Gastric%20cancer Treatment
Pharmacotherapy
Preoperative chemoradiation
- Studies have shown that patients who received sequential preoperative induction chemotherapy followed by chemoradiation yielded substantial pathologic responses that results in durable survival time
- Chemoradiation therapy includes radiation therapy of 45-50.4 Gy of external beam with the below preferred preoperative chemotherapy regimens:
- Paclitaxel & Carboplatin
- Cisplatin & Fluorouracil
- Oxaliplatin & Fluorouracil
- Cisplatin & Capecitabine
- Oxaliplatin & Capecitabine
- Other preoperative chemotherapy regimens are:
- Paclitaxel & fluoropyrimidine (Fluorouracil or Capecitabine)
Perioperative chemotherapy
- Widely adopted standard of care throughout most of the UK & Europe
- Composed of 3 cycles preoperative & 3 cycles postoperative:
- Epirubicin, Cisplatin & Fluorouracil (ECF)
- Epirubicin, Cisplatin & Fluorouracil (ECF) modifications:
- Epirubicin, Cisplatin & Capecitabine
- Epirubicin, Oxaliplatin & Capecitabine
- Fluorouracil & Cisplatin
- Since Capecitabine avoids the need for an indwelling central venous access & non-inferior to 5-fluorouracil (5-FU) in the advanced disease setting, Epirubicin, Cisplatin & Capecitabine is preferred than Epirubicin, Cisplatin & Fluorouracil regimen
- In patients with operable gastric & lower esophageal adenocarcinomas, perioperative chemotherapy with Epirubicin, Cisplatin & Fluorouracil (ECF) regimen significantly improved progression-free & overall survival rate
Postoperative chemoradiation
- Preferred treatment in patients who underwent surgery for ≥stage 1B esophagogastric cancer with D0 & D1 lymph node dissection who have not received any preoperative therapy
- For patients with T2, N0 tumors who underwent EMR, observation is recommended
- Postoperative chemoradiation is only for patients with high risk features (eg poorly differentiated or higher grade cancer, lymphovascular invasion, neural invasion or age <50 years old)
- Fluoropyrimidine (infusional Fluorouracil or Capecitabine) is used before & after fluoropyrimidine-based chemoradiation
- Radiotherapy may be given to a total dose of 45 Gy in 25 fractions of 1.8 Gy, 5 fractions/week by 3D-conformal or intensity-modulated radiation therapy techniques
- Clinical target volume encompasses the gastric bed (with stomach remnant when present), anastomoses, & draining regional lymph nodes
Postoperative chemotherapy
- Studies have shown that the use of postoperative chemotherapy after curative surgery with D2 lymph node dissection improved disease-free survival compared to surgery alone
- Regimen options include:
- Capecitabine & Oxaliplatin
- Capecitabine & Cisplatin
- Capecitabine-Oxaliplatin doublet has been reported to significantly improve overall & disease-free survival