ASO Author Reflection: Tending Towards a Personalized Treatment for Advanced Gastric Cancer Patients by Adding the Conve
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ASO AUTHOR REFLECTIONS
ASO Author Reflection: Tending Towards a Personalized Treatment for Advanced Gastric Cancer Patients by Adding the Conversion Surgery Guo-Ming Chen, MD, Run-Cong Nie, MD, PhD, and Ying-Bo Chen, MD State Key Laboratory of Oncology in South China, Department of Gastric Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
PAST Historically, the recommended treatment for advanced gastric cancer (AGC) was merely palliative chemotherapy. However, because of the intrinsic and secondary drug resistance, the survival outcomes of patients treated with palliative chemotherapy often were dismal with the median progression survival time of less than half a year. Coupled with the poor basic nutritional status, patients often died from the adverse events of chemotherapy. Plenty of surgical therapeutic strategies (i.e., palliative gastrectomy, peritoneal metastasectomy) had been explored to improve the prognosis for AGC patients. While palliative gastrectomy might alleviate symptoms, reduce tumor burden, and theoretically prolong the survival, the REGATTA trial demonstrated that palliative gastrectomy followed by chemotherapy failed to show the survival benefit for AGC patients.1 PRESENT The comprehensive treatment, based on systemic chemotherapy, combined with local treatment, e.g., radiotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), has been well accepted by oncologists. In the
Guo-Ming Chen, Run-Cong Nie have contributed equally to this study. Ó Society of Surgical Oncology 2020 First Received: 1 May 2020 Y.-B. Chen, MD e-mail: [email protected]
condition that the tumor burden is under good control, conversion surgery, also termed as adjuvant surgery, may reduce the secondary drug resistance and may be the optimal choice for quite a proportion of AGC patients. Previous studies also indicated that AGC patients could benefit from conversion surgery compared to chemotherapy alone.2,3 In the present study, we further reported the surgical and long-term outcomes for conversion surgery and found that a sufficient number of cycles of induction chemotherapy (usually C 6 cycles) were needed and surgical oncologists should perform R0 resection and avoid total gastrectomy.4 However, there are still two urgent issues that should be solved: how to improve the objective response rate of the current antitumor drugs and how to effectively select the potential beneficiaries for conversion surgery. FUTURE With the development of novel anti-tumor drugs, such as target agents and immune checkpoint inhibitors, the objective response for AGC will be improved. The concept of AGC treatment also will transfer from chemotherapy alone to multimodality therapy. In the era of personalized treatment, the HIPEC for peritoneal metastases, the ablation treatment for limited liver metastasis or the radiotherapy for para-aortic lymph nodes should be considered. Once the timing for surgical intervention is proper, surgeon should perform the conversi
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