2. I: 12.1 por cada 100 000 hab
M: 8.9 por cada 100 000 hab
EPIDEMIOLOGÍA
INCIDENCIA: 5to lugar
MORTALIDAD: 2da causa
•> incidencia: Este de Asia, Sudamérica, Europa Oriental
•< Incidencia: EUA, Europa occidental.
6. 17 trials (3838 patients), median follow-up > 7 years
OS was 4.9 years in CX / 7.8 years in ADY QT
5 years CX ALONE 49.6%/ ADY QT 55.3%
10 years CX ALONE 37,5%/ ADY QT 44.9%
Absolute benefits were 5.8%
SG & SLE (HR 0.82)
18% reduction of risk of death with ADY QT
DFS The absolute benefit at 5 years was 5.3%, from 48.7% to 54.0%
JAMA, May 5, 2010—Vol 303, No. 17
7. Estimated 3-year DFS ADY CHEMO was 75%
DFS OBSERV was 60%
Estimated 5-year DFS ADY CHEMO was 68%
DFS OBSERV was 53%
Estimated 5-year SG ADY CHEMO was 78%
SG OBSERV was 69%
.
Lancet Oncol 2014; 15: 1389–96
ADY QT; DFS (HR 0.58)
ADY QT; SG (HR 0.66)
A randomised Phase III Trial
1035 patients, EC II, IIIA – IIIB, ECOG O – 2
D2 resection within 6 w before randomisation
END POINT: SLE a los 3 años, SG
Absolute benefits 15%
Absolute benefits 9%
34% reduction of risk of death
42% reduction of risk of recurrence disease
8. A randomised Phase III Trial
556 patients
ECOG O - 2
Histologically: Adenocarcinoma
R0 – D0 – D1 – D2 (10%)
EC: IB through IVM0
T 1–4
NODES 0, 1–3, >3
END POINT: SG, SLR
CHEMO (5FU 425 mg/m2/d and leucovorin, 20 mg/m2/d for 5
days): Days 1 - 5 after 28 days: CT_RT x 25 days
CHEMO-RT: 4500 cGy of radiation at 180 cGy/d 5 days/week for
5 weeks + 5FU 400 mg/m2/d and leucovorin, 20 mg/m2/d: Days
1 – 4 and 26 – 28 of RT
1 m after the completion of RT, 2 cycles of 5-day of 5FU (425
mg/m2/d) and leucovorin (20 mg/m2/d)
MacDonaldJS, et al. N EnglJ Med2001;345:725–730
CT+ CT-RT + CT
NO TREATMENT
SURGERY
SURGICAL PROCEDURES
54 (10%): D2 dissection.
199 (36%): D1 dissection
299 (54%): D0 dissection.
SLR 3y 48% VS 31%
SG 3y 50% VS 41%
THE ROLE OF RADIATION IN THE POSTOPERATIVE
SETTING: ADJUVANT
Absolute benefits 17% y 9%
12. PROGNOSTIC VALUE OF THE METASTATIC LYMPH NODE (N) RATIO IN THE ADJUVANT CHEMORADIOTHERAPY IN
STOMACH TUMORS (ARTIST) PHASE III TRIAL
The proportion between metastatic and examined
lymph nodes (N ratio): independent prognostic
factor in gastric cancer (GC) patients.
Methods: We retrospectively reviewed the data of
458 ARTIST patients who underwent D2 gastrectomy
followed by adjuvant chemotherapy with
capecitabine plus cisplatin (XP, n = 228) or
chemoradiotherapy (XPRT, n = 230).
Four N ratio categories (0% v 1-9% v 10-25% v >
25%) were employed, and statistical analysis was
performed using adjusted Cox regression and
stratified survival analysis.
Soonil Lee, Se Hoon Park, Jeeyun Lee, Won Ki Kang; Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea; Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Samsung Medical Center, Seoul, Korea, The Republic of; Division of Hematology-Oncology, Department of Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
ASCO, 2016 (suppl; abstr 4038)
Results:
At multivariate analysis, N ratio was retained as an
independent prognostic factor for DFS: HR for N ratio 0%, 1; N
ratio 1-9%, 1.061; N ratio 10-25%, 1.202; and N ratio > 25%,
3.571.
In patients with N ratio > 25%, the 5-year DFS was 55% v 28%
for XPRT and XP arms, respectively (HR, 0.527; 95% CI, 0.307
to 0.904; P = 0.020).
13. PHASE III trial,
788 patients, GASTRIC CA IB – III, ECOG 0, 1
D1 + lymph node dissection
END POINT: SG, SLE, toxicity profile and quality of life
Control arm: ECC x 3
Experimental arm: QT-RT x 5 weeks.
Capecitabine: 575 mg/m2 bid from Mon to Frid
Cisplatin 20 mg/m2 intravenously weekly.
Epirubicin 50 mg/m2 day 1
Cisplatin 60 mg/m2 day 1
Capecitabine 1000 mg/m2 bid for 14 d
every 3 weeks
Dikken et al. BMC Cancer 2011, 11:329
14. CONCLUSIONES
PACIENTES CANDIDATOS A QUIMIOTERAPIA
- RADIOTERAPIA CONCURRENTE
Cirugías insuficientes: D1
Ratio ganglionar: > 25%
Según clasificación de Lauren: Adenocarcinomas de
Tipo intestinal
Grupo Molecular: CIN.
¿ PORQUE ELIGIRÍA ADYUVANCIA COMO OPCION TERAPEUTICA ?
STATUS PERFORMANCE INADECUADO PARA NEOADYUVANCIA
PACIENTES CANDIDATOS A
QUIMIOTERAPIA SISTEMICA
Cirugías D2, R0