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Effect of Paclitaxol, Cisplatin, and 5-Flurouracil Chemotherapy in Advanced Stomach Cancer
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Yeul Hong Kim, Sang Won Shin, Byung Soo Kim, Jin Ho Kim, Jong Kuk Kim, Young Jae Mok, Jong Suk Kim, Chi Wook Song, Ho Sang Ryu, Jun Suk Kim, Jin Hai Hyun
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J Korean Cancer Assoc. 1997;29(4):648-655.
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 Abstract
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- PURPOSE
Paclitaxel has not been used widely in gastrointestinal cancers. However, a recent phase II report of paclitaxel in patients with esophageal adenocarcinoma has suggested a possible role of paclitaxel for the treatment of advanced gastric carcinoma. A phase II trial was initiated to determine the clinical utility of a 3 drug combination (paclitaxel, cisplatin, and 5-fluorouracil) in patients with advanced gastric carcinoma.
MATERIALS AND METHODS
Eligibility included biopsy-proven inoperable or relapsed adenocarcinoma of the stomach with adequate bone marrow, hepatic, and renal function. Patients received paclitaxel at 175 mg/m2 (3 hour infusion) on day 1 followed by cisplatin at 20 mg/m2/day infusion and 5-fluorouracil at 750 mg/m2/day continuous infusion for 5 days. Treatment has been repeated in every 4 weeks. Total 31 patients were enrolled; 7 had relapsed disease after resection and 5-fluorouracil based adjuvant chemotherapy, 5 had previous chemotherapy. Twenty-one patients had measurable disease and 9 were evaluable. Demographics included; median age, 47 years (range, 27~64 years); male: female, 21: 10; median performance status 2 (range, 0~4).
RESULTS
Major responses occurred in 16/30 (53%; 95% confidence interval, 35~71%) patients (2 complete responses, 14 partial responses); 13 of 21 (61.9%) patients with measurable disease and 3 of 9 (33%) evaluable patients.
Median response duration was 17 weeks (range, 8~44+ weeks) and median time to progression was 20 weeks (range, 8~51+ weeks). Median survival was 27 weeks (range, 8~72+ weeks).
WHO grade 3~4 toxicities included: neutropenia (61.9%), nausea/vomiting (23.8%), mucositis (19%), and diarrhea (9.5%). Grade 2~3 neurotoxicity, fluid retention syndrome, hypersensitive reaction had occurred in 6, 2, and 1 patients, respectively. There was 1 instance of treatment-related death due to sepsis.
CONCLUSION
This regimen was highly active in advanced gastric carcinoma and had moderate toxicity. However, the response duration was short like other regimens. Considering poor performance status of our patients, this regimen may have strong potential in the neoadjuvant setting.
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Response to Informed Consent in Gastric Cancer Patients
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Jae Bok Lee, Young Jae Mok, Yun Sik Hong, Ho Sang Ryu, Sae Min Kim
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J Korean Cancer Assoc. 1996;28(5):868-876.
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Abstract
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- The response of gastric cancer patients who have received surgical resection and follow-up OPD treatment to the informed consent was analyzed. The subjects analyzed were the responses to questionnaires given to 80 patients who were receiving follow-up OPD treatment following gastric resections for gastric cancer. The questionnaire consisted of inquiry on the disease, abount the doctors attitude, about the operation, about the postoperative chemoimmunotherapy and about Expertise. (5 titles, 22 items). The preoperative patient information rate of gastric cancer at Korea University Hospital was 62.3%. 55% had knowledge of the cancer prior to surgery while 45% acquired knowledge following surgery. The source of informatian pertaining to the patient's disease was the attending doctor in 62.3%, and 32.1% of the patients first acquired knowledge through family members. Changes following knowledge of cancer included active participation in treatment in 54% of the patients, planning for the future of the family in 31%, and acquirement of a new religion in 10%, showing an overall positive change in 85% of the informed patients. Degree of satisfaction following the operation after the doctors explanation was very satisfactory in 69.4% compared to the 38.9% in the absence of explanatian(p=0.027). Patient questions pertaining to postoperative treatment included inquiries on future treatment plans in 30%, survival period in 10%, and possibility of recurrence in 10%, 50% of the respondents did not comment. The confidence that the patients had in their doctors was compared on the basis of whether there was prior explanation by the attending doctor. 75.8% of the patients who received a doctors explanation were very confident in their doctor, whereas only 27.8% of those who did not receive nay explanation had such confidence(p=0.037). Patient confidence in chemoimmunotherapy also varied, as 28(48.3%) of the 58 patients receiving therapy had prior explanation gieven while 30(51.7%) received were without any explanation. 60.7% of patients who received explanation about the therapy were very confident in the chemoimmunotherapy, while only 43.3% of the non-explained group had such confidence(p=0.044). The result showed that adequate explanation about disease and patient's course by doctor influenced the patient's participation to treatment and sense of well-being. In conclusion, doctors active explanation to patient of gastric cancer is needed and we should develop an adequate method of giving and receiving informed consent.
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The Usefuness of laparoscope for the Staging of Gastric Cancer
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Jae Bok Lee, Young Jae Mok, Ho Sang Ryu, Young Chul Kim, Jin Hai Hyun, Sae Min Kim
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J Korean Cancer Assoc. 1995;27(5):836-846.
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Abstract
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- The purpose of this study is to evaluate the usefulness of preoperative laparoscopic examination in gastric cancer. A more accurate preoperative cancer staging may allow a better prepared setting in which to avdoid unnecessary laparotomy, decide preoperative neoadjuvant chemotherapy and prepare the operation far combined resections or intraoperative radiotherapy. The subjects of this study were the 105 patients who were diagnosed preoperatively by gastrofiberscopic examination with biopsy and had received gastric resections in our department from 1986 to 1993. We performed laparoscopy preoperatively in all patients to characterize the location of the tumor and its and regional infiltration. Abdomi- nal CT staging, preoperative laparoscopic staging, and staging with CT and laparoscopy were compared for serosal infiltration, lymph node metastasis, peritoneal seeding and hepatic me- tastasis. The diagnostic indices such as sensitivity, specificity, accuracy, prevalence and predictive value of each staging were calculated and compared. For the statistical interpretation of the results, diagnostic indexes were calculated in two-way contingency tables of the frequencies of positive and negative results construed as either true or false upon surgical and histo- logic evaluation. The sensitivities for laparoscopic examination of serosal invasion, lymph node metastasis, peritoneal seeding and liver metastasis were 87.3%, 26.8%, 37.5% and 10.5% respectivelym and the specificity of the above findings were 61.8%, 76.5%, 100% and 94.2% respectively. The sensitivities of CT staging for above findings were 50.7%, 39.4%, 0%, 15.8% respectively, and the specificity was 73.5% 97.1%, 99.0%, 93.0% respectively. The sensitivity of combined modalities for above findings were 94.4%, 59.2%, 50.0%, 15.8% respectively, and the specificity was 70.6%, 70.6%, 99%, 94.2% respectively, and which indicates that seosal invasion, lymph node metastasis and peritoneal seeding could be detected accurately, while liver metas- tasis could not be. 1) Serosal infiltration was more accurately diagnosed by preoperative laparoscopy (sensitivity 87.3%, specificity 61.8%, p=0.024). 2) Diagnostic indices of lymph node metastasis, peritoneal seeding and liver metastasis were not different between preoperative laparoscopy and CT (p > 0.05).
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KCA
