No survival benefit for Neoadjuvant Chemotherapy Compared With Surgery Alone for Locally Advanced Cancer of the Stomach and Cardia, results from EORTC trial 40954

Patients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy, although fewer than 50% could receive postoperative chemotherapy. A Randomized EORTC trial (40954) examined the value of purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines. Authors found a significantly increased R0 (radical, no tumor left) resection rate in the preoperative chemotherapy group, but failed to demonstrate a survival benefit. Possible explanations are low statistical power, a high rate of proximal gastric cancer including esophagogastric junction (AEG) and/or a better outcome than expected after radical surgery alone due to the high quality of surgery with resections of regional lymph nodes outside the perigastic area (celiac trunc, hepatic ligament, lymph node at a. lienalis; D2).

FOLFIRINOX: a new standard treatment for advanced pancreatic cancer?

by Richard Kim on Lancet oncology

Pancreatic cancer is still a lethal disease because of its tendency to undergo early subclinical metastasis to the regional lymph nodes and liver. Gemcitabine has been the standard chemotherapy for metastatic pancreatic cancer for many years on the basis of a phase 3 trial showing its clinical benefit over fluorouracil;1 however, the median survival was only 5·6 months and response rate only 5%. Since then, many trials have been done with gemcitabine being the backbone of the doublet or triplet regimens to improve overall outcome in patients.

Linfoadenectomia nei tumori dello stomaco

Il ruolo della estensione della linfoadenectomia, ovvero della asportazione dei linfonodi, nel carcinoma dello stomaco e' un problema molto dibattuto in particolare in Europa dove la maggiore morbidita' e mortalita' perioperatoria associata ad una linfoadenectomia piu' estesa (D2) aveva di fatto messo in dubbio il vantaggio di questa procedura rispetto ad una linfoadenectomia limitata (D1).

Un follow-up a 15 anni dello stesso studio olandese che aveva messo in dubbio il vantaggio della D2, ora dimostra che una linfoadenectomia piu' estesa e' vantaggiosa in termini di minore incidenza di ripresa di malattia locale e locorgionale.

In conclusione, in tumori operabili ricevere una linfoadenectomia estesa D2 con risparmio della milza e' vantaggioso. Come ridurre il rischo legato alle maggiori complicanze di questa procedura? Rivolgersi a centri oncologici di riferimento dove vengano operati un numero cospicuo di pazienti per carcinoma gastrico.

fonte

The Lancet Oncology

Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial

Ilfet Songun, Hein Putter, Elma Meershoek-Klein Kranenbarg, Mitsuru Sasako, Cornelis J H van de Velde

Immagine tratta da http://www.hopkins-gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=AF793A59-B736-42CB-9E1F-E79D2B9FC358&GDL_Disease_ID=DB2F8EAC-4421-41DD-B04E-684AFEF2AD94