|Year : 2019 | Volume
| Issue : 1 | Page : 81-82
MCQs for “Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms”
HS Darling1, Senguttuvan Jayalakshmi2, Pradeep Jaiswal3
1 Department of Medical Oncology and Hemato-oncology, Artemis Hospital, Gurugram, Haryana, India
2 Department of Radiation Oncology, Artemis Hospital, Gurugram, Haryana, India
3 Department of Surgical Oncology, Command Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||4-Apr-2019|
H S Darling
Department of Medical Oncology and Hemato-oncology, Artemis Hospital, Gurugram, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Darling H S, Jayalakshmi S, Jaiswal P. MCQs for “Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms”. Indian J Cancer 2019;56:81-2
|How to cite this URL:|
Darling H S, Jayalakshmi S, Jaiswal P. MCQs for “Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms”. Indian J Cancer [serial online] 2019 [cited 2020 Apr 2];56:81-2. Available from: http://www.indianjcancer.com/text.asp?2019/56/1/81/255473
- The advantages of neoadjuvant chemotherapy (NaCT) in nonmetastatic gastric cancer include all except
- Tumor downstaging
- Surgery can be avoided in some cases
- Preoperative chemotherapy (CT) is better tolerated than postoperative CT
- Eradication of tumor micrometastases
- As per current available evidence, adjuvant chemoradiotherapy (CRT) is most appropriate in
- Patients with residual disease at surgery after NaCT
- Patients who have not received NaCT
- Patients with node positive disease at surgery
- Patients with D1 resection
- The conclusions from phase 3 study comparing NaCT followed by surgery followed by randomization to CT vs CRT are following except
- NaCT does not improve survival
- There is no progression-free survival (PFS) benefit of adding radiotherapy (RT)
- Completion of postoperative treatment was a challenge
- OS (overall survival) was numerically more in the CT arm
- Laurens intestinal type of gastric adenocarcinoma with a more common distal location of tumors is common in
- African Americans
- Pacific islanders
- The Japanese classification of gastric carcinoma as D1, D2, and D3 is based on
- Stage of gastric cancer
- Type of anastamosis after surgical resection
- Extent of nodal dissection in surgery resection
- Extent of mucosal serosal involvement
- The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) and SWOG---intergroup trials---two randomised controlled trials were practice changing in demonstrating a survival advantage in gastric cancer with
- Radical surgery alone
- Addition of radiotherapy
- Intraoperative radiotherapy
- Perioperative chemotherapy/adjuvant chemoradiotherapy
- The contentious issue of validity of pathological staging and biological response of the tumor to preoperative chemotherapy is being evaluated by which of the following ongoing trails
- MAGIC and SWOG trails
- ARTIST II and TOPGEAR trials
- To Ga and AVAGAST trials
- CLASSIC and CRITICS trials
- Incidence of lymph nodal metastasis in early gastric cancers limited to mucosa is
- D1+ nodal dissection as described in Chemoradiotherapy after Induction Chemotherapy in Cancer of the Stomach (CRITICS) trial involves
- Dissection of lymph node stations 1–12
- Dissection of lymph node station 1–10
- Dissection of lymph node stations 1–9 and 11
- Dissection of lymph node station 1–8
- The drug regimen used in landmark MAGIC trial was
- Epirubicin, Cisplatin, and 5FU (ECF infusional)
- Capecitabine, Oxaliplatin
- Epirubicin, Cisplatin, and 5FU (ECF bolus)
- Cisplatin, capecitabine.
| » Answers|| |
- b. Surgery can be avoided in some cases
Neoadjuvant or adjuvant treatments cannot be a substitute for meticulous surgery in nonmetastatic adenocarcinoma of stomach. Surgery is the mainstay of treatment in all nonmetastatic cases.
- c. Patients with node positive disease at surgery
In the ARTIST trial, 3-year disease-free survival was similar in both groups, except for the node positive subgroup, which showed a definite advantage, with chemoradiation.
- a. NaCT does not improve survival
CRITICS trial compares the CT vs CRT cohorts in nonmetastatic gastric cancer cases following NaCT. The median OS was 3.5 years in the chemotherapy arm and 3.3 years in the chemoradiotherapy arm, and the median PFS 2.3 and 2.5 years. Only 50% of the patients accrued had completed the planned course of treatment. OS was 43 months in the chemotherapy arm and 37 months in the chemoradiotherapy arm. NaCT was same in both the cohorts.
- c. Asians
Lauren's criteria classify gastric cancer into two major histological subtypes, namely intestinal type and diffuse type adenocarcinoma. They exhibit a number of distinct clinical and molecular characteristics, including histogenesis, cell differentiation, epidemiology, etiology, carcinogenesis, biological behaviors, and prognosis Laurens intestinal type of tumors is common in Asian population, and tumors tend to be located more distally among them.
- c. Extent of nodal dissection in surgical resection
The terms D1/D2/D3 nodal dissections were originally coined by the Japanese classification of gastric carcinoma. D1, D2, D3 dissection denotes removal of the N1, N2, N3 nodes, respectively.
- d. Perioperative chemotherapy/chemoradiotherapy
The MAGIC trial concluded that perioperative chemotherapy using epirubicin, cisplatin, and 5FU (ECF) regimen significantly improved OS and PFS over those who had only surgery. SWOG (Intergroup) trial documented improved OS and relapse-free survival after surgery with adjuvant locoregional radiotherapy with concurrent chemotherapy.
- b. ARTIST II and TOPGEAR trials
Preoperative chemotherapy can downstage the tumor and response to NaCT depends upon the disease biology. However, therapeutic decisions based on pathological staging after NaCT may be misleading. The results of ongoing trials such as the ARTIST II, TOPGEAR might throw a better light on these issues.
- b. 10%
T1 tumors limited to the mucosa have shown 10% incidence of lymph nodal involvement, whereas T1 tumors with submucosal extension show 20% incidence. T2 tumors, where muscle invasion is seen, have 50% incidence, and T3 tumors, which specifies serosal invasion, have 70% nodal involvement.
- c. Dissection of lymph node stations 1–9 and 11
The concept of a D1+ surgery was opted in the CRT after Induction CT in Cancer of the Stomach (CRITICS) study, where resection of level 1 to 9 and 11, without splenectomy and pancreatectomy was considered. This procedure was well tolerated with more than 87% undergoing a D1+ dissection and a median lymph nodal harvest of 20.
- a. Epirubicin, Cisplatin, and 5FU (ECF infusional)
MAGIC came out with the conclusion that perioperative chemotherapy using epirubicin, cisplatin, and 5FU (ECF) regimen significantly improved OS and PFS over those who had only surgery. The name itself gives a clue to the answer.