OBJECTIVEThis review discusses the current status and progress in studies on gastric cancer with liver metastasis (GCLM), involving the routes, subtypes, and prognosis of GCLM; the genes and molecules associated with metastasis; the feasibility and value of each imaging modality; and current treatment options.

DATA SOURCESThe data used in this review were mainly from Medline and PubMed published in English from 2005 to August 2010. The search terms were "gastric cancer" and "liver metastasis".

STUDY SELECTIONArticles regarding the characteristics, diagnostic modalities, and various therapeutic options of GCLM were selected.

RESULTSThe prognosis of GCLM is influenced by the clinicopathological characteristics of primary tumors, as well as the presence of liver metastases. Improved understanding of related genes and molecules will lead to the development of methods of early detection and targeted therapies. For the diagnosis of GCLM, each imaging modality has its relative benefits. There remains no consensus regarding therapeutic options.

CONCLUSIONSEarly detection and characterization of liver metastases is crucial for the prognosis of gastric cancer patients. Multidisciplinary team discussions are required to design optimal treatment strategies, which should be based on the clinicopathological characteristics of each patient.

Humans ; Liver Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Stomach Neoplasms ; complications ; diagnosis ; drug therapy ; surgery

Regional lymph node recurrence is no longer the prominent concern regarding the prognosis of gastric cancer patients since the establishment of the standard D2 dissection procedure. Peritoneal metastasis has become the most prominent clinical problem. The treatment strategy for peritoneal metastasis includes intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy and intraperitoneal chemotherapy with drug delivery systems. Intraperitoneal chemotherapy has pharmacokinetic advantage when used in combination with drug delivery systems. Intraperitoneal chemotherapy with drug delivery systems is an effective treatment and prevention method.
Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; therapeutic use ; Delayed-Action Preparations ; Humans ; Peritoneal Neoplasms ; drug therapy ; secondary ; Stomach Neoplasms ; drug therapy ; pathology

OBJECTIVETo evaluate the short-term therapeutic effects and side effects of combined hydroxycamptothecine and oxaliplatin in the treatment of advanced digestive tract cancers.

METHODSThirty patients suffering from advanced digestive tract tumors including gastric cancer 8, colorectal cancer 20, cholecystic cancer 1 and malignant fibroadenoma 1 were studied. They were treated with hydroxycamptothecine plus oxaliplatin for 2 cycles with interval of 21 days.

RESULTSThe complete response, partial response, stable disease and progressive disease rates were 3.3% (1/30), 36.7% (11/30), 53.3% (15/30) and 6.7% (3/30) respectively with an overall response rate (CR + PR) of 40.0% (12/30). In the whole 77 cycles, leukocytopenia was observed in 34 cycles (44.2%) and 19 cycles (55.9%) at grades III and IV. Diarrhea developed in 42 cycles (54.5%) and 20 cycles (47.6%) grades III and IV. The other side effects were fever, alopecia, nausea and vomiting, constipation, hepatic and renal function abnormity and neuritis.

CONCLUSIONSatisfactory response rate is obtainable in advanced colorectal cancer as treated by hydroxycamptothecine plus oxaliplatin. The toxicity consists of severe leukocytopenia and diarrhea.

Adenocarcinoma ; drug therapy ; secondary ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Camptothecin ; administration & dosage ; analogs & derivatives ; Colorectal Neoplasms ; drug therapy ; pathology ; Diarrhea ; chemically induced ; Female ; Humans ; Leukopenia ; chemically induced ; Liver Neoplasms ; drug therapy ; secondary ; Lung Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Neoplasm Staging ; Organoplatinum Compounds ; administration & dosage ; Remission Induction ; Stomach Neoplasms ; drug therapy ; pathology ; Treatment Outcome

BACKGROUND AND OBJECTIVEThere is a mounting evidence of the role of HER2 overexpression inpatients with gastric cancer, and it has been solidly correlated with poor outcomes and more aggressive diseases. This study was to investigate the relationship between the expression of HER2/neu and the clinical characteristics of advanced gastric carcinomas, including survival.

METHODSThe clinical data of 83 patients admitted in Cancer Hospital, Chinese Academy of Science, from 2006 to 2008 were reviewed. The HER2/neu status in 83 advanced gastric carcinomas was evaluated using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The survival rate was calculated by Kaplan-Meier method and the log-rank test using SPSS13.0 software.

RESULTSThe median age of the patients was 60 years and the male-to-female ratio was 2.95:1. HER2/neu overexpression (2+ and 3+) and amplification were found in 25 (30.1%) and 29 (34.9%) advanced gastric carcinomas, respectively. HER2/neu amplification/overexpression was associated with worse survival in patients with advanced gastric carcinoma. The median survival of the patients without HER2/neu amplification was 12.6 months and that of those with HER2 amplification was 5.5 months.

CONCLUSIONSHER2/neu status may be a clinical predictor of prognosis in advanced gastric cancer patients.

Adenocarcinoma ; drug therapy ; genetics ; metabolism ; pathology ; secondary ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Signet Ring Cell ; drug therapy ; genetics ; metabolism ; pathology ; secondary ; Female ; Gene Amplification ; Gene Expression Regulation, Neoplastic ; Genes, erbB-2 ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Receptor, ErbB-2 ; metabolism ; Stomach Neoplasms ; drug therapy ; genetics ; metabolism ; pathology ; Survival Rate

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.
Adenocarcinoma/*complications/secondary/surgery ; Anemia, Aplastic/*complications/drug therapy ; Case Report ; Human ; Male ; Middle Age ; Oxymetholone/therapeutic use ; Stomach Neoplasms/*complications/surgery

Gastric cancer remains one of the most common malignancies and leading causes of cancer death in China with a complex biological behavior. The incidence of liver metastasis from gastric cancer is particularly high. The indication of hepatectomy is controversial, however, surgery should be considered. How to choose the right regimen to obtain macroscopically complete resections represents a controversial subject. Newer generation cytotoxic agents such as docetaxel, S-1 and irinotecan as well as targeted therapy agent trastuzumab exhibit promising activity in gastric cancer. Further study and clinical trials are needed to confirm the benefits of systemic treatment in gastric cancer patients with liver metastasis.
Antibodies, Monoclonal, Humanized ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Camptothecin ; analogs & derivatives ; Hepatectomy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Molecular Targeted Therapy ; Stomach Neoplasms ; drug therapy ; pathology ; Taxoids ; Trastuzumab

OBJECTIVETo investigate the safety and efficacy of postoperative intraperitoneal hyperthermic perfusion chemotherapy(IHPEC) following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis.

METHODSBetween March 2010 and October 2013, 37 patients with advanced gastric cancer were treated by IHPEC(cisplatin 100 mg, 5-fluorouracil 1000 mg and saline 2000 mL) following laparoscopic palliative resection in our department between March 2010 and October 2013 were analyzed retrospectively. Short-term efficacy and adverse reactions were observed.

RESULTSComplete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) were found in 18, 4, 8 and 7 cases respectively, and the total progression-free rate was 59.5%(22/37). The significant improved, improved, stable and progressive cases of Karnofsky performance status were 6, 13, 10 and 8 respectively, and the rate of improved and stable cases was 78.4% (29/37). Serious adverse reactions (class III ( or IIII) were noted in 3 cases (8.1%), including 2 cases of abdominal pain (class III), 1 case of nausea and vomiting.

CONCLUSIONSThe modality of IHPEC adopting cisplatin plus 5-fluorouracil regimen following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis is technically feasible and safe, which has certain effect on postponing the progression of gastric cancer.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; Fluorouracil ; Humans ; Laparoscopy ; Palliative Care ; Peritoneal Neoplasms ; drug therapy ; secondary ; surgery ; Remission Induction ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery

OBJECTIVETo investigate the clinical effect of intraoperative peritoneal hyperthermic chemotherapy (IPHC) for advanced gastric cancer (AGC).

METHODSA total of 118 AGC patients with serosal invasion were enrolled in this study from 1998 to 2001. Among these cases, 96 patients without macroscopic peritoneal metastases were selected for prophylactic study, including 42 cases with IPHC and 54 cases without IPHC as control. Other 22 patients with macroscopic peritoneal metastases were selected for therapeutic study, including 10 cases with IPHC and 12 without IPHC. Postoperative survival rate and peritoneal recurrence were compared.

RESULTSFor prophylactic study, the 1, 2 and 4 years survival rates were 85.7%, 81.0% and 63.9% respectively in the patients with IPHC,significantly higher than 77.3%, 61.0% and 50.8% in the patients without IPHC. Cox ratio hazard model revealed that IPHC procedure was an independent prognostic factor. More patients in the control group suffered from peritoneal recurrence than those in IPHC group (34.7% vs 10.3%). For therapeutic study,the median survival period of the patients with IPHC was 10 months, higher than 5 months in the patients without IPHC. The overall 1, 2, 4 year survival rates were 76.9%, 69.2%, 55.2% respectively in all cases with IPHC, higher than 66.2%, 49.7%, 41.4% in the cases without IPHC.

CONCLUSIONIPHC procedure can improve the prognosis of AGC patients with serosal invasion, reduce the risk for peritoneal recurrence, and is an independent prognostic factor.

Adult ; Aged ; Chemotherapy, Cancer, Regional Perfusion ; methods ; Female ; Follow-Up Studies ; Humans ; Hyperthermia, Induced ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Peritoneal Neoplasms ; drug therapy ; secondary ; Prognosis ; Stomach Neoplasms ; drug therapy ; mortality ; pathology ; Survival Rate ; Treatment Outcome

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
Stomach Neoplasms/complications/*pathology/surgery ; Prodrugs ; Organoplatinum Compounds/*therapeutic use ; Middle Aged ; Male ; Liver Neoplasms/complications/*drug therapy/secondary ; Liver Function Tests ; Liver Failure/diagnosis/drug therapy/*etiology ; Humans ; Gastrectomy ; Follow-Up Studies ; Fluorouracil/*analogs & derivatives/therapeutic use ; Drug Therapy, Combination ; Deoxycytidine/*analogs & derivatives/therapeutic use ; Antineoplastic Agents/*therapeutic use ; Adenocarcinoma/complications/secondary/*therapy

OBJECTIVETo observe and compare the response rate and toxicity of irinotecan or oxaliplatin combined with capecitabine in the treatment of advanced gastric cancer.

METHODSSixty-three patients with advanced gastric cancer were randomly divided into two groups. The CPT-11 + CAP group consisted of 32 patients who received irinotecan plus capecitabine: CPT-11 100 mg/m(2) was injected in 90 minutes on d 1, 8;capecitabine 2000 mg/m(2), bid, with the first dose in the evening of day 1 and last dose the morning of day 15, repeated for every 21 days. The L-OHP + CAP group consisted of 31 patients who received oxaliplatin plus capecitabine: oxaliplatin 100 mg/m(2) on day 1, capecitabine 2000 mg/m(2), bid, with the first dose in the evening of day 1 and last dose the morning of day 15, repeated for every 21 days. Two or more cycle chemotherapy was completed in each group.

RESULTSIn the CPT-11 + CAP group, no patient achieved complete response and 13 patients achieved partia1 response. The overall response rate was 40.6% (13/32), and the median progression-free survival time was 6.3 months. In the L-OHP + CAP group, no patient achieved complete response and 12 patients achieved partial response. The overall response rate was 38.7% (12/31), and the median progression-free survival time was 6.1 months. There was no significant difference between them (P > 0.05). The most common toxicities were gastrointestinal reaction, peripheral neuropathy and myelosuppression in the two groups. Patients in CPT-11 + CAP group experienced more III/IV diarrhea (28.1%/3.2%, P = 0.018). On the contrary, the rate of III/IV neurotoxicity in the group B was higher (25.8%/3.1%, P = 0.027). No chemotherapy-related death occurred.

CONCLUSIONThe therapeutic effects of irinotecan or oxaliplatin combined with capecitabine in the treatment of advanced gastric cancer are good and comparable, and their toxicities are tolerable.

Adenocarcinoma ; drug therapy ; pathology ; secondary ; Adult ; Aged ; Agranulocytosis ; chemically induced ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Camptothecin ; administration & dosage ; adverse effects ; analogs & derivatives ; Capecitabine ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Diarrhea ; chemically induced ; Disease-Free Survival ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; analogs & derivatives ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neuritis ; chemically induced ; Organoplatinum Compounds ; administration & dosage ; adverse effects ; Ovarian Neoplasms ; drug therapy ; secondary ; Remission Induction ; Stomach Neoplasms ; drug therapy ; pathology ; Young Adult