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Efficacy of pre-operative chemotherapy with docetaxel, cisplatin, and S-1 (DCS therapy) and curative resection for gastric cancer with pathologically positive para-aortic lymph nodes
Katsunobu Oyama; Sachio Fushida; Jun Kinoshita; Isamu Makino; Keishi Nakamura; Hironori Hayashi; Hisatoshi Nakagawara; Hidehiro Tajima; Hideto Fujita; Hiroyuki Takamura; et al. (Profiled Authors: TETSUO OTA; TAKASHI FUJIMURA; KATSUNOBU OYAMA; JUN KINOSITA; SACHIO FUSHIDA; HIROHISA KITAGAWA; HIDETO FUJITA; HIDEHIRO TAJIMA; HISATOSHI NAKAGAWARA; ITASU NINOMIYA; HIROYUKI TAKAMURA; HIRONORI HAYASHI)
Journal of Surgical Oncology. 2012;105(6):535-541.Abstract
Background The prognosis of gastric cancer with para-aortic lymph node (PAN) metastasis is poor. We applied triple combination chemotherapy with docetaxel, cisplatin, and S-1 (DCS therapy) as pre-operative chemotherapy and investigated the outcome of the combination of this therapy and gastrectomy with para-aortic lymph node dissection (PAND). Methods We retrospectively identified 44 patients with pathologically positive PAN who underwent curative surgery at Kanazawa University Hospital between 1990 and 2008. Among the 44 patients, 16 received pre-operative DCS therapy and subsequent surgical resection after two courses of the therapy. Results Pre-operative DCS therapy showed high clinical response ratio (68.8%) and disease control ratio (100%). The pathological response ratio of resected specimen was 87.5%. At 2 years after surgery, the overall survival ratio was 93.8% and relapse-free survival was 75.0%. Pre-operative DCS therapy was only independent prognostic factor in multivariate analysis. Grade 3/4 toxicity was observed only in 25.0% of patients who underwent DCS therapy. Surgical complication was observed in 31.3% of patients, and this ratio was equal to that of patients who did not receive DCS therapy. Conclusion Multimodal therapy comprising combined pre-operative DCS therapy and gastrectomy with PAND was extremely effective and feasible for advanced gastric cancer with PAN metastasis. J. Surg. Oncol. 2012; 105:535-541. © 2011 Wiley Periodicals, Inc.
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