Springer 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 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typesetting: Best-set Typesetter Ltd., Hong Kong SPIN: 10727230 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