演題抄録

ECCO/JSCO Joint Symposium

開催概要
開催回
第52回・2014年・横浜
 

Neoadjuvant treatment prevalence and "High Quality" surgical strategy in gastric cancer : possible explanations for apparent contradiction in Eastern and Western Guidelines

演題番号 : ECJS-1

[筆頭演者]
D'Ugo Domenico:1 
[共同演者]
Biondi Alberto:1、Persiani Roberto:1

1:MiniInvasive Surgical Oncology, Surgery, A.Gemelli Gen. Hospital-Catholic University of Rome, Italy

 

Perioperative chemotherapy treatment protocols have gained widespread interest among Western researchers and reprsent the standard of care throughout most of Europe, based upon a grade A recommendation mainly deriving from the MRC MAGIC and the FFCD trial.
The European Society of Medical Oncology (ESMO) has issued recent guidelines including perioperative chemotherapy as the preferred pathway for all resectable tumors >T1,N0, implying a delay of surgical operation with intent to cure; by contrast, these guidelines show a striking difference from the JSCOG guidelines, which consider neo-adjuvant therapy just as an investigational treatment modality.
On behalf of ESSO (European Society of Surgical Oncology)the Authors analyze the reasons of the apparent contradiction of these two positions, addressing at first to enrollment criteria, focusing on the accuracy of preoperative staging. This represents the main bias in the interpretation of the MAGIC trial results, with a high "non-resectional" surgery rate due to a pre-treatment staging based on CT alone, whilst the rate of D1 lymphadenectomies and the average number of harvested nodes were unacceptably low.
Furthermore, epidemiological differences between Eastern and Western Countries explain the rationale for different approaches, with a preponderance of undifferentiated, locally advanced, subcardial neoplasm in the West; in these cases,latest phase III studies and recent meta-analyses show an evident benefit in reducing local relapse when applying neo-adjuvant treatment protocols, but the impact on overall survival is significant just in "good responders" for whom tumor downstaging has been reached and high quality R0 surgery can be safely applied.
In the West poor outcomes even in the setting of operable disease justify a continuous effort about the standardization of high-quality surgical rules. Multidisciplinarity and individualization of treatment partly reflect the epidemiology of gastric cancer across the World.

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