Stomach Cancer
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Gastric cancer (cancer of the stomach) is a disease in which malignant cells arise in the tissues of the stomach. Early symptoms can include indigestion, feeling bloated after eating, mild nausea, loss of appetite, or heartburn. In more advanced stages symptoms may include blood in the stool, vomiting, weight loss, or pain in the stomach. Known risk factors include prior stomach infection by Helicobacter pylori, smoking, frequent diet of dry salted foods, Menetrier's disease, and familial polyposis. Most cancers of the stomach are adenocarcinomas of which there are many sub-types.

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Information for Patients and the Public
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Helicobacter pylori and cancer
Gastrointestinal System Cancers
Latest Research Publications

Information for Patients and the Public (16 links)

Information for Health Professionals / Researchers (16 links)

See also: CDH1 Genetic Information

Helicobacter pylori and cancer (4 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Kim HG, Ryu SY, Kim DY
Single port intra-gastric full thickness resection: Using "Rotation and Revolution Single Instrument Tie (RRSIT)".
Hepatogastroenterology. 2014; 61(134):1843-6 [PubMed] Related Publications
BACKGROUND/AIMS: Recently, minimize incisions has led to a reduction in the number of ports, and has led to transumbilical single-port surgery. We evaluated the treatment result of single-port, intragastric, full thickness resections for gastric SMTs. In addition, we introduce a novel intracorporeal knot tying method.
METHODOLOGY: From August 2010 to March 2011, five patients underwent single-port intragastric, full thickness gastric wedge resections. After performing a gastrostomy, a single port was inserted into the stomach. After full thickness resection, the defect in the gastric wall was sutured by full thickness interrupted suture and a new knot tying technique.
RESULTS: The mean operative time was 129 ± 21.0 min and the mean mass size was 3.0±0.6 cm. There were two very low-risk GISTs, 2 leiomyomas, and 1 carcinoid. The post-operative course was uneventful in all patients. The mean hospital stay was 7.2±1.2 days.
CONCLUSIONS: Single-port intra-gastric full thickness resection with novel intracorporeal knot tying method is feasible and safe. novel intracorporeal knot tying method is a very useful knot tying method. We expect the application of novel intracorporeal knot tying method to be diverse and broad.

Ju F, Lu L, Zhao QY, et al.
Systematic analysis of gene expression and molecular interactions in cardiac and non-cardiac gastric carcinomas.
Hepatogastroenterology. 2014; 61(134):1835-42 [PubMed] Related Publications
BACKGROUND/AIMS: : This study aims to comparing the gene expression profiles and molecular interactions among gastric cardiac adenocarcinomas (GCA), gastric noncardiac adenocarcinomas (GNCA) and their adjacent normal tissues.
METHODOLOGY: Gene expression profile of GSE29272 was downloaded from Gene expression omnibus. Differentially expressed genes (DEGs) were identified at the cut-off of p-value ≤ 0.01. Gene ontology (GO) enrichment analysis was further performed for the DEGs, and then the binding sites of the transcriptional factors and the specific protein-protein interactions were analyzed.
RESULTS: Total 1024 DEGs were screened, including 741 up-regulated genes and 283 down-regulated genes. VSNL1 (visinin-like protein-1) is expressed relatively higher in the GNCA and could be its molecular biomarker, as KRT14 (cytokeratin 14) in the GCA. GO analysis showed that the analogous cancer-relevant factors network appears in these two cancer subgroups. The DEGs in the GCA tend to be bound by SPIB and ZNF354C. FN1 lies in the center of the protein-protein interaction networks of the two cancer subgroups.
CONCLUSIONS: We found out the RNA expression level of the two gastric cancers varied greatly from the normal tissues while gene expression profile of them were very similar, however, the different biomarker and transcriptional factors indicate the differences of two mechanisms.

Kim JY, Ha TK, le Roux CW
Metabolic effects of gastrectomy with or without omentectomy in gastric cancer.
Hepatogastroenterology. 2014; 61(134):1830-4 [PubMed] Related Publications
BACKGROUND/AIMS: The metabolic effects of gastrectomy and the reduction of visceral adiposity through omentectomy for gastric cancer are unknown.
METHODOLOGY: We retrospectively reviewed of prospectively collected data of 67 patients over one year who underwent radical gastrectomy with either a complete or partial omentectomy for gastric cancer. The change in Body mass index (BMI), triglyceride, low density lipoprotein, high density lipoprotein, and hematological profile were evaluated.
RESULTS: In the group of 67 patients changes were observed after 1 year follow-up for BMI (23.7±3.1 versus 21.3±2.5kg/m2; p<0.001), triglyceride (155.2±136.1 versus 89.7±41.2mg/dL, p=0.011), low density lipoprotein (107.4±45.4 versus 95.8±27.5mg/dL, p=0.020), vitamin B12 (681.4±297.4 versus 558.1±338.6pg/mL, p=0.076). High density lipoprotein (41.4±12.6 versus 52.8±10.5mg/dL) increased after surgery (p<0.001). There were no changes between the complete and partial omentectomy groups for BMI, albumin, triglyceride, lipoprotein, and hemoglobin.
CONCLUSIONS: Gastrectomy with or without omentectomy induced a decrease of BMI and improvements in metabolic parameters such as triglyceride, low density lipoprotein, high density lipoprotein. Omentectomy had no significant impact on any measured parameter in this group.

Fan LQ, Li Y, Zhao Q, et al.
Comparative proteomics in gastric cancer cell line BGC823 after ZNF139 gene inhibited with RNA interference.
Hepatogastroenterology. 2014; 61(134):1822-9 [PubMed] Related Publications
BACKGROUND/AIMS: Zinc finger protein 139 (ZNF139) gene is proved play an important role in gastric cancer. Aim of this study is to identify changes of proteins after ZNF139 gene was inhibited in gastric cancer cell line BGC823.
METHODS: siRNA-specific ZNF139 was synthesized and transfected into BGC823; 2-D fluorescence difference gel electrophoresis (2-D DIGE) and liquid chromatography-mass spectrometry (LC-MS) were applied to screen, identify differentially expressed proteins, and function of these proteins was analyzed; Western blot method was applied to verify the identified proteins.
RESULTS: ZNF139 expression in siRNA transfected cancer cell BGC823 decreased significantly. Results of 2-D DIGE showed eight differential protein spots, of which seven were identified with LC-MS, including switches associated protein 70, far upstream element binding protein 1, heat shock protein 60, annexin A7, small ubiquitin-like modifier 1 activating enzyme, chaperonin-containing tail-less complex protein 1 and annexin A2. These proteins were found to be associated with proliferation, apoptosis, invasion, metastasis, adhesion of gastric cancer cells with bioinformatic analysis. Western blot analysis confirmed that expressions of these proteins in BGC823 were consistent with the proteomic results.
CONCLUSIONS: ZNF139 gene may influence the biological behavior of gastric cancer cells in many ways by regulating multiple proteins.

Chen XZ, Zhang WH, Yao WQ, et al.
Immunohistochemical HER2 expression not associated with clinicopathological characteristics of stage I-III gastric cancer patients.
Hepatogastroenterology. 2014; 61(134):1817-21 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to investigate the association of human epidermal growth factor receptor 2 (HER2) expression with clinicopathological characteristics of resectable gastric cancer patients.
METHODOLOGY: A total of 394 stage I-III surgical gastric cancer patients who were detected of immunohistochemical (IHC) HER2 expression postoperatively were included in this retrospective study. Association of IHC HER2 over-expression (3+) rate with clinicopathological characteristics was tested by univariate and multivariate analyses.
RESULTS: IHC HER2 over-expression rate was 5.1% (95% CI 3.1%-7.7%). By univariate analyses, none of the clinicopathological characteristics was associated with the IHC HER2 over-expression compared to negative expression (0/1+) (p>0.05), with the exception of a higher rate (12.2%) of IHC HER2 (3+) in moderate differentiation subset (p=0.02). However, the multivariate analyses didn’t selected any characteristic as an independent risk factor of IHC HER2 over-expression or the combination of IHC HER2 (2/3+).
CONCLUSIONS: IHC HER2 over-expression rate is relatively low among stage I-III gastric cancer patients, and might be generally not associated with clinicopathological characteristics.

Wang F, Zu HL, Jiang H, et al.
Clinical investigation of combined Billroth II with Braun anastomosis for patients with gastric cancer.
Hepatogastroenterology. 2014; 61(134):1812-6 [PubMed] Related Publications
BACKGROUND/AIMS: This study gives insight into the effect of combined Billroth II with Braun anastomosis for patients with gastric cancer.
METHODOLOGY: The clinical data of 720 patients with gastric cancer who underwent surgical treatment in our hospital from 1997 to 2011 were reviewed retrospectively. The results of different operative approaches were analyzed.
RESULTS: Combined Billroth II with Braun anastomosis was performed in 378 cases, and Billroth II in 342 cases. The Gastrointestinal Quality of Life Index (GIQLI) was used to evaluate postoperative quality of life.
CONCLUSIONS: If the indications for combined Billroth II with Braun anastomosis are strictly controlled, and more attention is paid to perioperatively support, combined Billroth II with Braun anastomosis can prolong the life span of the patients with gastric cancer rather than increase the surgical complications and the mortality.

Bi YM, Chen XZ, Jing CK, et al.
Safety and survival benefit of surgical management for elderly gastric cancer patients.
Hepatogastroenterology. 2014; 61(134):1801-5 [PubMed] Related Publications
OBJECTIVE: To study the safety and survival outcome of surgical management for elderly gastric cancer patients. Methods: Patients proven of gastric cancer who aged ≥80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients’ characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness.
RESULTS: Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p=0.797). Clinical-pathological T stage and node status were comparable. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and nonsurgery, respectively (p=0.006). Incidence of postoperative complications and hospital mortality were 25.0% and 2.1%, respectively. The 2-year survival rates of M0 subgroups were 35.7% and 0% for surgery and nonesurgery, respectively (HR=3.98, p=0.022).
CONCLUSIONS: The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

Paik HJ, Choi CI, Kim DH, et al.
Risk factors for delayed gastric emptying caused by anastomosis edema after subtotal gastrectomy for gastric cancer.
Hepatogastroenterology. 2014; 61(134):1794-800 [PubMed] Related Publications
BACKGROUND/AIMS: Delayed gastric emptying (DGE) is one of the most troublesome complications after subtotal gastrectomy for gastric cancer. We evaluated operative and perioperative variables to assess for independent risk factors of DGE caused by anastomosis edema.
METHODOLOGY: The study retrospectively reviewed clinical data of 382 consecutive patients who underwent subtotal gastrectomy for gastric cancer between 2009 and 2011 at a single institution.
RESULTS: Delayed gastric emptying had occurred in twelve patients (3.1%). Univariate analysis revealed high body mass index (>25kg/m2), open gastrectomy, and Billroth II or Roux-en Y reconstructions to be significant factors for delayed gastric emptying. Multivariate analysis identified high body mass index and open gastrectomy as predictors of delayed gastric emptying.
CONCLUSIONS: To avoid delayed gastric emptying, surgeons should take care in creating the gastrointestinal anastomosis, particularly in patients with high BMI or in cases of open gastrectomy.

Fujiwara Y, Tsujie M, Hara J, et al.
Comparison of gastric cancer surgery between patients aged >80 years and <79 years: complications and multivariate analysis of prognostic factors.
Hepatogastroenterology. 2014; 61(134):1785-93 [PubMed] Related Publications
BACKGROUND/AIMS: To evaluate the clinicopathological features and results of surgery for gastric cancer in elderly patients aged ˃80 years relative to those aged ˂79 years, and to recommend the appropriate surgical treatment for elderly patients.
METHODOLOGY: A total of 332 patients with gastric cancer who underwent gastrectomy in our department between 2002 and 2012 were evaluated. Of these, 81 were aged ˃80 years (Group A) and 251 were aged ˂79 years (Group B). We compared surgical outcomes and survival in these two groups. RESULTS; Postopeartive complications were associated with preoperative cormorbid disease(p<0.01). D2 and R0 resection was common in GroupB (p<0.01). Respiratory complications and hospital deaths were higher in Group A than in Group B. Overall survival (OS) was significantly lower in Group A than in Group B. Regarding Stage I disease, OS was significantly lower in Group A; however, cause-specific survival was similar between the two groups. Multivariate analysis showed that radicality and postoperative complications were independent prognostic factors for OS in elderly gastric cancer patients.
CONCLUSIONS: These results indicate that postoperative respiratory complications and other causes of death worsened the prognosis of elderly. Preoperative accurate judgment of co-morbid disease, meticulous postoperative management and follow up might be improved survival of gastric cancer in elderly.

Hu H, Li C, Cai S, et al.
Increased expression of pleiotrophin is a prognostic marker for patients with gastric cancer.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1478-82 [PubMed] Related Publications
UNLABELLED: BACKGROUND/AIMs: Pleiotrophin (PTN) have been demonstrated to play an important role in the development of human gastric cancer. However, the prognostic value remains unclear. The aim of this study was to investigate whether expression of PTN has prognostic relevance in human gastric cancer.
METHODOLOGY: Immunohistochemistry was used to investigate the expression of PTN proteins in 178 patients with gastric cancer. The level of PTN mRNA in gastric cancer tissues and paratumor tissues were evaluated in 52 paired cases by quantitative real-time polymerase chainreaction(qRT-PCR). Survival analysis by the Kaplan-Meier method was performed to assess prognostic significance.
RESULTS: The expression level of PTN in gastric cancer tissues was significantly higher (P<0.001) than those in paratumor tissues according to the immunohistochemistry analysis, which was confirmed by qRT-PCR analysis. Additionally, the overexpression of PTN was significantly associated with the tumor site (P=0.001), Lauren’s classification (P<0.001),histologic differentiation(P=0.014),depth of invasion(P<0.001), TNM stage (P=0.003),and lymph node metastasis (P=0.002). Moreover, the Cox proportional- hazards regression analysis revealed that the increased expression of PTN was an independent prognostic factor for poor recurrence-free survival(RFS) and overall survival(OS)(both P<0.001).
CONCLUSIONS: These findings indicated that the expression of PTN is significantly correlated with prognosis in gastric cancer patients, suggesting that the expression of PTN may be used as an independent prognostic marker.

Related: Cytokines

Deng X, Jin X, Xue S, et al.
Postoperative chemoradiotherapy for advanced gastric cancer after D2 gastrectomy.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1472-7 [PubMed] Related Publications
BACKGROUND/AIMS: The purpose of this study is to investigate the role of postoperative chemoradiotherapy with paclitaxel and cisplatin in the multimodality treatment of locally advanced gastric cancer after D2 gastrectomy.
METHODOLOGY: Sixty-five patients underwent D2 gastrectomy with stage IB-IV (M0) gastric cancers were enrolled. A postoperative radiotherapy dose of 46 Gy in 23 fractions with concurrent chemotherapy of paclitaxel and cisplatin were delivered to the patients. Chemotherapy was administrated with paclitaxel 135mg/ m2 at day 1 and 21, cisplantin 20mg/ m2 at day 1-3 and day 29-31 during the radiotherapy course. Sixty-three out off 65 eligible patients were irradiated to a total dose of 46Gy and completed two cycles of full-dose chemotherapy. Thirty-three patients died at the time of analysis.
RESULTS: The median follow-up was 68.0 months (range 1.9-119.1). The 3-year overall survival (OS) and disease-free survival (DFS) were 78.5% and 73.2%, respectively. The 5-year OS and DFS were 57.4% and 54.8%, respectively. Toxicity was tolerant. The main toxicities were gastrointestinal disorder, hematologic toxicity and hair loss.
CONCLUSION: This novel postoperative chemoradiotherapy regimen for patients with gastric cancer after D2 gastrectomy had a tolerable toxicity, however, it did not decrease the local recurrence rate.

Related: Cisplatin Paclitaxel

Ahn JY, Nam SH, Jung HY, et al.
Endoscopic surveillance can increase the chance of resectability and endoscopic treatment in gastric cancer.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1465-71 [PubMed] Related Publications
BACKGROUND/AIMS: Little is known about the effects of periodic endoscopic screening before detection of primary gastric cancer. We compared clinical outcomes in patients who did and did not undergo endoscopy before diagnosis.
METHODS: Between January 2009 and November 2011, 769 patients were referred to Asan Medical Center after diagnosis of gastric cancer. Clinical outcomes were compared in patients who had (n=512) and had not (n=257) undergone endoscopic screening before diagnosis of gastric cancer. Factors about resectability and possibility of endoscopic resection were analyzed.
RESULTS: In the nonexamined group, 225 patients (87.5%) had resectable gastric cancers and were treated surgically (n=151, 67.1%) or by endoscopic resection (n=74, 32.9%). In the examined group, 493 (96.3%) had resectability and were resected surgically (n=243, 49.3%) or endoscopically (n=250, 50.7%). Multivariate analysis showed that symptoms, no endoscopic screening, and lower serum albumin were associated with unresectability. Of the 718 resectable tumors, 394 underwent surgery and 324 underwent endoscopic resection. Multivariate analysis showed that older age, no symptoms, ≤1 year interval endoscopy, and higher serum albumin were associated with endoscopic resection.
CONCLUSIONS: Previous endoscopy can increase gastric cancer resectability. Moreover, a ≤1 year interval from endoscopic examination can increase the possibility of endoscopic resection.

Liu J, Wang L, Yang A, et al.
Up-regulation of SALL4 associated with poor prognosis in gastric cancer. .
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1459-64 [PubMed] Related Publications
BACKGROUND/AIMS: SALL4 [encoding the Sal-Like 4 (Drosophila) protein, also known as spalt-like transcription factor 4] plays crucial roles in the development of different cancers, as well as vital embryogenic roles. However, knowledge of its relationship to gastric cancer is limited, and its association with prognosis in gastric cancer has not yet been reported.
METHODOLOGY: comprehensive bioinformatics analyses including mRNA expression, gene occurrence, protein/gene interaction, pathway enrichment and biological processes annotation were performed.
RESULTS: we indicated that the expression of SALL4 was up-regulated at least 2.2-fold in 103 cases of gastric cancers, compared with its expression in 65 normal controls. Further analysis indicated that SALL4 was co-occurred and interacted with 23 proteins/genes which all were associated with a poor gastric cancer prognosis. It also associated with 14 biological processes and Wnt signaling pathway, which have been proven to be closely related to gastric cancer and its prognosis.
CONCLUSIONS: for the first time, we have shown that the up-regulation of SALL4 in gastric cancers should serve as a worthwhile biological marker of poor prognosis in gastric cancer therapies, via the strong interactions with a number of proteins, genes, biological processes and pathways which all were associated with poor prognosis in gastric and other cancer.

Kim KH, Kim MC, Jung GJ
Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1446-53 [PubMed] Related Publications
BACKGROUND/AIMS: The goal of this study was to elucidate the risk factors for duodenal stump leakage after gastrectomy for gastric cancer. In addition, the management of duodenal stump leakage is reviewed.
METHODOLOGY: From January 2002 through December 2012, 1,195 patients with gastric cancer who underwent gastric R0 resection were enrolled in this study. The clinicopathologic features, postoperative outcomes (i.e., operation time, hospital stay, surgical procedures, method of duodenal stump closure, retrieved lymph nodes), and the risk factors of duodenal stump leakage were analyzed.
RESULTS: Of the 1,195 patients, 13 patients (1.1%) suffered duodenal stump leakage. Most of the patients with duodenal stump leakage were male (92.3%). Nine patients underwent a subtotal gastrectomy with Billroth- II or Roux-en-Y anastomosis; the other four patients underwent a total gastrectomy with a Roux-en-Y anastomosis. There were two mortalities. With univariate and multivariate analysis, age was the most predictable factor for duodenal stump leakage (p= 0.034, p=0.044) CONCLUSIONS: Duodenal stump leakage was affected by the age. For older patients who undergo a radical gastrectomy for gastric cancer, the surgeon must pay meticulous attention to the transection and mobilization of the duodenum in order to prevent duodenal stump leakage.

Aizawa M, Nashimoto A, Yabusaki H, et al.
Clinical benefit of surgical management for gastric cancer with synchronous liver metastasis.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1439-45 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to evaluate the benefit of resection for liver metastasis from gastric cancer.
METHODOLOGY: Consecutive 74 patients of gastric cancer who undergone the gastrectomy for primary gastric cancer and simultaneous hepatic resection for synchronous liver metastasis were enrolled. The clinicopathological factors were retrospectively compared to the prognosis.
RESULTS: The median survival time and 5-year overall survival rate in 53 patients who accomplished microscopically negative margin resection was 27.4 months and 18.6%, respectively. In the multivariate survival analysis, the number of liver metastasis was identified as an independent prognostic factor (HR;2.232, 95%CI;1.036-4.808, p=0.04). When the patients undergone curative resection were subdivided into solitary and multiple liver metastasis, the median survival time and 5-year overall survival rate in a subgroup with solitary liver metastasis was 24.2 months and 27.2%, which was superior to the corresponding values of 12.6 months and 5.5% in another group with multiple liver metastasis (p=0.02).
CONCLUSIONS: The resection for liver metastasis might offer a chance for long-term survival in a carefully selected group of patients. The number of liver metastasis was a reliable criterion to discriminate the subgroup of patients who are most likely to benefit from hepatic resection.

Jang HJ, Choi MH, Shin WG, et al.
Is annual endoscopic surveillance necessary for the early detection of gastric remnant cancer in Korea? A retrospective multi-center study.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1283-6 [PubMed] Related Publications
BACKGROUND/AIMS: This study investigated the clinical characteristics, survival outcomes of the patients with gastric remnant cancers (GRC) diagnosed after gastric cancer surgery and the need of annual endoscopic surveillance after gastric resection for early detection of GRC.
METHODOLOGY: We reviewed the medical records of 30 patients who underwent endoscopy and diagnosed with GRC between 1999 and 2009. We analyzed the clinical features, tumor characteristics, regular endoscopic surveillance, treatment, and survival outcomes.
RESULTS: The median time interval between first operation and diagnosis of GRC was 36 months. Fifteen patients (50%) had GRC at non-anastomotic sites. Seventeen patients (56.7%) underwent annual endoscopic surveillance and nine patients (30%) had no symptom at the time of diagnosis of GRC. GRC were detected earlier in patients with annual endoscopic surveillance than those without surveillance (p=0.0014). The median overall survival (OS) after the diagnosis of GRC for all patients was 35.9 months. The median OS of patients with curative resection including endoscopic resection for early gastric cancer was longer than those without resectability (46.3 vs. 13.6 months, p=0.0026).
CONCLUSIONS: These results suggest that annual endoscopic surveillance program after gastric partial resection would be helpful to detect early cancer of remnant stomach for curative resection.

Related: Cancer Screening and Early Detection

Han Y, Zhao H, Xu H, et al.
Cure and prevention strategy for postoperative gastrointestinal fistula after esophageal and gastric cardiac cancer surgery.
Hepatogastroenterology. 2014 Jul-Aug; 61(133):1253-6 [PubMed] Related Publications
Gastrointestinal fistula is the most serious complication of esophageal and gastric cardiac cancer surgery. According to occurrence of organ, gastrointestinal fistula can be divided into anastomotic fistula, gastric fistula; According to occurrence site, fistula can be divided into cervical fistula, thoracic fistula; According to time of occurrence, can be divided into early, middle and late fistula. There are special types of fistula including ‘thoracic cavity’-stomach-bronchial fistula, ‘thoracic cavity’-stomach-aortic fistula. Early diagnosis needs familiarity with various types of clinical gastrointestinal fistulas. However, Prevention of gastrointestinal fistula is better than cure, including perioperative nutritional support, respiratory tract management, and acid suppression, positive treatment of complications, antibiotic prophylaxis, and gastrointestinal decompression and eating timing. Prevention can effectively reduce the incidence of postoperative gastrointestinal fistula. Collectively, early diagnosis and treatment, nutritional supports are key to reducing mortality of gastrointestinal fistula.

Related: Cancer of the Esophagus Esophageal Cancer

Zhu Y, Liu Y, Qian Y, et al.
Research on the efficacy of Celastrus Orbiculatus in suppressing TGF-β1-induced epithelial-mesenchymal transition by inhibiting HSP27 and TNF-α-induced NF-κ B/Snail signaling pathway in human gastric adenocarcinoma.
BMC Complement Altern Med. 2014; 14:433 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Celastrus orbiculatus has been used as a folk medicine in China for the treatment of many diseases. In the laboratory, the ethyl acetate extract of Celastrus orbiculatus (COE) displays a wide range of anticancer functions. However, the inhibition of the metastasis mechanism of COE in gastric cancer cells has not been investigated so far.
METHODS: The present study was undertaken to determine if the anti-metastasis effect of COE was involved in inhibiting of epithelial-mesenchymal transition (EMT) of human gastric adenocarcinoma SGC-7901 cells. In vitro, a well-established experimental EMT model involving transforming growth factor β1 (TGF-β1) was applied. Viability, invasion and migration, protein and mRNA expression of tumor cells were analyzed by MTT assay, transwell assay, western blot and real-time PCR, respectively. The molecular targets of COE in SGC-7901 cells were investigated by two-dimensional gel electrophoresis (2-DE) and MALDI-TOF-TOF mass spectrometer. Overexpression of heat shock protein 27 (HSP27) was performed by transfected with the recombinant retroviral expression plasmid. In vivo, the anti-metastasis mechanisms of COE in the peritoneal gastric cancer xenograft model was explored and the effect was tested.
RESULTS: The non-cytostatic concentrations of COE effectively inhibited TGF-β1 induced EMT process in SGC-7901 cells, which is characterized by prevented morphological changes, increased E-cadherin expression and decreased Vimentin, N-cadherin expression. Moreover, COE inhibited invasion and migration induced by TGF-β1. Using a comparative proteomics approach, four proteins were identified as differently expressed, with HSP27 protein being one of the most significantly down-regulated proteins induced by COE. Moreover, the activation of nuclear factor κB (NF-κB)/Snail signaling pathway induced by tumor necrosis factor-α (TNF-α) was also attenuated under the pretreatment of COE. Interestingly, overexpression of HSP27 significantly decreases the inhibitory effect of COE on EMT and the NF-κB/Snail pathway. Furthermore, COE significantly reduced the number of peritoneal metastatic nodules in the peritoneal gastric cancer xenograft model.
CONCLUSIONS: Taken together, these results suggest that COE inhibits the EMT by suppressing the expression of HSP27, correlating with inhibition of NF-κB/Snail signal pathways in SGC-7901 cells. Based on these results, COE may be considered a novel anti-cancer agent for the treatment of metastasis in gastric cancer.

Related: Signal Transduction TGFB1 TNF

Lee SJ, Sohn TS, Lee J, et al.
Adjuvant chemoradiation with 5-fluorouracil/leucovorin versus S-1 in gastric cancer patients following D2 lymph node dissection surgery: a feasibility study.
Anticancer Res. 2014; 34(11):6585-91 [PubMed] Related Publications
PURPOSE: We retrospectively analyzed the feasibility and adverse events for two regimens, postoperative chemoradiation (CRT) with 5-fluorouracil/leucovorin (5-FU/LV) compared to S-1 in D2-resected gastric cancer patients.
PATIENTS AND METHODS: The study included 405 gastric cancer patients who underwent curative gastrectomy with D2 lymph node dissection and received adjuvant therapy between January 2008 and July 2009. Feasibility and adverse events for the CRT and S-1 regimens were analyzed.
RESULTS: Out of the 405 patients, 244 (60.2%) had CRT and 161 (39.8%) had S-1 treatment. The regimen was selected based on the preferences of the physician and the patient. S-1 was more frequently administered to patients with older age (age≥70) and those with early-stage disease (stage II). The stage was significantly more advanced in the CRT group compared to the S-1 group (S-1 vs. CRT: stage II, 59.6% vs. 36.1%; stage III/IV, 28.0% vs. 48.3%, respectively; p<0.001). The completion rate of the planned therapy was significantly higher in the CRT group than in the S-1 group (95.1% vs. 72.8%, respectively; p<0.001). Regarding severe adverse events (grade 3-4), neutropenia (CRT vs. S-1; 40.2% vs. 8.7%, respectively, p<0.001), nausea (CRT vs. S-1; 5.7% vs. 0%, respectively; p=0.002) and stomatitis (CRT vs. S-1; 7.4% vs. 2.5%, respectively; p=0.034) were significantly more frequent in the CRT cohort compared to the S-1 group.
CONCLUSION: Both adjuvant CRT with 5-FU/LV and adjuvant S-1 are safe and feasible in D2-resected gastric cancer patients. Patients with old age or early stage disease tend to prefer S-1 therapy to chemoradiation.

Related: Fluorouracil Leucovorin Tegafur-uracil

Seabra AD, Araújo TM, Mello Junior FA, et al.
High-density array comparative genomic hybridization detects novel copy number alterations in gastric adenocarcinoma.
Anticancer Res. 2014; 34(11):6405-15 [PubMed] Related Publications
AIM: To investigate frequent quantitative alterations of intestinal-type gastric adenocarcinoma.
MATERIALS AND METHODS: We analyzed genome-wide DNA copy numbers of 22 samples and using CytoScan® HD Array.
RESULTS: We identified 22 gene alterations that to the best of our knowledge have not been described for gastric cancer, including of v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 4 (ERBB4), SRY (sex determining region Y)-box 6 (SOX6), regulator of telomere elongation helicase 1 (RTEL1) and UDP-Gal:betaGlcNAc beta 1,4- galactosyltransferase, polypeptide 5 (B4GALT5). The most significant alterations related to peritoneal invasion involved the regions 13q21.1 (gain) and 15q15.1, 17q23.1, 19q13.2 and 20q11.22 (loss of heterozygozity; LOH), where we found LOH of erythrocyte membrane protein band 4.1-like 1 (EPB41L1) gene. In relation to early age of onset, the most significant alterations were gains in the regions Xq26 and Xp22.31 and a loss in the region 11p15.4.
CONCLUSION: These quantitative changes may play a role in the development of this type of neoplasia and may be used as markers in evaluating poor prognosis, as well as act as potential therapeutic targets for gastric cancer.

Related: CGH

Masuda T, Nakashima Y, Ando K, et al.
Nuclear expression of chemokine receptor CXCR4 indicates poorer prognosis in gastric cancer.
Anticancer Res. 2014; 34(11):6397-403 [PubMed] Related Publications
BACKGROUND: The CXCL12/CXCR4 axis plays a pivotal role in cancer progression and metastases in various epithelial cancer cells. The aim of the present study was to evaluate the localization and correlation between CXCL12/CXCR4 expression and clinicopathological features in gastric cancers.
MATERIALS AND METHODS: This study included 111 Japanese patients with primary gastric cancers, which invade submucosa or more, all of whom underwent gastrectomy between 1992 and 1996. Immunohistochemical analysis was performed.
RESULTS: A significant correlation was found in the immunoreactivity of nuclear CXCR4 and poor differentiation (p=0.0026), infiltrated pattern (p<0.0001), larger size (p<0.0001), advanced stage (p=0.0342) and reduced 5-year survival rate (30% vs. 61%, p=0.0012). Multivariate analysis revealed that high nuclear CXCR4 immunoreactivity (RR: 3.077, p=0.0329) retained its strength as an independent prognostic factor for overall survival.
CONCLUSION: High immunoreactivity of nuclear CXCR4 in gastric cancer suggests that CXCL12 binds to its unique receptor CXCR4 at the membrane, translocates to the nucleus and then becomes more invasive, and thus can be considered a prognostic factor.

Related: CXCR4

Aurello P, Magistri P, Nigri G, et al.
Surgical management of microscopic positive resection margin after gastrectomy for gastric cancer: a systematic review of gastric R1 management.
Anticancer Res. 2014; 34(11):6283-8 [PubMed] Related Publications
BACKGROUND: The prognosis after a curative resection for gastric cancer is modified by the lymph node involvement, while the prognostic significance of a microscopically-positive resection margin is debated. We systematically reviewed the literature from 1998 to 2013 to describe the role of surgery in the management of gastric cancer with a R1 after gastrectomy.
MATERIALS AND METHODS: The research was systematically performed on Pubmed, EMbase, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up ToDate databases. Twelve studies were included in this review, for a total of 15,008 patients.
RESULTS: The results reported in literature are inconsistent and the impact of surgical and oncological therapies is unknown. Intraoperative frozen sections should be performed to achieve a negative margin with intraoperative re-excision.
CONCLUSION: A surgical re-excision of an R1 resection should be considered for patients with fewer than three disease-positive nodes because survival is more likely to be governed by positive margins than by nodal status.

Shao Y, Zou LL, Zhou QH, et al.
Fast-track surgery for gastroenteric neoplasms: a meta-analysis.
Tumori. 2014 Sep-Oct; 100(5):e197-203 [PubMed] Related Publications
AIMS AND BACKGROUND: Fast-track surgery has been shown to enhance postoperative recovery. The objective of the study was to determine the differences of fast-track surgery and conventional care for patients with gastroenteric neoplasms.
METHODS AND STUDY DESIGN: We searched PubMed, EMBASE, and the Cochrane Library for related trials to compare hospital stay and rates of complications and readmission.
RESULTS: Thirteen randomized controlled trials, with 1,962 patients, were included. Results showed the length of hospital stay was significantly reduced in the fast-track group. The complications rate was lowered in colorectal surgery. There were no significant differences in rate of readmissions.
CONCLUSIONS: Current trials show that fast-track surgery may reduce the length of hospital stay and lower the rate of complications of gastroenteric surgery.

Related: Colorectal (Bowel) Cancer

Chen Y, Wang XJ, Lin RB, et al.
Efficacy of intraperitoneal and intravenous chemotherapy for advanced gastric cancer with peritoneal metastasis.
Tumori. 2014 Sep-Oct; 100(5):e180-8 [PubMed] Related Publications
AIMS AND BACKGROUND: Peritoneal metastasis (PM) in patients with advanced gastric cancer (AGC) is a poor prognostic indicator. The aim of this study was to compare the response of AGC patients with PM to paclitaxel-based systemic multidrug chemotherapy with and without additional intraperitoneal (IP) chemotherapy through retrospective analysis.
METHODS AND STUDY DESIGN: Two hundred and sixty-three AGC patients with PM were enrolled. Eighty-two patients received systemic paclitaxel/oxaliplatin and leucovorin/5-fluorouracil (POF) and 181 patients received 2-drug systemic therapies, PO (paclitaxel + oxaliplatin) or PF (paclitaxel + 5-fluorouracil + leucovorin), and IP infusion of a third drug.
RESULTS: Patients who received the POF regimen had longer progression-free survival (PFS) and overall survival (OS) than patients who received PO/PF + IP therapy (P = 0.026 and P = 0.046), respectively. In subgroup analysis, no significant differences in PFS and OS were observed between the POF regimen and PF/PO + IP regimens in patients with isolated peritoneal metastatic disease. Patients with multiorgan metastatic disease receiving POF had better PFS and better OS than patients receiving PO/PF + IP chemotherapy (P = 0.005 and P = 0.036, respectively). In multivariate analysis, ECOG performance status and the interaction between different therapeutic strategies and multiorgan metastasis were independent prognostic factors for survival. Leukopenia, fatigue and peripheral neuropathy were higher on the triplet regimen than the doublet regimens.
CONCLUSIONS: Paclitaxel-based doublet therapy combined with IP chemotherapy had more manageable toxicity and equal efficiency compared to triplet therapy for AGC patients with isolated PM. The POF regimen may be a good choice for AGC patients with multiorgan metastasis, especially those having a good performance status.

Related: Cisplatin Fluorouracil Leucovorin Paclitaxel Oxaliplatin

Jing H, Dai F, Zhao C, et al.
Association of genetic variants in and promoter hypermethylation of CDH1 with gastric cancer: a meta-analysis.
Medicine (Baltimore). 2014; 93(19):e107 [PubMed] Related Publications
Gastric cancer (GC) is a common cause of cancer-related death. The etiology and pathogenesis of GC remain unclear, with genetic and epigenetic factors playing an important role. Previous studies investigated the association of GC with many genetic variants in and promoter hypermethylation of E-cadherin gene (CDH1), with conflicting results reported.To clarify this inconsistency, we conducted updated meta-analyses to assess the association of genetic variants in and the promoter hypermethylation of CDH1 with GC, including C-160A (rs16260) and other less-studied genetic variants,Data sources were PubMed, Cochrane Library, Google Scholar, Web of Knowledge, and HuGE, a navigator for human genome epidemiology.Study eligibility criteria and participant details are as follows: studies were conducted on human subjects; outcomes of interest include GC; report of genotype data of individual genetic variants in (or methylation status of) CDH1 in participants with and without GC (or providing odds ratios [OR] and their variances).Study appraisal and synthesis methods included the use of OR as a measure of the association, calculated from random effects models in meta-analyses. We used I for the assessment of between-study heterogeneity, and publication bias was assessed using funnel plot and Egger test.A total of 33 studies from 30 published articles met the eligibility criteria and were included in our analyses. We found no association between C-160A and GC (OR = 0.88; 95% confidence interval [CI], 0.71-1.08; P = 0.215), assuming an additive model (reference allele C). C-160A was associated with cardia (OR = 0.21; 95% CI, 0.11-0.41; P = 2.60 × 10), intestinal (OR = 0.66; 95% CI, 0.49-0.90; P = 0.008), and diffuse GC (OR = 0.57; 95% CI, 0.40-0.82; P = 0.002). The association of C-160A with noncardia GC is of bottom line significance (OR = 0.65; 95% CI, 0.42-1.01; P = 0.054). Multiple other less-studied genetic variants in CDH1 also exhibited association with GC. Gene-based analysis indicated a significant cumulative association of genetic variants in CDH1 with GC (all Ps <10). Sensitivity analysis excluding studies not meeting Hardy-Weinberg equilibrium (HWE) yielded similar results. Analysis by ethnic groups revealed significant association of C-160A with cardia GC in both Asian and whites, significant association with noncardia GC only in Asians, and no significant association with intestinal GC in both ethnic groups. There was significant association of C160-A with diffuse GC in Asians (P = 0.011) but not in whites (P = 0.081). However, after excluding studies that violate HWE, this observed association is no longer significant (P = 0.126). We observed strong association of promoter hypermethylation of CDH1 with GC (OR = 12.23; 95% CI, 8.80-17.00; P = 1.42 × 10), suggesting that epigenetic regulation of CDH1 could play a critical role in the etiology of GC.Limitations of this study are as follows: we could not adjust for confounding factors; some meta-analyses were based on a small number of studies; sensitivity analysis was limited due to unavailability of data; we could not test publication bias for some meta-analyses due to small number of included studies.We found no significant association of the widely studied genetic variant C-160A, but identified some other genetic variants showing significant association with GC. Future studies with large sample sizes that control for confounding risk factors and/or intensively interrogate CpG sites in CDH1 are needed to validate the results found in this study and to explore additional epigenetic loci that affect GC risk.

Related: CDH1

Muto O, Sawada T, Kotanagi K, et al.
Modified administration schedule of docetaxel, cisplatin, and fluorouracil for advanced or recurrent gastric cancer with gastrointestinal stenosis.
Gan To Kagaku Ryoho. 2014; 41(10):1227-30 [PubMed] Related Publications
PURPOSE: To evaluate the safety and efficacy of a modified administration schedule of docetaxel, cisplatin, and fluorouracil (mDCF)in patients with advanced gastric cancer with gastrointestinal stenosis in clinical practice.
METHODS: In the chemotherapy-naïve patients who had metastatic or recurrent histologically confirmed gastric cancer, docetaxel(40mg/m2), levofolinate(200mg/m / / / 2), fluorouracil(400mg/m2)on day 1, fluorouracil 1,000 mg/m2d-2 days intravenous continuous in fusion beginning on day 1, and cisplatin(40mg/m2)on day 3 was administered every 2 weeks.
RESULTS: Six patients received mDCF therapy. In 5 patients with measurable disease, the overall response rate was 86%. Median progression-free survival was 310 days and median overall survival was 599 days. Symptom improvement after the first cycle of mDCF was obtained in all patients. Grade 3 or 4 leukopenia and neutropenia were observed in 2(33%)and 6(100%)patients, respectively. There were no treatment-related deaths.
CONCLUSION: mDCF seems to be active against metastatic and recurrent gastric cancer with gastrointestinal stenosis. Further study is needed to confirm the efficacy and safety of mDCF regimen.

Related: Cisplatin Fluorouracil Docetaxel

Bringeland EA, Wasmuth HH, Fougner R, et al.
Impact of perioperative chemotherapy on oncological outcomes after gastric cancer surgery.
Br J Surg. 2014; 101(13):1712-20 [PubMed] Related Publications
BACKGROUND: Perioperative chemotherapy has become standard care for resectable gastric cancer. However, available evidence is based on a limited number of trials, and the outcomes in routine clinical practice and in unselected patients are scarcely reported.
METHODS: The study included a consecutive series of patients with resectable gastric cancer treated between 2001 and 2011 in Central Norway. Before 2007, patients with resectable gastric cancer did not receive perioperative chemotherapy. Since 2007, medically fit patients with resectable gastric cancer and aged 75 years or less have been offered this. Response rates were evaluated by CT, and tolerability was assessed by the frequency of hospital admission, need for dose reduction or treatment discontinuation. The two time intervals were compared on an intention-to-treat basis for patients aged no more than 75 years for any impact on resection rates, surgical morbidity, postoperative mortality and long-term survival.
RESULTS: About two-thirds (259) of the 419 patients registered were aged 75 years or less at diagnosis. Ninety-five of 136 patients in the later interval were eligible for chemotherapy, of whom 90 actually received the specified regimen, and 78 (87 per cent) were able to complete the preoperative course. Only 40 (44 per cent) completed all scheduled preoperative and postoperative cycles. Thirty-eight (43 per cent) of 89 evaluable patients showed a definite response on CT. Chemotherapy had no impact on postoperative morbidity or mortality. The 5-year survival rate on an intention-to-treat basis was 40·7 (95 per cent c.i. 30·7 to 50·7) per cent in the first interval, compared with 41·7 (31·5 to 51·9) per cent after the introduction of perioperative chemotherapy (P = 0·765). After adjustment for other risk factors, based on comparisons of the two time intervals, there were no differences in oncological outcomes with the use of perioperative chemotherapy.
CONCLUSION: Perioperative chemotherapy was completed in less than half of the patients with resectable gastric cancer. An observed tumour response to chemotherapy did not translate into any long-term survival benefit compared with surgery alone.

Sakurai U, Lauwers GY, Vieth M, et al.
Gastric high-grade dysplasia can be associated with submucosal invasion: evaluation of its prevalence in a series of 121 endoscopically resected specimens.
Am J Surg Pathol. 2014; 38(11):1545-50 [PubMed] Related Publications
Gastric neoplasms classified as high-grade dysplasia (HGD) by Western pathologists are frequently diagnosed as tubular adenocarcinoma in Japan. Here, we evaluated the prevalence of submucosal and lymphovascular invasion in a series of 125 endoscopically resected gastric neoplasms. On the basis of Western criteria, the lesions were classified as poorly cohesive carcinomas (n=4) (excluded from further analysis), low-grade dysplasia (n=4), pure HGD (n=78), HGD with tubular adenocarcinoma (n=4), and pure tubular adenocarcinoma (n=35). Submucosal invasion was found in 3.8% of the 78 HGDs, 75.0% of the 4 HGDs combined with adenocarcinoma, and 11.4% of the 35 adenocarcinomas. Venous invasion was detected in 1.3% of the 78 HGDs, 75% of the 4 HGDs combined with adenocarcinoma, and none of the 35 tubular adenocarcinomas. Lymphatic invasion was absent in HGD but noted in 25% of the HGDs combined with adenocarcinoma, and 2.9% of the tubular adenocarcinomas. Thus, we demonstrated that lesions characterized as HGD on the basis of Western criteria can be associated with submucosal and lymphovascular invasion. Endoscopic therapy has made it less crucial to differentiate between HGD and intramucosal adenocarcinoma in biopsy samples of small tubular neoplasms. However, it is important to recognize that the criteria for dysplasia currently used in the West may understate the degree of malignant potential. To limit any diagnostic discrepancy between biopsy, endoscopic resection, and surgical specimens, it is suggested that the features of HGD and adenocarcinoma be reevaluated, which may result in some lesions being classified as mucosal adenocarcinoma.

Gwak M, Choi YJ, Yoo NJ, Lee S
Expression of DNA cytosine deaminase APOBEC3 proteins, a potential source for producing mutations, in gastric, colorectal and prostate cancers.
Tumori. 2014 Jul-Aug; 100(4):112e-7e [PubMed] Related Publications
AIMS AND BACKGROUND: APOBEC3B is a deaminase that possesses DNA C-to-T editing activity. A recent report showed that APOBEC3B mRNA was overexpressed in breast cancer and that its expression was responsible for the high C-to-T mutation spectrum in breast cancer, suggesting that APOBEC3B could serve as a source for producing mutations. To see whether APOBEC3B is overexpressed in other common cancers at the protein level, we investigated APOBEC3 protein expression in 100 gastric, 103 colorectal and 107 prostate cancer tissues as well as in 10 breast cancers by immunohistochemistry using antibody that could detect APOBEC3B, APOBEC3F and APOBEC3D proteins.
RESULTS: In the cancers, APOBEC3 expression was detected in 100% of breast cancers, 67% of gastric, 84% of colorectal and 67% of prostate cancer. Also, it was expressed in 100% of normal breast, 90% of normal stomach, 82% of normal colon and 93% of normal prostate tissues. In contrast to earlier data that showed an increased APOBEC3B expression in breast cancer cells compared to normal breast cells, APOBEC3 expression in cancers was lower than in normal tissues (gastric and prostate cancer) or was not different from normal tissues (colorectal and breast cancer). There was no significant association of APOBEC3 expression with clinocopathological parameters, including histology, metastasis and stage.
CONCLUSIONS: Our data indicate that APOBEC3 overexpression might not be restricted to specific cancer types. Also, APOBEC3 expression in many normal epithelial cells suggests that there might be a mutation unrelated function of APOBEC3 in the normal cells.

Related: Colorectal (Bowel) Cancer Prostate Cancer

Wang Q, Liu H, Jia X, et al.
Combined neutron brachytherapy with external beam radiation in patients with inoperable gastroesophageal junction adenocarcinoma.
Tumori. 2014 Jul-Aug; 100(4):470-5 [PubMed] Related Publications
AIMS AND BACKGROUND: To assess the safety and feasibility of neutron brachytherapy (NBT) combined with external beam radiation (EBRT) in the treatment of patients with inoperable gastroesophageal junction adenocarcinoma (GEJAC).
METHODS AND STUDY DESIGN: From January 2001 until November 2011, 67 patients with inoperable GEJAC received EBRT combined with NBT. Radiotherapy consisted of EBRT up to a total dose of 40 to 54 Gy in 20 to 27 fractions and NBT up to 12 to 25 Gy in 3 to 5 fractions. The patients were divided into 2 total-dose groups: a low-dose group (28 patients, 52 to 57 Gy) and a high-dose group (39 patients, 58 to 69 Gy).
RESULTS: The duration of follow-up ranged from 16 to 106 months. The median survival time for the 67 patients was 15.7 months, and the 1-, 2-, 3- and 5-year rates for overall survival (OS) were 56.7%, 37.2%, 30.8% and 12.7%, respectively. The corresponding local-regional control (LRC) rates were 72.4%, 59.1%, 51.2% and 42.0%, respectively. In univariate analysis, the 5-year OS rates were 7.1% and 16.5% for patients of the low-dose and high-dose groups, respectively (P = 0.024). The incidence of acute esophagitis (grade ≥2) was significantly higher in the high-dose group (56.4%) than the low-dose group (32.1%) (P = 0.049). No fistulas or massive bleeding were observed during treatment. Six of the 67 patients (9.0%) experienced late toxicity: fistulas developed in 3 patients and massive bleeding occurred in 3 patients. Of these 6 patients, 4 had persistent or locally recurrent tumors, and 2 displayed no evidence of tumors. Three patients each were in the low-dose and high-dose groups.
CONCLUSIONS: The combination of EBRT and NBT was safe and effective in patients with GEJAC. The high-dose group achieved better LRC and OS but had a higher rate of acute esophagitis.

Related: Brachytherapy Cancer of the Esophagus Esophageal Cancer

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