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KMID : 0371319950490060922
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Journal of the Korean Surgical Society
1995 Volume.49 No. 6 p.922 ~ p.930
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The Clinicopathological Down Staging Effect of Neoadjuvant Chemotherapy in Far Advanced Gastric Cancer
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라기혁
김용일/노성훈/김명진/김호근/민진식
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Abstract
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Significant portion of gastric cancer patients are non-resectable at the time of diagnosis or exploration. Despite the introduction of variety of multidiciplinary therapy. The prognosis of these patients is nor and beyond hope of cure. There are
some
reports that neoadjuvant chemotherapy may improve the resectability. So we tried to investigate the clinicopathological effect of neoadjuvant chemotherapy in far advanced gastric cancer and to assess the surgical outcome after neoadjuvant
chemotherapy.
The present report is concerned wit 27 patients who were initially diagnosed with locally advanced or non-resectable gastric cancer and later assessed as resectable after neoadjuvant chemotherapy. The clinical staging was done according to the
AjCC
staging..
The neoadjuvant chemotherapy consisted of a 5-FU based regimen injected an average of 3.7 cycle. The median age of the patients studied was 53 year old with 16: 11 male to female ratio. In the preoperative study, pancreas was the most commonly
involved
adjacent organ with 19 cases and 3 cases and 3 cases showed involvement in two or more adjacent organs. Two patients were in stage Ⅲa:9 inⅢb:16 in Ⅳ. In radiologic follow up studies, neoadjuvant chemotherapy showed positive effect in 19
cases(70.4%)[CR:1, PR: 18] and down staging was observed in 11 cases(40.7%). Eight patients showed no response to chem otherapy and 5 cases were up-staged at the time of surgery compared to the initial state. Curative resections were done on 13
cases
and palliative resections on 12 cases and nonresection on 2 cases only. This means 92.6% of resectability. After the operation, the pathologic staging according to the AJCC showed 2 cases in stage II: 7 cases in Ⅲa:4 cases in Ⅲb: 14 cases in
Ⅳ.
Sixteen(59%) of these patients expired within 2 years after surgery and their mean survival time was 24.9 months.
Neoadjuvant chemotherapy has made far advanced gastric cancer resectable through its effects of lowering the clinical stage. A more fine and accurate preoperative staging seems to be necessary for more accurate assessment of neoadjuvant
chemotherapy.
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