Photodynamic therapy and topical aminolevulinic acid: an overview.

AIM: Gastric Cancer (GC) is a poor prognosis neoplasm and it is often diagnosed at advanced stage. Neoadjuvant Chemotherapy (NAC) may increase the possibility of complete surgical resection and improve Overall Survival (OS).

PATIENTS AND

METHODS

Since November 2006, six patients with gastric adenocarcinoma, diagnosed by endoscopy, endoscopic ultrasonography and total body 18FDG-PET-CT, were enrolled in a program of peri-operative chemotherapy, according to the following inclusion criteria: cT2N+M0 or cT3-4NxM0, age < 75 years, Karnofsky Performance Status > 60%, absence of hepatic, renal and bone marrow failures. The patients undergo three cycles of pre-operative and post-operative chemotherapy based on Epirubicine, Cisplatin, and 5-Fluorouracil (ECF) as MAGIC Trial proposed. Fifteen days after the end of pre-operative chemotherapy the patient undergoes endoscopic ultrasonography and total body 18FDG-PET-CT to evaluate the tumor response to treatment, and then he is addressed to surgery. Thirty days after surgery he starts the post-operative chemotherapy.

RESULTS

All patients completed the pre-operative chemotherapy. Five patients underwent D2 subtotal gastrectomy and only one patient D1 total gastrectomy. No peri- and post-operative mortality and morbidity were observed. One month after surgery all patients started chemotherapy. During post-operative chemotherapy two patients developed subclavian vein thrombosis, one patient developed renal failure.

CONCLUSIONS

Although surgical resection remains the key component in the treatment of GC, it is clear that improved outcome will depend on a multidisciplinary treatment. NAC is associated with appreciable toxicity and it may improve the OS, allowing the downstaging of the primary tumor and increasing its resecability, as shown by MAGIC trial.