Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
ObjectiveTo summarize the research progress of neoadjuvant chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of neoadjuvant chemotherapy in the advanced gastric cancer were reviewed. ResultsThe neoadjuvant chemotherapy in the advanced gastric cancer could significantly improve the R0 resection rate, improve the long-term survival rate, and reduce the risk of death.The course of neoadjuvant chemotherapy for locally advanced gastric cancer without distant metastasis generally was 6-9 weeks, and then according to the results of the curative effect evaluation to decide whether to undergo surgery treatment.Further the clinical research and improvement of chemotherapy sensitivity detection method were helpful to the unity of the standard of neoadjuvant chemotherapy. ConclusionsThe curative effect of neoadjuvant chemotherapy in advanced gastric cancer is clear.But there is no uniform standard on such as indications, chemotherapy regimens, medication time, and curative effect evaluation index, and so on.It is still needed the further research of multicenter and large clinical trials.
ObjectiveTo discuss the role of imatinib preoperative chemotherapy in treatment of advanced gastrointestinal stromal tumor(GIST). MethodThe related literatures about imatinib preoperative chemotherapy for GIST were reviewed. ResultsImatinib preoperative chemotherapy is an effective treatment for advanced GIST, which significantly improve the resection rate and prolong the overall survival time for patients with advanced GIST. ConclusionsPreoperative imatinib treatment has good effect for metastatic or locally advanced GIST. It should be individualized by gene type of the GIST, which is deserved to be further studied.
ObjectiveTo evaluate the influence of pathological differentiation in the effect of preoperative chemo-therapy for patients with locally advanced gastric cancer (LAGC). MethodsThirty-two patients with LAGA received preoperative chemotherapy with oxaliplatin and capecitabine (XELOX regimen).According to the pathological examina-tion, patients were classified into better (well and moderate, 16 cases) and poorly (16 cases) differentiated groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups.Morphological changes and toxic reactions were monitored after chemotherapy. ResultsThe results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% vs.6.4%, P=0.000).The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% vs.25.0%, P=0.000).A significant shrinking of tumor size and necrosis of tumor tissues caused by chemotherapy could be observed. ConclusionThe better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy with XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for better differentiated group.