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STOMACH CANCER PANEL DISCUSSION

STOMACH CANCER PANEL DISCUSSION

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STOMACH CANCER PANEL DISCUSSION

  1. 1. DR KANHU CHARAN PATRO MD,DNB [RADIATION ONCOLOGY], MBA. PDCR. CEPC, FAROI HOD, RADIATION ONCOLOGY. MGCHRI. VISAKHAPATNAM 1 drkcpatro@gmail.com M-9160470564 MULTIDISCIPLINARY TUMOR BOARD [CANCER STOMACH]
  2. 2. Case details • 27 years female. • Presented with complaints of fullness after meals, intermittent vomiting since last few days associated with significant weight loss, for which the she was evaluated.
  3. 3. Upper GI Endoscopy Upper GI Endoscopy (01/04/2020) reported A hard nodular growth in the antro-pyloric region with gastric outlet obstruction.
  4. 4. Endoscopy and biopsy • UGI endoscopy guided Biopsy (19.02.2020) reported mild focal acute on chronic gastritis, no H.pylori seen, D2 Biopsy reported Giardiasis. • Gastritic Biopsy (02.04.2020) reported a focus of atypical single cell infiltrate (low volume); favours poorly cohesive carcinoma, superimposed candida infection present.
  5. 5. Dr Ashutosh please • Are you happy with histology report? • Do you want Review/rebiopsy? • Any molecular profile? • Any further investigation?
  6. 6. Whole Body PET CT Scan (04/04/2020) reported Mildly FDG avid circumferential concentric enhancing mural wall thickening (Max Thickness 1.8cm) with mildly increase FDG uptake SUVm0061 2.7 is seen involving anteropyloric region of stomach, causing significant luminal narrowing and gastric outlet obstruction (GOO) - Likely malignant No other focal abnormal FDG avid lesion in rest of the body
  7. 7. Surgical detail • Patient underwent Exploratory Laparotomy + Radical Distal Gastrectomy + Gastrojejunostomy + Feeding Jejunostomy done under GA on 09/04/2020.
  8. 8. Histopathology detail • Post operative histopathology (10/04/2020) s/o poorly cohesive carcinoma, – Poorly differentiated carcinoma, – Non-signet ring cell type, – Maximum dimesnion:5cm, – LVI +ve, – PNI +ve(multifocal), – 1/9 regional lymph nodes shows metastatic tumour deposits, – 1/5 common hepatic lymph node positive for metastatic carcinoma. – TNM stage - T4aN1.
  9. 9. Dr Suvadip please • Comment on surgery performed? • Which case do you prefer total gastrectomy? • How do you define margin? • Optimum number of nodes to be dissected?
  10. 10. Dr Moses please • How do you decide adjuvant treatment? • CT • CT+RT • CTCT+RTCT
  11. 11. Preoperative chemotherapy SL TRIAL ARM RESULT 1 MAGIC SX VS ECF-SX-ECF 1. 5-YEAR SURVIVAL FROM 23% TO 36% FOR PATIENTS WITH RESECTABLE STAGE II AND III GASTRIC CANCERS 2 FRENCH SX VS C5F-SX-C5F 1. 5-YEAR RATE 24% VS 38% 2. ADENOCARCINOMA OF THE LOWER ESOPHAGUS, GEJ, OR STOMACH, PERIOPERATIVE CHEMOTHERAPY USING FLUOROURACIL PLUS CISPLATIN SIGNIFICANTLY INCREASED THE CURATIVE RESECTION RATE, DISEASE-FREE SURVIVAL, AND OS 3 GERMAN AIO ECF-SX-ECF Vs FLOT-SX-FLOT 1. HIGHER RATES OF PATHOLOGICAL RESPONSE FOR FLOT (15.6% VERSUS 5.8%); 2. HOWEVER, CORRELATION WITH SURVIVAL OUTCOMES IS AWAITED EVEN IN RESPECTABLE PERIOPERATIVE CHEMOTHERAPY HAVING ADDED BENEFIT
  12. 12. Postoperative chemoradiotherapy SL TRIAL ARM RESULT 1 CRITCS CT-SX-CT VS CT-SX-CRT 1. No significant difference in overall survival was found between postoperative chemotherapy and chemoradiotherapy 3 DUTCH D1D2 1. CRT reduces local recurrence rates following D1 resection, but provides no benefit in patients who have undergone D2 resection 4 INTERGROUP 0116 SX VS SX-CRT [5FU-LV] 1. 50% 3-year survival for patients treated with CRT versus 41% for those treated with surgery alone 2. After 10 years of follow-up, this OS improvement remains significant In current postoperative CRT regimens, RT should preferably be given as a concomitant regimen of fluoropyrimidine-based CRT to a total dose of 45 Gy in 25 fractions of 1.8 Gy, 5 fractions/ week by intensity-modulated RT techniques
  13. 13. 1. No radiotherapy if used preoperative chemotherapy and use adjuvant chemo 2. If indicated use chemoradiotherapy in postoperative settings if no preoperative chemo 3. FLOT is the standard/
  14. 14. Dr Vikas please • Which type of chemo? • How many cycles? • Role of targeted agents
  15. 15. Capecitabine and oxaliplatin
  16. 16. Adjuvant treatment • She received 6 cycles FOLFOX based adjuvant chemo, last on 26/10/2020.
  17. 17. Dr Avinash please • Role of targeted agents?
  18. 18. Dr Ashutosh please • Pattern of follow up? • Any supplementations
  19. 19. Supplementations
  20. 20. Whole body PET CT (17-Nov-2020) • Post radical distal gastrectomy and gastro jejunostomy status. • No focal abnormal FDG avid lesion seen at surgical bed / anastomotic site. • No other focal abnormal FDG avid lesion in rest of the body. • As compared to previous PET CT scan dated 27.07.2020, there is no significant interval change.
  21. 21. PET CT (27/7/2020): Mass in anteropyloric region of stomach not visualised with no new FDG avid lesion seen in present study.

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