内容紹介
Summary
There is no known recommended chemotherapy after radical surgery for gastric cancer for patients who have non—curative disease. We defined positive peritoneal cytology(CY1), resection margin involvement, pathological peritoneal metastasis(pP1)and pN3b as clinical non—curative factors and administered adjuvant chemotherapy with S—1 and docetaxel(DOC)(80 mg/m2 day 1—14 of S—1 for 2 weeks with 40 mg/m2 of DOC on day 1, every 3 weeks). This regimen lasted for 1 year;however, if chemotherapy could be continued after this period, we used S—1 only. We reported the results of 11 cases who received this treatment. Patients:There were 6 total gastrectomies and 5 distal gastrectomies. Clinical non—curative factors were 5 pP1, 5 pN3b, 3 CY1 and 1 resection margin involvement. Results:At the end of adjuvant therapy there were 6 completions, 4 recurrences, and 1 patient with side effects. The main adverse event of Grade 3 or greater was neutropenia(46%). The recurrence rate was 63.6%. Types of relapse included 6 disseminations and 1 patient with lymph node involvement. One—, 3—, and 5—year survival rates were 100%, 72.7% and 72.7%, respectively, and the RFS was 64.0 months. Conclusion:S—1 and DOC adjuvant chemotherapy produced good results and may serve as a therapy of choice for patients with advanced gastric cancer with non—curative factors after a relatively curative resection.
要旨
背景:R0切除後のStage Ⅲ胃癌症例に対する術後補助化学療法(AC)は2019年以降,S—1・docetaxel(DOC)併用療法に統一されたが,非治癒因子を有するR1切除例の至適ACレジメンは未だ不明である。目的:R1切除例に対する術後S—1・DOC療法の治療効果を検討する。方法:肉眼的R0切除例のうち,腹腔洗浄細胞診陽性(CY1),切除断端陽性[断端(+)],組織学的腹膜転移(pP1),組織学的リンパ節転移16個以上(pN3b)を臨床的非治癒例とし,S—1・DOC療法(S—1 80 mg/m2 day 1～14,DOC 40 mg/m2 day 1,休薬7日間を含めた1コース21日間)を行った。術後1年間を目標とし,以降継続する場合はS—1単剤投与を行った。結果:術式は胃全摘6例,幽門側胃切除が5例で,全例他臓器合併切除を施行した。臨床的非治癒因子は,pP1 5例,pN3b 5例,CY1 3例,断端(+)1例であった(重複あり)。治療終了理由は完遂6例,再発4例,副作用中止1例であり,主な副作用(Grade 3以上)は顆粒球減少(46%)であった。7例(63.6%)に再発を認め,内訳は播種再発6例(54.5%),リンパ節転移1例(9.1%)であった。生存率は1年100%,3年72.7%,5年72.7%で,無再発生存期間は64.0か月であった。結語:R1切除後のS—1・DOC療法は治療選択肢の一つになり得ると考えられた。
目次
There is no known recommended chemotherapy after radical surgery for gastric cancer for patients who have non—curative disease. We defined positive peritoneal cytology(CY1), resection margin involvement, pathological peritoneal metastasis(pP1)and pN3b as clinical non—curative factors and administered adjuvant chemotherapy with S—1 and docetaxel(DOC)(80 mg/m2 day 1—14 of S—1 for 2 weeks with 40 mg/m2 of DOC on day 1, every 3 weeks). This regimen lasted for 1 year;however, if chemotherapy could be continued after this period, we used S—1 only. We reported the results of 11 cases who received this treatment. Patients:There were 6 total gastrectomies and 5 distal gastrectomies. Clinical non—curative factors were 5 pP1, 5 pN3b, 3 CY1 and 1 resection margin involvement. Results:At the end of adjuvant therapy there were 6 completions, 4 recurrences, and 1 patient with side effects. The main adverse event of Grade 3 or greater was neutropenia(46%). The recurrence rate was 63.6%. Types of relapse included 6 disseminations and 1 patient with lymph node involvement. One—, 3—, and 5—year survival rates were 100%, 72.7% and 72.7%, respectively, and the RFS was 64.0 months. Conclusion:S—1 and DOC adjuvant chemotherapy produced good results and may serve as a therapy of choice for patients with advanced gastric cancer with non—curative factors after a relatively curative resection.
要旨
背景:R0切除後のStage Ⅲ胃癌症例に対する術後補助化学療法(AC)は2019年以降,S—1・docetaxel(DOC)併用療法に統一されたが,非治癒因子を有するR1切除例の至適ACレジメンは未だ不明である。目的:R1切除例に対する術後S—1・DOC療法の治療効果を検討する。方法:肉眼的R0切除例のうち,腹腔洗浄細胞診陽性(CY1),切除断端陽性[断端(+)],組織学的腹膜転移(pP1),組織学的リンパ節転移16個以上(pN3b)を臨床的非治癒例とし,S—1・DOC療法(S—1 80 mg/m2 day 1～14,DOC 40 mg/m2 day 1,休薬7日間を含めた1コース21日間)を行った。術後1年間を目標とし,以降継続する場合はS—1単剤投与を行った。結果:術式は胃全摘6例,幽門側胃切除が5例で,全例他臓器合併切除を施行した。臨床的非治癒因子は,pP1 5例,pN3b 5例,CY1 3例,断端(+)1例であった(重複あり)。治療終了理由は完遂6例,再発4例,副作用中止1例であり,主な副作用(Grade 3以上)は顆粒球減少(46%)であった。7例(63.6%)に再発を認め,内訳は播種再発6例(54.5%),リンパ節転移1例(9.1%)であった。生存率は1年100%,3年72.7%,5年72.7%で,無再発生存期間は64.0か月であった。結語:R1切除後のS—1・DOC療法は治療選択肢の一つになり得ると考えられた。