ABCD: Arquivos Brasileiros de Cirurgia Digestiva (Apr 2019)

CONVERSION THERAPY FOR GASTRIC CANCER: EXPANDING THE TREATMENT POSSIBILITIES

  • Marcus Fernando Kodama Pertille RAMOS,
  • Marina Alessandra PEREIRA,
  • Amir Zeide CHARRUF,
  • André Roncon DIAS,
  • Tiago Biachi de CASTRIA,
  • Leandro Cardoso BARCHI,
  • Ulysses RIBEIRO-JÚNIOR,
  • Bruno ZILBERSTEIN,
  • Ivan CECCONELLO

DOI
https://doi.org/10.1590/0102-672020190001e1435
Journal volume & issue
Vol. 32, no. 2

Abstract

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ABSTRACT Background: Conversion therapy in gastric cancer (GC) is defined as the use of chemotherapy/radiotherapy followed by surgical resection with curative intent of a tumor that was prior considered unresectable or oncologically incurable. Aim: To evaluate the results of conversion therapy in the treatment of GC. Methods: Retrospective analysis of all GC surgeries between 2009 and 2018. Patients who received any therapy before surgery were further identified to define the conversion group. Results: Out of 1003 surgeries performed for GC, 113 cases underwent neoadjuvant treatment and 16 (1.6%) were considered as conversion therapy. The main indication for treatment was: T4b lesions (n=10), lymph node metastasis (n=4), peritoneal carcinomatosis and hepatic metastasis in one case each. The diagnosis was made by imaging in 14 cases (75%) and during surgical procedure in four (25%). The most commonly used chemotherapy regimens were XP and mFLOX. Major surgical complications occurred in four cases (25%) and one (6.3%) died. After an average follow-up of 20 months, 11 patients (68.7%) had recurrence and nine (56.3%) died. Prolonged recurrence-free survival over 40 months occurred in two cases. Conclusion: Conversion therapy may offer the possibility of prolonged survival for a group of GC patients initially considered beyond therapeutic possibility.

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