Table Of ContentSpringer Japan KK
T. Nakajima, T. Yamaguchi
(Eds.)
Multimodality Therapy
for Gastric Cancer
Appendix: Database of the Cancer Institute
Hospital
With 130 Figures Including 15 in Color
B Springei
Toshifusa Nakajima, M.D., Ph.D.
Vice Director, Cancer Institute Hospital
1-37-1 Kamiikebukuro, Toshima-ku, Tokyo 170-8455, Japan
Toshiharu Yamaguchi, MD., Ph.D.
Associate Professor, The First Department of Surgery
Kyoto Prefectural University of Medicine
Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan
ISBN 978-4-431-68009-3
Library of Congress Cataloging-in-Publication Data
Multimodality therapy for gastric cancer / T. Nakajima, T. Yamaguchi
(eds.).
p. cm.
"Appendix: Database of the Cancer Institute Hospital."
Includes bibliographical references and index.
ISBN 978-4-431-68009-3 ISBN 978-4-431-67927-1 (eBook)
DOI 10.1007/978-4-431-67927-1
1. Stomach—Cancer—Adjuvant treatment. 2. Combined modality
therapy. I. Nakajima, Toshifusa. II. Yamaguchi, T. (Toshiharu),
1948- . III. Cancer Institute Hospital (Tokyo, Japan).
[DNLM: 1. Stomach Neoplasms—drug therapy. 2. Chemotherapy,
Adjuvant. 3. Databases, Factual. 4. Stomach Neoplasms—surgery.
WI 320 M961 1999]
RC280.S8M85 1999
616.99'43306—dc21
DNLM/DLC
for Library of Congress 99-27919
Printed on acid-free paper
© Springer Japan 1999
Originally published by Springer-Verlag Tokyo Berlin Heidelberg New York in 1999
Softcover reprint of the hardcover 1st edition 1999
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Dedicated to Dr. Tamaki Kajitani (1909-91) and Dr. Mitsumasa
Nishi (1925-98) for unsurpassedachievement in theirprofession and
lasting inspiration to their colleagues.
Dr.Tamaki Kajitani (1909-1991) Dr. Mitsumasa Nishi (1925-1998)
the Director Emeritus of CIH,and the Director Emeritus ofCIH, and
PresidentEmeritusofJapanese Research PresidentEmeritusofJapaneseGastric
Society for Gastric Cancer (JRSGC) CancerAssociation (JGCA)
Preface
Results of gastric cancer treatment recently have improved remarkably in Japan,
mainly as a result of the relative increase in the number of patients who undergo
surgeryatanearlystageofdisease.Advanced-stagecancerstillaccountsfor acertain
percentage of cases that are operated on, and the results of their late treatment
remain poor. Multimodality therapy may be an alternative approach to improving
the treatment results of these cases,because surgery itselfcontributes to controlling
only localized tumors.
Although clinical trials of multimodality therapy for gastric cancer have a long
history beginning in the late 1950s,controversy continues in terms ofclinical signifi
cance.MostWestern researchersmaintainanegative,skepticalattitude regardingthe
survival benefitsofvariousadjuvant therapies.Japaneseclinical trials,unlike those in
the West, have sometimes reported favorable results in certain subsets of advanced
gastriccancer.Itisdifficult to explain these discrepancies betweenWestern countries
and Japan, which could be attributed to the amount of tumor burden after surgery.
Japanese D2 surgery for resectable gastric cancer has gradually been accepted in
Western countries as the standard procedure. The residual tumor burden after D2
surgeryprobablyissmallerinJapanthaninWesterncountries,becausestage-adjusted
survival is better in Japan than in other countries. Larger tumor burden might over
whelm the effectofpostoperativeadjuvantchemotherapy.
A characteristic ofthis book is that almost all the authors are surgeons who have
been meeting the challenge of new modality therapies, preoperative or intraopera
tive chemotherapy, or a combination of systemic and regional chemotherapy. If an
advanced cancercould be reduced in size by chemotherapy enough to be eradicated
to RO by extensive surgery, patients with advanced cancer might be expected to live
for a long time.Although most ofthe current trials are phase II trials with relatively
small sample sizes, and randomized trials are needed to demonstrate the survival
benefit, readers still may find something in these studies that will be useful for initi
ating a novel treatment.
The Appendix is devoted to tabular analysis of the gastric cancer database at the
Cancer Institute Hospital (CIH),Tokyo, which was founded in 1932.Although data
collectedbeforeWorldWarII werelostasaresultofwartime bombing,essentialclin
ical records ofgastric cancer patients since 1946 were put into the computer. It may
be the largestdatabase for gastriccancerin the world originatingfrom asingle insti
tution. Tabular analysis of 12419 cases of gastric cancer creates data that serve to
present the state of the art in treatment. The existence of the data owes greatly to
the superhuman effort of the late Dr. Tamaki Kajitani (1909-91), a Director
Emeritus ofCIH,and the late Dr.Mitsumasa Nishi (1925-98),also a Director Emer
itus of CIH and President Emeritus of the Japanese Gastric Cancer Association
(JGCA).They were not only prominent,skillful surgeons,but also opinion leadersin
thefield ofsurgicaloncologyinJapan for manyyears.Forinstance,para-aorticlymph
node dissection was initiated by Dr. Kajitani in the late 1970s; and superextended
radical gastrectomy,the left upper abdominal evisceration (LUAE),was established
VII
VIII Preface
by Drs. Kajitani and Nishi in the 1980s.These surgical procedures now are widely
accepted in many institutions in Japan.
The first randomized clinical trial of adjuvant chemotherapy was initiated at CIH
in 1959. One of the editors (T.N.) succeeded to the position of head of the Depart
ment of Gastrointestinal Surgery of CIH in 1989, and serves this year as the Presi
dent ofthe71stJGCA.On the occasionoftheannual meetingoftheJGCA,itisour
honor and pleasure to publish this book which is dedicated to the memory of Drs.
Kajitani and Nishi with the hope that this work will contribute to the development
offuture clinicalresearch.Theeditorsthankallauthorsfor theircontributionsto this
book, and express special thanks to the three doctors from abroad for their fine
reviews and original study.
June 1999
TOSHIFUSA NAKAJIMA, M.D., Ph.D.
TOSHIHARU YAMAGUCHI, M.D., Ph.D.
Contents
Dedication V
Preface VII
Color Plates XII
Adjuvant Chemotherapy for Gastric Cancer
Success ofAdjuvant ChemotherapyTrials for Gastric Cancer
T. NAKAJIMA 3
Randomized ControlledTrials onAdjuvantTherapy for Gastric Cancer:
Japanese Experience
T. SANO,M. SASAKO, H. KATAI, and K. MARUYAMA 7
MultimodalityTherapy for Completely Resected (RO) Gastric Cancer
(Excluding JapaneseTrials)
H.o. DOUGLASS JR., H.R. NAvA,and 1.L. SMITH 17
Meta-Analysis ofAdjuvant ChemotherapyTrials for Gastric Cancer at
the Cancer Institute Hospital,Tokyo
T. NAKAJIMA,K. OHTA,S. OHYAMA,and N. HAMAJIMA ................... 27
Adjuvant Chemotherapy ofGastric Cancer: JCOG Experience
M. KITAMURA,T. NAKAJIMA,K. OHTA,A. NASHIMOTO,Y.YAMAMURA,
H. FURUKAWA,M. SASAKO,T. KINOSHITA, and H. MOTOHASHI 32
Prevention and Control of Peritoneal Dissemination
Activated Carbon ParticlesAdsorbing Mitomycin C Used Against
Peritoneal Carcinomatosis in Gastric Cancer
A. HAGIWARA,T.TAKAHASHI,and H.YAMAGISHI .................... ... 45
Control ofPeritoneal Dissemination with Sequential Methotrexate and
5-Fluorouracil
T. KONISHI,T. NOIE, K. MAFUNE, M. MAKUUCHI, and 1.YOSHIDA 51
Intraperitoneal Chemotherapy with Mitomycin C or Cisplatin
M. HIRATSUKA,H. FURUKAWA,T.YASUDA,K.MURATA,T.YAMADA,
H. OHIGASHI,M. KAMEYAMA,Y. SASAKI,T. KABuTO, O. ISHIKAWA,and
S. IMAOKA 58
Usefulness ofIntraperitonealAdministration of Cisplatin Using a
Reservoir for Advanced Gastric Cancer Complicated by Peritoneal
Dissemination
K. OHTA, S. OHYAMA,T.TAKAHASHI,and T. NAKAJIMA 66
IX
X Contents
Peritonectomy as aTreatment Modality for Patients with Peritoneal
Dissemination from Gastric Cancer
Y.YONEMURA,T. FUJIMURA, S. FUSHIDA,H. FUJITA,E. BANDO,
K.TANIGUCHI, G. NISHIMURA, K. MIWA,S. OHYAMA, and K. SUGIYAMA 71
Control of Liver Metastasis
Management ofLiver Metastases
Y. ARAI 83
Control ofLiver Metastasis by Intrahepatic Chemotherapy with
Angiotensin II
Y. IWASAKI, K. ARAI, M. OHASHI,T.TAKAHASHI, and M. KITAMURA 90
Control of Distant Lymph Node Metastasis
Neoadjuvant Chemotherapy with FLEP Regimen for Incurable
Gastric Cancer
T. NAKAJIMA, K. OHTA, S. ISHIHARA,S. OHYAMA,M. NISHI,Y. OHASHI,
A. YANAGISAWA, and Y. KATO 97
Case Report ofPathological Complete Remission with FLEPTherapy
S. OHYAMA, 0. KOMATSU,T. NAKAJIMA, K. OHTA,T.TAKAHASHI, and
A.YANAGISAWA 104
Neoadjuvant Chemotherapy with FLEPTherapy for Advanced
Gastric Cancer: Evaluation ofIntraaortic and Intravenous FLEP Infusions
S.-K. SONG and S.-w. KIM ~ ........................... 108
Neoadjuvant Chemotherapy for Operable Disease
Rationale for Neoadjuvant Chemotherapy for Advanced Gastric Cancer
T. YAMAO 115
MultimodalityTherapy of Locoregional Gastric Carcinoma
lA. AJANI 122
Histopathological Effect ofPreoperative Chemotherapy Using
Oral 5-Fluorouracil in Patients with Operable Gastric Cancer
M. FUJII,G. KOSAKI, S.TSUCHIYA,K. KIMURA, H. SUZUKI,T. NAKAJIMA,
Y. AWANE, M. KITAMURA,Y. KITAMURA, K. SUZUKI,S.TSURUI,K. NISHIYAMA,
1 WAKASUGI, M. KOCHI, and M. NAKASHIMA (GASTRIC CANCER
CHEMOTHERAPY GROUP) .......................... ................ 126
Neoadjuvant Chemotherapy ofGastric Cancer with UFT
Y. NIO, C. IGUCHI, K. YAMASAWA, M. ITAKURA,H. OMORI, N. HASHIMOTO,
S.YANO,S. SUMI,and K.TAMURA 131
Neoadjuvant Systemic Chemotherapy for Advanced Gastric Cancer with
Noncurative Clinical Factors
A. NASHIMOTO, H.YABUSAKI,1 SASAKI,0.TANAKA,M.TSUTSUI, and
Y.TSUCHIYA ................ ................................... 141
New Strategy for the Treatment ofAdvanced or Recurrent Gastric
Carcinoma: Neoadjuvant Immunochemotherapy ofFLPO Regimen
(5-FU, Leucovorin, CDDP, OK-432)
T.YOSHIKAWA,H. MOTOHASHI,A.TSUBURAYA, 0. KOBAYASHI, M. SAIRENJI,
and Y. NOGUCHI. ............................................... 148
Contents XI
Intraoperative Local Infusion Chemotherapy for Advanced Gastric Cancer
K. ARAKI,T. BEPPu, H.YAMAMOTO, M. KOBAYASHI, and K. MATSUURA. ..... 154
The Future Perspective
Future ClinicalTrial ofAdjuvant Chemotherapy with SensitivityTest
T. KUBOTA,Y. OTANI,K. KUMAI, and M. KITAJIMA .................... .. 163
Angiogenesis and Angiogenic Factors of Gastric Cancer
Y.TAKAHASHI and M. MAl 170
IntratumoralAngiogenesis and Micrometastasis in Bone Marrow of
Patients with Gastric Cancer
Y. KAKEJI,Y. MAEHARA, K. SHIBAHARA,S. HASUDA, E.TOKUNAGA, E. OKI,
and K. SUGIMACHI 177
Targeting Chemotherapy ofPeritoneally Disseminated Gastric Cancer
with Monoclonal Antibody-Drug Conjugates
T.YAMAGUCHI, K. OKAMOTO,T.TAKAHASHI, K. KITAMURA, E. OTSUJI,
H.TANIGUCHI, C. SAKAKURA, M. SHIRASU, H. MATSUMURA, K.YAMAMOTO,
T. NISHIDA, S. KOBAYASHI, and H. YAMAGISHI 183
Future Perspectives of GeneTherapy for Gastric Cancer
Y. MIKI 187
Appendix 195
Subject Index 269
~....
d
c, c.d 3,b
L..--.:.._••-.b~... A71-year-oldwomanwithIIc-likeadvancedcancerwasgiven300mg/dayfor16days.Shehadacompleteresponse,withtheFig.1.UFT'lesionbecomingascar.aBeforeAftercResectedspecimen.HistologyP.UFT'.bUFT'.d(See134) rw_,.a.:l'..:!!"MiI..~.==:.n..:3~.....).•...:... A77-year-oldmanwithBorrmanntypeadvancedgastriccanceratthepyloricringwasgiven300mg/dayfordays.HeFig.2.IIUFT'23hadacompleteresponse,withthelesionbecomingascar.aBeforeAftercResectedspecimen.HistologyP.UFT'.bUFT'.d(See134) A75-year-oldmanwithBorrmanntypeIIgastriccancerwasA50-year-oldmanwithlivermetastasiswasgiven600Fig.3.Fig.4.UFT'givenmg/dayfor400mg/dayfordays.Hehadapartialresponse(size35days.Hehadacompleteresponse,withthelesiondis UFT'8+reduction,appearing(theprimarylesionshowedapartialresponse).aBeforetoIIclIb).aBeforeAfterP.UFT'.bUFT'(See134)AfterP.UFT'.bUFT'(See135)
a, a,b a,b
