Stage 3 stomach cancer
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Stage 3 Stomach Cancer: Treatment and Survival Insights
Neoadjuvant Chemotherapy for Stage 3 Stomach Cancer
Efficacy of S-1 Plus Cisplatin and Paclitaxel Plus Cisplatin
Neoadjuvant chemotherapy, which is administered before surgical intervention, has shown promise in treating stage 3 stomach cancer. A study compared two regimens: S-1 plus cisplatin (SC) and paclitaxel plus cisplatin (PC). The results indicated that both regimens had similar 3-year overall survival (OS) rates, with SC at 60.9% and PC at 64.3%. The study concluded that two courses of SC are recommended for future phase III trials due to their effectiveness and manageable duration.
Neoadjuvant Chemotherapy Versus Surgery Alone
Another study evaluated the impact of neoadjuvant chemotherapy compared to surgery alone. The findings revealed that neoadjuvant chemotherapy significantly increased the R0 resection rate (complete removal of the tumor) from 66.7% to 81.9%. However, despite this improvement, no significant survival benefit was observed, suggesting that while neoadjuvant chemotherapy can enhance surgical outcomes, it may not necessarily extend overall survival.
Adjuvant Chemotherapy and Chemoradiotherapy
Comparison of Adjuvant Regimens
The ARTIST 2 trial compared three adjuvant regimens: S-1 monotherapy, S-1 plus oxaliplatin (SOX), and SOX plus chemoradiotherapy (SOXRT). The study found that both SOX and SOXRT significantly improved disease-free survival (DFS) compared to S-1 alone, with 3-year DFS rates of 74.3% and 72.8%, respectively, versus 64.8% for S-1. However, adding radiotherapy to SOX did not significantly reduce recurrence rates, indicating that SOX alone is a highly effective adjuvant treatment.
Impact of Adjuvant Chemotherapy on Survival
Adjuvant chemotherapy has been shown to improve survival outcomes in stage 3 gastric cancer patients. A study involving 534 patients demonstrated that those who received adjuvant chemotherapy had better overall survival (OS) and disease-free survival (DFS) compared to those who did not. This underscores the importance of adjuvant chemotherapy in enhancing long-term survival following D2 gastrectomy.
Surgical Considerations
Importance of Lymph Node Removal
The number of lymph nodes removed during surgery significantly impacts survival in stage 3 gastric cancer patients. A study found that patients who had more than 15 lymph nodes removed had a median survival of 33.8 months, compared to 14.4 months for those with 15 or fewer lymph nodes removed. This suggests that extended lymphadenectomy, which involves the removal of a larger number of lymph nodes, should be considered to improve survival outcomes.
Challenges in Diagnosis and Treatment
Late Diagnosis in East African Countries
A review of stomach cancer cases in East African countries revealed that most diagnoses occur at advanced stages (stage III and IV), negatively affecting clinical outcomes and overall survival rates. This highlights the need for improved diagnostic facilities and early detection strategies to enhance survival rates in these regions.
Conclusion
Stage 3 stomach cancer presents significant treatment challenges, but advancements in neoadjuvant and adjuvant chemotherapy, as well as surgical techniques, offer hope for improved survival outcomes. Neoadjuvant chemotherapy can enhance surgical success, while adjuvant chemotherapy, particularly SOX, significantly prolongs disease-free survival. Additionally, extended lymphadenectomy during surgery is crucial for better survival rates. Early diagnosis remains a critical factor, especially in regions with limited healthcare resources. Continued research and clinical trials are essential to refine these treatment strategies and improve patient outcomes.
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