Clinical Implications of Decreased Computed Tomography Value after Ramucirumab in Advanced Gastric Cancer

Oncology ◽  
2019 ◽  
Vol 97 (2) ◽  
pp. 94-101
Author(s):  
Naoki Izawa ◽  
Yu Sunakawa ◽  
Ayako Doi ◽  
Hiroyuki Arai ◽  
Yoshiki Horie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Advanced Gastric Cancer ◽  
Clinical Implications

scholarly journals ROLE OF COMPUTED TOMOGRAPHY WITH PNEUMOGASTROGRAPHY IN DETERMINING THE REGRESSION GRADE OF LOCALLY ADVANCED GASTRIC CANCER AFTER NEOADJUVANT CHEMOTHERAPY

2021 ◽  
Vol 20 (5) ◽  
pp. 18-30
Author(s):  
I. D. Amelina ◽  
A. M. Karachun ◽  
D. V. Nesterov ◽  
L. N. Shevkunov ◽  
A. S. Artemieva ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Lymph Node ◽  
Advanced Gastric Cancer ◽  
Tumor Response ◽  
Response Rate ◽  
Locally Advanced ◽  
Imaging Biomarkers ◽  
Locally Advanced Gastric Cancer ◽  
Regression Grade

Introduction. A multimodal approach to the treatment of locally advanced gastric cancer with the addition of systemic or local treatment methods, such as chemotherapy and radiation therapy, reduces the risk of cancer recurrence, thus improving survival of patients. Advances in anticancer therapy dictate the need to develop systems for assessing tumor response to new treatment modalities.Material and Methods. The study included 162 patients with locally advanced gastric cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. All patients underwent subtotal gastric resection or gastrectomy with lymph node dissection and previously received neoadjuvant polychemotherapy. Patients were in the age range 30 to 80 years old. The tumor pathomorphological response to chemotherapy was assessed in all patients using a pathomorphological response rate system according to the classification of the Japanese Gastric Cancer Association (JGCA, 3rd English edition). All patients underwent computed tomography with pneumogastrography before neoadjuvant chemotherapy and immediately before surgery. For each of 162 patients, 96 qualitative and quantitative biomarkers of tumor and paragastric lymph node imaging were analyzed.Results. The accuracy of determining the tumor response rate using computed tomography with pneumogastrography was 82.6 % for TRG-0/1, 90 % for TRG-1/2, and 88 % for TRG-2/3. Discussion. The tumor pathomorphological response to treatment is a predictor of long-term results; however, it can be assessed only after analyzing the surgical specimen, and this marker cannot be used in inoperable cases and for correction of palliative chemotherapy. The study of imaging biomarkers based on quantitative and qualitative data reflecting the histopathological features of the tumor and lymph nodes can help determine the tumor regression grade and optimize treatment.Conclusion. The proposed algorithm for assessing the response grade of locally advanced gastric cancer to chemotherapy using imaging biomarkers is a promising prognostic marker and requires further study. 

scholarly journals Clinical Complete Response after Chemotherapy and Palliative Surgery for Unresectable Gastric Cancer

2020 ◽  
Vol 13 (2) ◽  
pp. 689-695 ◽  
Author(s):  
Masayuki Shishida ◽  
Kazuhiro Toyota ◽  
Masahiro Ikeda ◽  
Nozomi Karakuchi ◽  
Masashi Inoue ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Advanced Gastric Cancer ◽  
Hepatic Metastases ◽  
Complete Response ◽  
Gastric Body ◽  
Clinical Complete Response ◽  
Response To Chemotherapy ◽  
Unresectable Gastric Cancer ◽  
Potassium Oxonate

Gastric cancer incidence is high in several countries, and management of advanced gastric cancer remains a challenge. Chemotherapy for unresectable gastric cancers is still evolving, and achieving a complete cure is difficult. Although a clinical complete response to chemotherapy has been reported in patients with unresectable gastric cancer, the chemotherapy duration for these patients is unclear. Here, we report the case of a 71-year-old man who presented with abdominal discomfort. Upper endoscopy revealed advanced gastric cancer on the upper gastric body. Histopathological examination revealed a poorly differentiated adenocarcinoma. Computed tomography revealed regional lymph node and multiple bilobar hepatic metastases. Radical surgery was not possible; therefore, palliative resection of the primary lesion was planned for symptomatic improvement. Tegafur, 5-chloro-2,4-dihydro­pyrimidine, and potassium oxonate were administered prior to surgery, and proximal gastrectomy was performed. Tegafur, 5-chloro-2,4-dihydropyrimidine, and potassium oxonate administration was reinitiated after surgery. A clinical complete response was achieved in the 8th postoperative month, with no hepatic metastases noted on radio imaging. Computed tomography performed in the 1st postoperative year revealed ascites; however, the cytological examination findings were negative. The initial chemotherapy was discontinued, and paclitaxel administration was commenced. Computed tomography performed annually thereafter demonstrated no recurrence, and paclitaxel was discontinued in the 9th postoperative year. The patient remained recurrence free at 12 years postoperatively. For elderly patients like the one presented here, it may be necessary to consider ceasing chemotherapy; however, because it is possible for a complete clinical response over the long term, it should be continued if the patient is well.

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