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Gastric Cancer

A multimodal treatment approach including high-dose chemotherapy in very advanced gastric cancer: evidence for control of metastatic disease

Bone Marrow Transplantation volume 32, pages 665–671 (2003)Cite this article

Summary:

The present multimodal treatment approach was designed to achieve prolonged tumor control in advanced gastric cancer. A total of 26 patients with stage IV gastric cancer (metastatic disease n=25), ECOG performance status 0–3 and laparoscopically evaluated peritoneal status received a modified EAP schedule to prove chemosensitivity and to mobilize autologous peripheral blood stem cells (aPBSC). Patients without progressive disease proceeded to tandem high-dose chemotherapy (HD-CT) and aPBSCT. Patients with >50% reduction of the target lesion received a second cycle of HD-CT. Responders were selected for local R0 resections (D2 resection) according clinical criteria. Of 26 patients, 20(77%) achieved partial remission after dose-intensive chemotherapy: local R0 resection was achieved in 12 out of 14 patients selected for surgery (46% of all patients). Eight of these R0-resected patients initially had peritoneal carcinomatosis. With a median follow-up of 3.2 years, four patients are still alive. The median overall survival was 8.4 months (CI 2.5–14.4 months), for histologic regression grade 3 (seven out of 25 patients, 28%) 29 months (CI 12–46 months). The combined treatment approach is tolerable and feasible in advanced disease and opens a therapeutic window for a significant proportion of patients, even in cases with histologically proven peritoneal carcinomatosis.

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Authors and Affiliations

  1. Department of Hematology and Oncology, University of Regensburg, Germany

    A Reichle, H Wagner, M Zaiss & R Andreesen

  2. Department of Surgery, University of Regensburg, Germany

    U Bolder & K-W Jauch

  3. Department of Gastroenterology, University of Regensburg, Germany

    H Messmann

  4. Department of Pathology, University of Regensburg, Germany

    F Bataille, P Wild & F Hofstädter

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  1. A Reichle
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  2. U Bolder
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  3. F Bataille
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  8. F Hofstädter
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Correspondence to A Reichle.

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Reichle, A., Bolder, U., Bataille, F. et al. A multimodal treatment approach including high-dose chemotherapy in very advanced gastric cancer: evidence for control of metastatic disease. Bone Marrow Transplant 32, 665–671 (2003). https://doi.org/10.1038/sj.bmt.1704203

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