evaluated atrophy of the gastric mucosa was classified as C-0 to O-3 according to the Kimura and Takemoto classification system. The cancer detection rate in relation to the degree of gastric mucosal atrophy was 0.04% (2/4,183 patients) for C-0, 0% (0/4,506) for C-1, 0.25% (9/3,660) for C-2, 0.71% (21/2,960) for C-3, 1.32% (75/5,684) for O-1, 3.70% (140/3,780) for O-2 and 5.33% (160/3,004) for O-3. As to the proportions of differentiated and undifferentiated cancers, the latter were relatively frequent in the C-0 to C-2 groups, but differentiated cancers became predominant as atrophy progressed. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as gastric mucosal atrophy progressed. In addition, open-type atrophy was found in 29 (96.7%) of 30 patients with synchronous multiple gastric cancers and in all 20 patients with metachronous multiple gastric cancers. Endoscopic evaluation of gastric mucosal atrophy can provide a simple and reliable predictive index for both current and future carcinogenic risk. © 2015 S. Karger AG, Basel.

  16. Gene therapy for gastric diseases.

    OpenAIRE

    Fumoto, Shintaro; Nishi, Junya; Nakamura, Junzo; Nishida, Koyo

    2008-01-01

    Gene therapy for gastric cancer and gastric ulcer is a rationalized strategy since various genes correlate with these diseases. Since gene expressions in non-target tissues/cells cause side effects, a selective gene delivery system targeted to the stomach and/or cancer must be developed. The route of vector transfer (direct injection, systemic, intraperitoneal, gastric serosal surface and oral administration) is an important issue which can determine efficacy and safety. Strategies for cancer...

  17. Epidemiological characteristics of gastric cancer

    OpenAIRE

    Šipetić Sandra B.; Tomić-Kundaković Slađana; Vlajinac Hristina D.; Maksimović Nataša; Knežević Anita; Kisić Darija

    2005-01-01

    Introduction. Gastric cancer was the third most common cancer worldwide in 2000, accounting for approximately 876 000 new cases or 9% of the global cancer burden. Epidemiological characteristics As a result of changes in diet, the incidence of gastric cancer has decreased in most countries. Now days, consumption of fresh vegetables and fruits is increasing in regard to canned food. In addition to unhealthy diet, the main risk factors for gastric cancer are H. pylori infection, alcohol consump...

  18. Gastric adenocarcinoma inducing portal hypertension: A rare presentation

    Institute of Scientific and Technical Information of China (English)

    Pradipta Ghosh; Katsumi Miyai; Mario Chojkier

    2007-01-01

    Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.

  19. Hereditary diffuse gastric cancer

    DEFF Research Database (Denmark)

    van der Post, Rachel S; Vogelaar, Ingrid P; Carneiro, Fátima

    2015-01-01

    Germline CDH1 mutations confer a high lifetime risk of developing diffuse gastric (DGC) and lobular breast cancer (LBC). A multidisciplinary workshop was organised to discuss genetic testing, surgery, surveillance strategies, pathology reporting and the patient's perspective on multiple aspects......, including diet post gastrectomy. The updated guidelines include revised CDH1 testing criteria (taking into account first-degree and second-degree relatives): (1) families with two or more patients with gastric cancer at any age, one confirmed DGC; (2) individuals with DGC before the age of 40 and (3...... the high mortality associated with invasive disease, prophylactic total gastrectomy at a centre of expertise is advised for individuals with pathogenic CDH1 mutations. Breast cancer surveillance with annual breast MRI starting at age 30 for women with a CDH1 mutation is recommended. Standardised endoscopic...

  20. Reirradiation With Cetuximab in Locoregional Recurrent and Inoperable Squamous Cell Carcinoma of the Head and Neck: Feasibility and First Efficacy Results

    Energy Technology Data Exchange (ETDEWEB)

    Balermpas, Panagiotis; Keller, Christian [Department of Radiation Therapy and Oncology, Goethe University, Frankfurt am Main (Germany); Hambek, Markus; Wagenblast, Jens [Department of Otorhinolaryngology, Goethe University, Frankfurt am Main (Germany); Seitz, Oliver [Department of Oral Maxillofacial and Plastic Facial Surgery, Goethe University, Frankfurt am Main (Germany); Roedel, Claus [Department of Radiation Therapy and Oncology, Goethe University, Frankfurt am Main (Germany); Weiss, Christian, E-mail: christian.weiss@kgu.de [Department of Radiation Therapy and Oncology, Goethe University, Frankfurt am Main (Germany)

    2012-07-01

    Purpose: To report our experience with a prospective protocol of external beam reirradiation (Re-RT) combined with cetuximab for patients with inoperable, recurrent squamous cell carcinoma of the head and neck (SCCHN). Patients and Methods: Between August 2008 and June 2010, 18 patients with inoperable recurrence of SCCHN after adjuvant or definitive radiotherapy (RT) and simultaneous or sequential cisplatin-based chemotherapy for primary SCCHN were enrolled. Acute and late toxicity from the experimental regimen were recorded every week during RT and every 3 months thereafter. Efficacy was assessed with repeated imaging using response evaluation criteria in solid tumors and clinical examinations 8-12 weeks after completion of the treatment and every 3 months thereafter. Results: Median follow-up time for all patients was 9.4 (range: 3.85-31.7) months and for patients alive 30.4 (range: 15.7-31.7) months. Acute toxicity was generally mild or moderate. Five patients developed a grade 3 acneiform rash related to cetuximab. Late toxicity occurred as grade 3 trismus in five and as grade 3 abacterial salivary gland inflammation in one patient, respectively. Overall response rate was 47%. Median overall and progression-free survival for all patients was 8.38 months and 7.33 months, respectively. The overall survival rate was 44% at 1 year, with a 1 year local control rate of 33%. Conclusion: Notwithstanding the limitations of our preliminary data Re-RT combined with cetuximab for recurrent and inoperable SCCHN is feasible and the integration of newer targeted agents seems to be less toxic compared to conventional chemotherapy with encouraging response rates at least for a subset of patients.

  1. The spatial and temporal `cost' of volcanic eruptions: assessing economic impact, business inoperability, and spatial distribution of risk in the Auckland region, New Zealand

    Science.gov (United States)

    McDonald, Garry W.; Smith, Nicola J.; Kim, Joon-hwan; Cronin, Shane J.; Proctor, Jon N.

    2017-07-01

    Volcanic risk assessment has historically concentrated on quantifying the frequency, magnitude, and potential diversity of physical processes of eruptions and their consequent impacts on life and property. A realistic socio-economic assessment of volcanic impact must however take into account dynamic properties of businesses and extend beyond only measuring direct infrastructure/property loss. The inoperability input-output model, heralded as one of the 10 most important accomplishments in risk analysis over the last 30 years (Kujawaski Syst Eng. 9:281-295, 2006), has become prominent over the last decade in the economic impact assessment of business disruptions. We develop a dynamic inoperability input-output model to assess the economic impacts of a hypothetical volcanic event occurring at each of 7270 unique spatial locations throughout the Auckland Volcanic Field, New Zealand. This field of at least 53 volcanoes underlies the country's largest urban area, the Auckland region, which is home to 1.4 million people and responsible for 35.3% (NZ201481.2 billion) of the nation's GDP (Statistics New Zealand 2015). We apply volcanic event characteristics for a small-medium-scale volcanic eruption scenario and assess the economic impacts of an `average' eruption in the Auckland region. Economic losses are quantified both with, and without, business mitigation and intervention responses in place. We combine this information with a recent spatial hazard probability map (Bebbington and Cronin Bull Volcanol. 73(1):55-72, 2011) to produce novel spatial economic activity `at risk' maps. Our approach demonstrates how business inoperability losses sit alongside potential life and property damage assessment in enhancing our understanding of volcanic risk mitigation.

  2. Symptomatic treatment with lanreotide microparticles in inoperable bowel obstruction resulting from peritoneal carcinomatosis: a randomized, double-blind, placebo-controlled phase III study.

    Science.gov (United States)

    Mariani, Pascale; Blumberg, Joëlle; Landau, Alain; Lebrun-Jezekova, Daniela; Botton, Estelle; Beatrix, Olivier; Mayeur, Didier; Herve, Robert; Maisonobe, Pascal; Chauvenet, Laure

    2012-12-10

    To investigate the somatostatin analog lanreotide as symptomatic treatment for inoperable bowel obstruction due to peritoneal carcinomatosis. In all, 80 patients with peritoneal carcinomatosis, inoperable malignant digestive obstruction, and two or more vomiting episodes per day or nasogastric tube (NGT) who were previously treated with intravenous corticosteroids and proton pump inhibitors were randomly assigned to one 30-mg injection of lanreotide microparticles (n = 43) or placebo (n = 37) in a 10-day, double-blind, parallel-group phase. The primary end point was the proportion of patients responding on day 7 (one or fewer episodes of vomiting per day or no vomiting recurrence after NGT removal [for ≥ 3 consecutive days in both cases]). Vomiting frequency/NGT secretion volumes, nausea, abdominal pain, well-being, and safety were also assessed. Patients could then enter an open-label lanreotide-only phase. The study was conducted at 22 European hospitals. More patients receiving lanreotide than placebo were responders; this difference was not statistically significant for the intent-to-treat (ITT) population on the basis of diary cards (primary analysis; 41.9% [18 of 43] v 29.7% [11 of 37], respectively; odds ratio, 1.75; 95% CI, 0.68 to 4.49; P = .24) but was statistically significant for the corresponding supportive per protocol analysis (57.7% [15 of 26] v 30.4% [seven of 23]; P < .05) and ITT analysis, on the basis of investigators' assessments (50.0% [19 of 38] v 28.6% [10 of 35]; P < .05). Improvements in well-being were significantly greater with lanreotide on days 3, 6, and 7. No significant differences were observed for other secondary end points. Only two (mild/moderate) treatment-emergent adverse events were considered related to lanreotide. These results show that lanreotide has some efficacy and is safe in the symptomatic treatment of patients with inoperable bowel obstruction due to peritoneal carcinomatosis.

  3. 糖化血红蛋白水平与晚期胃癌 FOLFOX 方案化疗的近期有效率相关性研究%Association of the Glycosylated Hemoglobin Levels with the Short-term Effect of FOLFOX Chemotherapy in Advanced Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    汪青; 郑磊贞; 朱美玲; 陈思宇; 章莉

    2015-01-01

    目的:研究晚期胃癌患者不同的糖化血红蛋白水平与化疗的近期有效率的相关性。方法对52例晚期胃癌患者进行回顾性分析,测定化疗前后的患者糖化血红蛋白水平的变化,观察该指标与近期有效率( RR)的相关性。结果全组52例患者均完成至少3个周期化疗,并行疗效评价。该组患者FOLFOX方案化疗的近期有效率为32.7%,晚期胃癌患者化疗后糖化血红蛋白水平与患者不同的病灶数目的差异有统计学意义(P=0.039)。晚期胃癌患者糖化血红蛋白的低、中、高水平组RR分别为9、6、2例,3组患者化疗的近期有效率比较,差异有统计学意义( P<0.05);低、中、高糖化血红蛋白水平组疾病控制率分别为89.4%(17/19)、76.1%(16/21)、41.6%(5/12),组间比较,差异均有统计学意义(P<0.05)。结论糖化血红蛋白水平较高的晚期胃癌患者近期有效率较差,糖化血红蛋白水平可能是潜在的化疗近期疗效预测指标之一。%Objective To explore the correlation of the different glycosylated hemoglobin levels with the short-term effect of chemo-therapy in advanced gastric cancer.Methods Past immunohistochemical data of 52 advanced gastric cancer patients after FOLFOX chemotherapy were analyzed retrospectively.According to the change of the glycosylated hemoglobin levels before and after chemotherapy, it could be observed the association of the glycosylated hemoglobin levels with the short-term effect of chemotherapy.Results The whole group of 52 patients had completed at least three cycles of chemotherapy, and then got completed efficacy evaluation.Recent response rate of the patients who got FOLFOX chemotherapy was 17 cases (32.7%).The glycosylated hemoglobin levels with the different number of metastasis ( P=0.036) were significantly different.Advanced gastric cancer patients with low, medium and high level

  4. Rett syndrome and gastric perforation.

    Science.gov (United States)

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  5. Epigenetic alterations in gastric carcinogenesis

    Institute of Scientific and Technical Information of China (English)

    In-Seon CHOI; Tsung-Teh WU

    2005-01-01

    Gastric cancer is believed to result in part from the accumulation of multiple genetic alterations leading to oncogene overexpression and tumor suppressor loss. Epigenetic alterations as a distinct and crucial mechanism to silence a variety of methylated tissue-specific and imprinted genes, have been extensively studied in gastric carcinoma and play important roles in gastric carcinogenesis. This review will briefly discuss the basic aspects of DNA methylation and CpG island methylation, in particular the epigenetic alterations of certain critical genes implicated in gastric carcinogenesis and its relevance of clinical implications.

  6. Nutrition and Gastric Cancer

    OpenAIRE

    Carlo La Vecchia; Silvia Franceschi

    2000-01-01

    The reasons for the worldwide decline in stomach cancer incidence and mortality rates are not fully understood, but dietary changes are clearly implicated. While the possible mechanisms of gastric carcinogenesis and the impact of Helicobacter pylori eradication remain open to debate, at least two practical recommendations – to increase fruit and vegetable intake, and to reduce consumption of salt – are already supported by epidemiological evidence. These dietary recommend...

  7. The effect of preoperative anemia, low albumin, low body mass index in the prognosis of advanced gastric cancer%术前贫血、低蛋白及低体质量指数对进展期胃癌预后的影响

    Institute of Scientific and Technical Information of China (English)

    王明华; 康悦; 迟强

    2014-01-01

    Objective To investigate the relationship between preoperative anemia,low albumin,low body mass index and the prognosis of advanced gastric cancer.Methods Three hundred and seventeen patients diagnosed with advanced gastric cancer as well as complete clinical pathology data from January 2006 to January 2008 were retrospectively analyzed.The clinical pathologic factors including age,gender,tumor size,type of Borrmann,hemoglobin,serum albumin,body mass index,type of histology,blood vessels and lymphatic invasion,infiltration depth,lymph nodes metastasis.The single factor and multiple factors were analyzed.Results Tumor size,type of Borrmann,hemoglobin,serum albumin,body mass index,type of histology,blood vessels and lymphatic invasion,infiltration depth and lymph node metastasis were identified as influencing factors of the prognosis,while independent factors associated with the prognosis of gastric cancer were serum albumin (OR =1.546,95% CI:1.069-2.237),infiltration depth (OR =1.933,95% CI:1.182-3.162) and lymph nodes metastasis (OR =1.586,95% CI:1.358-1.853).Conclusion Anemia and low body mass index are the influence factors but not the independent factors in the prognosis of gastric cancer,while low albumin concentration is the independent factor in the prognosis of gastric cancer.%目的 探讨术前贫血、低蛋白及低体质量指数(BMI)对进展期胃癌预后的影响.方法 回顾性分析2006年1月至2008年1月有完整临床病理资料的317例进展期胃癌患者的临床资料.选择性别、年龄、肿瘤大小、Borrmann类型、血红蛋白、血清白蛋白、BMI、组织学类型、血管/淋巴管侵犯、浸润程度、淋巴结转移作为临床病理因素进行单因素及多因素分析.结果 单因素分析结果显示,肿瘤大小、Borrmann类型、血红蛋白、血清白蛋白、BMI、组织学类型、血管/淋巴管侵犯、浸润程度、淋巴结转移是影响进展期胃癌患者预后的危险因素(P<0.01).

  8. Clinicopathologial features of gastric hepatoid adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Cheng-Yu Lin

    2015-02-01

    Full Text Available Background: Gastric hepatoid adenocarcinoma (GHA, a rare type of primary gastric cancer, is characterized by hepatocellular carcinoma-like histology. As details of this disease remain unknown, the aim of this study was to evaluate the clinicopathological features of GHA. Methods: From January 2001 to December 2010, 4563 patients were diagnosed with primary gastric cancer at Chang Gung Memorial Hospital, Linkou Medical Center. Ten (0.22% of these patients were diagnosed with GHA. The clinicopathological characteristics of these patients were collected retrospectively. Results: The median age at diagnosis was 65.5 years, and six patients (60% were male. Seven patients had lymph node metastasis and five had distant metastasis, with the liver as the most common site (four cases. Serum alpha-fetoprotein (AFP levels were elevated in seven of eight patients (median: 359.2 ng/ml; range: 4.3-6535.6 ng/ml. Endoscopically, six tumors were classified as Borrmann's type III cancer with the appearance of fungating mass lesion with a purple, berry-like surface. Of the five patients without distant metastasis, all received curative-intent surgery and four received adjuvant chemotherapy. Four patients with distant metastasis received either palliative operation or chemotherapy, and one patient received neither operation nor chemotherapy due to a poor performance status. The median survival time was 7.2 months (range: 0.7-131.8 months, and the 5-year survival rate was 20%. There was survival benefit in the chemotherapy groups. Conclusions: GHA is a rare subtype of gastric cancer which is prone to lymph node and liver metastasis. Most GHAs appear as Borrmann's type III fungating mass lesion with a purple, berry-like surface. Although the prognosis of advanced stage GHA is poor, chemotherapy might provide some benefit.

  9. and Gastric Cancers

    Directory of Open Access Journals (Sweden)

    Sebahattin Celik

    2015-01-01

    Full Text Available Purpose. To examine the relationship between esophageal and gastric cancers commonly seen in Van Lake region and the traditional eating habits of the geography. Materials and Methods. Esophageal and gastric cancer cases, who underwent surgery between January 1, 2012, and December 31, 2013, were examined. Pathology reports of the patients and presence of Helicobacter pylori (HP were recorded. Surveys were filled by face to face meeting or telephone call. Control group was created with randomly selected individuals without any cancer diagnosis having age, gender, and socioeconomic characteristics similar to patient group. All data were analyzed using SAS.9.3 statistical programme. Results. Compared with the control group, herby cheese consumption (a component of eating habits and smoking were significantly higher in the patient group (P<0.001. Tandoor exposure is compared in terms of female gender, and significant difference was found between the groups (P=0.0013. As a result of the analysis with logistic regression more than 150 gr of herby cheese consumption per day was found to increase the cancer risk (odds ratio 1.017; 95% CI: 1.012–1.022. Conclusion. A high consumption of herby cheese, cooking bread on tandoor, and heavy smoking were seen to be important risk factors for esophageal and gastric cancers.

  10. Tricholithobezoar Causing Gastric Perforation

    Directory of Open Access Journals (Sweden)

    Juliana Santos Valenciano

    2012-01-01

    Full Text Available A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment.

  11. Chemotherapy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Javier Sastre; Jose Angel García-Saenz; Eduardo Díaz-Rubio

    2006-01-01

    Metastatic gastric cancer remains a non-curative disease.Palliative chemotherapy has been demonstrated to prolong survival without quality of life compromise. Many single-agents and combinations have been confirmed to be active in the treatment of metastatic disease. Objective response rates ranged from 10-30% for single-agent therapy and 30-60% for polychemotherapy. Results of phase Ⅱ and Ⅲ studies are reviewed in this paper as well as the potential efficacy of new drugs. For patients with localized disease, the role of adjuvant and neoadjuvant chemotherapy and radiation therapy is discussed.Most studies on adjuvant chemotherapy failed to demonstrate a survival advantage, and therefore, it is not considered as standard treatment in most centres. Adjuvant immunochemotherapy has been developed fundamentally in Korea and Japan. A meta-analysis of phase Ⅲ trials with OK-432 suggested that immunochemotherapy may improve survival of patients with curatively resected gastric cancer. Based on the results of US Intergroup 0116study, postoperative chemoradiation has been Accepted as standard care in patients with resected gastric cancer in North America. However, the results are somewhat confounded by the fact that patients underwent less than a recommended D1 lymph node dissection and the pattern of recurrence suggested a positive effect derived from local radiotherapy without any effect on micrometastatic disease.Neoadjuvant chemotherapy or chemoradiation therapy remains experimental, but several phase Ⅱstudies are showing promising results. Phase Ⅲ trials are needed.

  12. Diet and gastric cancer

    Directory of Open Access Journals (Sweden)

    Šipetić Sandra B.

    2003-01-01

    Full Text Available The aim of this case-control study, conducted in Serbia during the period 1998-2000, was to investigate whether diet was associated with the development of gastric cancer. The case group consisted of 131 patients with histologically confirmed gastric cancer, and the control group of 131 patients with orthopedics diseases and injuries. Cases and controls were individually matched by age (±± 2 years, gender, and place of residence. On the basis of multivariate logistic regression analysis, following factors were found as independent risk factors for gastric cancer: more frequent consumption of high-fat milk [Odds ratio (OR =1.45, 95% confidence interval (CI = 0.99-2.16]; mutton, lamb and/or calf meat (OR = 2.46, 95% CI = 1.11-5.47, sugar (OR = 2.13, 95% CI = 1.43-3.18, semi-white bread (OR = 2.09, 95% CI = 1.25-3.50, and salting food (OR = 5.72, 95% CI = 2.63-12.42. Factors found as protective were: more frequent consumption of margarine (OR = 0.41, 95% CI = 0.25-0.69, „other“ cheeses (OR = 0.47, 95% CI = 0.29 - 0.77, and fish (OR = 0.39, 95% CI = 0.19-0.76.

  13. Changes in Gut Hormones After Roux en Y Gastric bypass, Sleeve Gastrectomy, and Adjustable Gastric Banding

    Directory of Open Access Journals (Sweden)

    Miroslav Ilić

    2015-12-01

    Full Text Available The obesity epidemic has burdened healthcare systems worldwide. Bariatric surgery is currently the most effective method for long-term weight loss in obese adults, but the exact mechanism of weight loss is poorly understood. Bariatric procedures were initially classified by their presumed mechanism of action into restrictive, malabsoptive, or mixed procedures; however, due to recent advancements in the field of neuroendocrinology, hormones are increasing being recognized as important regulators of satiation, hunger, and energy expenditure. Studies examining changes in gut hormones following bariatric surgery have yielded conflicting results and the relationship between these hormones and weight loss is nothing but clear. This review will summarize the effect of Roux en Y gastric bypass, sleeve gastrectomy and adjustable gastric banding on various gut hormones including ghrelin, cholecystokinin, glucagon-like polypeptide-1, peptide YY3, and pancreatic polypeptide. Furthermore, the relationship between these hormones and weight loss will be examined.

  14. Primary Closure versus Gastric Resection for Perforated Gastric ...

    African Journals Online (AJOL)

    Surgical Scales: Primary Closure versus Gastric Resection for. Perforated Gastric ... best choice? Minor or ... current practice is reserved mostly for Johnson Type I and IV ulcers .... if gastrectomy is indicated and even if the patient is fit for major ...

  15. 多梳基因Bmi-1与胃癌关系研究进展%Advances in Studies on Relationship between Polycomb Group Gene Bmi-1 and Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    刘朋伟

    2011-01-01

    多梳基因(PcG)在胚胎发育、细胞周期调节、造血干细胞更新、肿瘤发生中起重要作用.转录抑制因子Bmi-1是PcG家族成员之一,与多种人类恶性肿瘤的发生、发展有关.最新研究发现Bmi-1高表达与胃癌的发生、发展、浸润、转移、预后等密切相关.本文就Bmi-1的分子结构、作用机制及其与胃癌关系的研究进展作一综述.%Polycomb group gene (PcG) play a crucial role in regulation of embryonic development, cell cycle, selfrenewal of hematopoietic stem cells and tumor genesis. Bmi-1, which is a transcription repressor, is a member of PcG family. It was found to be related with the genesis and development of several human malignancies. Recent studies have shown that overexpression of Bmi-1 was correlated with the genesis, development, invasion, metastasis and prognosis of gastric cancer. This article reviewed the molecular structure and mechanism of action of Bmi-1, and its relationship with gastric cancer.

  16. Evidence based review of the impact of image enhanced endoscopy in the diagnosis of gastric disorders

    Science.gov (United States)

    Hussain, Ikram; Ang, Tiing Leong

    2016-01-01

    Gastric cancer is the third most common cause of cancer-related death. Advanced stages of gastric cancers generally have grim prognosis. But, good prognosis can be achieved if such cancers are detected, diagnosed and resected at early stages. However, early gastric cancers and its precursors often produce only subtle mucosal changes and therefore quite commonly remain elusive at the conventional examination with white light endoscopy. Image-enhanced endoscopy makes mucosal lesions more conspicuous and can therefore potentially yield earlier and more accurate diagnoses. Recent years have seen growing work of research in support of various types of image enhanced endoscopy (IEE) techniques (e.g., dye-chromoendoscopy; magnification endoscopy; narrow-band imaging; flexible spectral imaging color enhancement; and I-SCAN) for a variety of gastric pathologies. In this review, we will examine the evidence for the utilization of various IEE techniques in the diagnosis of gastric disorders. PMID:28042388