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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2020

01-02-2020 | Gastric Cancer | ASO Author Reflections

ASO Author Reflections: Do Advances in Neoadjuvant Therapy Influence How We Surgically Manage the Regional Lymphatics in Gastric Cancer?

Authors: Casey J. Allen, MD, Brian D. Badgwell, MD

Published in: Annals of Surgical Oncology | Issue 2/2020

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Excerpt

Treatment for gastric cancer (GC) has undergone a paradigm shift, where multimodal therapy is now the standard of care.1 Our institution frequently performs neoadjuvant chemoradiation (NACXRT) prior to planned curative resection, and we have shown high rates of pathologic complete response, microscopically negative resection, and long-term survival with this approach.2 Preoperative radiotherapy not only includes the primary tumor but also the involved nodes and nodal regions at risk. In other solid tumors, trials have shown no benefit of aggressive locoregional lymphadenectomy (LAD) when treated in combination with modern adjuvant therapies.3,4 With regard to GC, the optimal extent of LAD after NACXRT is not known. …
Literature
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Badgwell B. Multimodality therapy of localized gastric adenocarcinoma. J Natl Compr Cancer Netw. 2016;14(10):1321–1327.CrossRef
2.
Ikoma N, Estrella JS, Hofstetter W, Das P, Minsky BD, Ajani JA, et al. Nodal downstaging in gastric cancer patients: promising survival if ypN0 is achieved. Ann Surg Oncol. 2018;25(7):2012–2017.CrossRef
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Giuliano AE, Giuliano AE, Ballman KV, McCall L, Beitsch PD, Brennan MB, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial. JAMA. 2017;318(10):918–926.CrossRef
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Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, Jahkola T, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–2222.CrossRef
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Leong T, Smithers BM, Haustermans K, Michael M, Gebski V, Miller D, et al. TOPGEAR: a randomized, phase III trial of perioperative ECF chemotherapy with or without preoperative chemoradiation for resectable gastric cancer: interim results from an international, intergroup trial of the AGITG, TROG, EORTC and CCTG. Ann Surg Oncol. 2017;24(8):2252–2258.CrossRef
Metadata
Title
ASO Author Reflections: Do Advances in Neoadjuvant Therapy Influence How We Surgically Manage the Regional Lymphatics in Gastric Cancer?
Authors
Casey J. Allen, MD
Brian D. Badgwell, MD
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07993-6

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