胃癌课件英文Gastric-Cancer

ChemotherapyinGastricCancerGASTRICCANCERWorldwideincidence**Incidenceper100,000population.ParkinDM,etal.CACancerJClin.1999;49:33-64.Male16.4Female8.2Male36.3Female16.9Male77.9Female33.3Male10.8Female4.9Male43.6Female19.0Male5.9Female2.6Male11.5Female4.3Male18.6Female13.3Male8.4Female4.0EasternEuropeJapanAustralia/NewZealandChinaNorthernAfricaSouthernAfricaCentralAmericaWesternEuropeNorthAmerica2ndmostcommoncancerintheworld,558400newcasesand405200deaths.Almost40%ofcasesoccurinChina.PazdurRetal.Cancermanagement:Amultidisciplinaryapproach.6thedition,2002CountriesinwhichtheincidenceofgastriccarcinomaisextremelyhighincludeJapan,CostaRica,Peru,Brazil,China,Korea,Chile,Taiwan,andthecountriesoftheformerSovietUnion.Atdiagnosis,approximately50%ofpatientshavegastriccarcinomathatextendsbeyondthelocoregionalconfines.Approximately50%ofpatientswithlocoregionalgastriccarcinomacannotundergoacurativeresection(R0).IncountriesintheWesternHemisphere,gastriccarcinomahasmigratedproximally,occurringmostfrequentlyalongtheproximallessercurvature,inthecardia,andinvolvingthegastroesophagealjunction.ItispossiblethatinthecomingdecadesthesechangingtrendswillalsooccurinSouthAmericaandAsia.Nearly70%to80%ofresectedgastriccarcinomaspecimenshavemetastasesintheregionallymphnodes.Thus,itiscommontoencounterpatientswithadvancedgastriccarcinomaattheoutset.IntheWesternHemisphere,R0resectionispossibleinapproximately50%to80%ofpatients.ThemediansurvivalofpatientswhoundergoanR0resectionisapproximately25months,and5-yearsurvivalratesrangefrom30%to37%.NCNNGuidelinesTheworkuppermitsclassificationofpatientsinto1of2groups:(1)patientswithapparentlocoregionalcarcinoma(stagesItoIIIorM0),and(2)thosewithobviousmetastaticcarcinoma(stageIVorM1).Patientswithapparentlocoregionaldiseasecanbefurtherclassified:(1)thosewhoaremedicallyfitandwhosecancerisresectable,(2)thosewhoaremedicallyfitbutwhosecancerisunresectable,and(3)thosewhoareinoperable(medicallyunfit).GlobalConsensusGoodlocalcontrolisessentialtocuregastriccarcinomaTheonlypotentiallycurativetreatmentforlocalizedgastriccancerissurgery.Mostgastriccancersarediagnosedatanadvancedstage.The5-yearsurvivalrateafter“curativeresection”forgastriccancerisonlybetween30%and40%.Theefficacyofchemotherapywithpalliativeintentisnowwidelyaccepted.ChemotherapyofGastricCancerKohneCH,WilsJA,WilkeHJ:DevelopmentsinthetreatmentofgastriccancerinEurope.Oncology(Huntingt)14:22-25,2000ChemotherapyofGastricCancerFluorouracil(5-FU)isoneofthemosteffectiveandwidelyuseddrugsinthetreatmentofadvancedgastriccancer(AGC),producingaresponserateofapproximately20%,withmanageabletoxicity.Overallsurvivalofbetween5and7monthshasbeenreportedfor5-FUmonotherapyinphaseIIIrandomizedstudies.CoombesR,ChilversCE,AmadoriD,etal:AnInternationalCollaborativeCancerGroup(ICCG)study.AnnOncol5:33-36,19946.ChemotherapyofGastricCancer5-FUmodulationbyfolinicacid(FA)hasgenerallyresultedinenhancedantitumorefficacy(22%to48%overallresponserate)andhasledtosomecompleteresponses(5%to9%).AllcurrentreferencecombinationregimensinAGCcontain5-FU.LouvetC,DeGramontA,DemuynckB,etal:.AnnOncol2:229-230,1991ChemotherapyofGastricCancer5-FU,doxorubicin,andmitomycin(FAM);5-FU,doxorubicin,andhigh-dosemethotrexate(FAMTX);etoposide,doxorubicin,andcisplatin(EAP);etoposide,leucovorin,and5-FU(ELF);epirubicin,cisplatin,and5-FUcontinuousinfusion(ECF);cisplatin,epirubicin,leucovorin,and5-FU(PELF);cisplatinand5-FU.ChemotherapyofGastricCancerSeveralrandomizedstudiescomparingFAMversusFAMTX(5-FU,adriamycin,andmethotrexate[withleucovorinrescue),FAMTXversusECF(epirubicin,cisplatin,and5-FU),andFAMTXversusELF(etoposide,leucovorin,and5-FU)versus5-FUpluscisplatinhavebeenreportedinthepastseveralyears.Noonestandardtherapyhasemergedfromthesetrials.Outsideofclinicaltrials,therecommendedchemotherapyforadvancedgastriccarcinomaiseithercisplatin-basedor5-FU--basedcombinationchemotherapy.ChemotherapyofGastricCancerThenewagentsincludepaclitaxel,docetaxel,irinotecan,UFT,oraletoposide,andS-1.Severalreportsofnewercombinationchemotherapyregimenshavealsoappeared.Anumberofneweroralagentsalsoholdpromiseinthetreatmentofgastriccarcinoma.Agentsthathavenotbeenextensivelystudiedincludecapecitabine,oxaliplatin.Inaddition,anumberofnewcategoriesofagentsareofinterest.Theseincludevaccines,antireceptoragents,andantiangiogenicagents.AnumberofchemotherapycombinationsarecurrentlyinphaseIIItrials,andweanticipatethatawidelyacceptedfront-linestandardforpatientswithadvancedgastriccarcinomamightemergeinthenearfuture.NCNNGuidelinesThelandmarktrialistheIntergrouptrialINT-0116.EligibilityincludedpatientswithT3andorN+adenocarcinomaofthestomachorgastroesophagealjunction.Afteraresectionwithnegativemargins,603patientswererandomlyassignedtoeitherobservationaloneorpostoperativecombinedmodalitytherapyconsistingof5monthlycyclesofboluschemotherapywith45Gyconcurrentwithcycles2and3.Therewasasignificantdecreaseinlocalfailureasthefirstsiteoffailure(19%versus29%)aswellasanincreaseinmediansurvival(36versus27months),3-yearrelapse-