Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Apr;19(2):329-338.
doi: 10.1007/s10120-015-0575-z. Epub 2015 Dec 7.

Is Conversion Therapy Possible in Stage IV Gastric Cancer: The Proposal of New Biological Categories of Classification

Affiliations
Free PMC article
Review

Is Conversion Therapy Possible in Stage IV Gastric Cancer: The Proposal of New Biological Categories of Classification

Kazuhiro Yoshida et al. Gastric Cancer. .
Free PMC article

Abstract

Conversion therapy for gastric cancer (GC) has been the subject of much recent attention. It is defined as a surgical treatment aiming at an R0 resection after chemotherapy for tumors that were originally unresectable or marginally resectable for technical and/or oncological reasons. However, the indications for resection remain to be clarified. In the present review, we focus on the biology and heterogeneous characteristics of stage IV GC and propose new categories of classification. Stage IV GC patients can be divided based on the absence (categories 1 and 2) or presence (categories 3 and 4) of macroscopically detectable peritoneal dissemination, which has a different biological outcome compared to hematological metastasis. Category 1 is defined oncologically as stage IV but the metastasis is technically resectable. Category 2 includes a marginally resectable metastasis or patients for whom the operation would not necessarily be the best choice. Category 3 includes a potentially unresectable metastasis of peritoneal dissemination that is only macroscopically detectable. Category 4 includes noncurable metastasis with peritoneal and other organ metastasis. The indications for conversion therapy might include the patients from category 2, some patients from category 3 and a very small number of patients from category 4. The longer survival can be expected for patients corresponding to categories 1, 2 and, to a lesser extent, 3, while the treatment of other patients focuses on "care." The provision of conversion therapy for stage IV GC patients might be one of the main roles of surgical oncologists in the near future.

Keywords: Adjuvant surgery; Chemotherapy; Conversion therapy; Gastric cancer; Stage IV gastric cancer.

Figures

Fig. 1
Fig. 1
The history of metastatic GC clinical trials in Japan
Fig. 2
Fig. 2
The new biological categories for the classification of stage IV GC

Similar articles

See all similar articles

Cited by 56 articles

See all "Cited by" articles

References

    1. GLOBOCAN 2012 database GLOBOCAN database. http://www-dep.jarc.fr/globocan/globocan.html.
    1. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011;14:97–100. doi: 10.1007/s10120-011-0040-6. - DOI - PubMed
    1. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;3:215–221. doi: 10.1016/S1470-2045(08)70035-4. - DOI - PubMed
    1. Yoshida K, Ninomiya M, Takakura N, Hirabayashi N, Takiyama W, Sato Y, et al. Phase II study of docetaxel and S-1 combination therapy for advanced or recurrent gastric cancer. Clin Cancer Res. 2006;12:3402–3407. doi: 10.1158/1078-0432.CCR-05-2425. - DOI - PubMed
    1. Koizumi W, Kim YH, Fujii M, Kim HK, Imamura H, Lee KH, et al. Addition of docetaxel to S-1 without platinum prolongs survival of patients with advanced gastric cancer: a randomized study (START) J Cancer Res Clin Oncol. 2014;140:319–328. doi: 10.1007/s00432-013-1563-5. - DOI - PMC - PubMed

Publication types

Feedback