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GCA

Dec 05, 20232 min read

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🌱來自: snippets

GCA

Smoking, quite for 8 weeks

Gastric cancer, PW/high body (<3cm from EGJ) (P/D) adenocarcinoma, pT4aN1(2/38)M0 (AJCC 7th), LVI+, perineural invasion, stage IIIa, no ascites, no peritoneal carcinomatosis, negative washed cytology s/p robotic radical total gastrectomy with D2 LN dissection on 2010/00/00, HER2:0

  • Initial presentation:
  • Treatment plan: adjuvant chemotherapy will be started post op 4~6 weeks
  • Follow up parameter: abdominal CT scan, EGD annualy for partial gastrectomy, not necessary for total gastrectomy unless s/s, and tumor marker if elevated: follow up interval: 36 month for 1-2 yr then 612 month for 3-5 yr then annually
  • 2010/00/00: the purpose of adjuvant chemotherapy is to prolong disease free survival and overall survival and decrease risk of recurrence and distant mets but not 100%. Explain adjuvant chemotherapy regimen such as S-1 (80,100,120; 4week on 2 week off) for 1 year (ACTS-GC JP study, DFS HR 0.653; OS HR 0.669), XELOX Q2W for 12 cycles (85/1000 CLASSIC trial, DFS HR 0.58, OS HR 0.66), and weekly 5-FU based regimen (500/200 6 weeks on and 2 weeks off) for 8 months. Consider TS-1 + taxotere (JACCRO GC-07 trial, stage IIIb RFS HR 0.614) [#1 TS-1 (14/7);2-7 + taxotere 40mg/m2,8-11 (28/14)] @ RTC on ? (4th week) for lab and #1 XELOX, S-1 or weekly 5FU/LV @ Vascular assessment, nutritional assessment, dental check, pharmacist education before chemotherapy. TS-1 **explain the AEs of chemotherapy, such as myelosuppression, neutropenic fever, nausea/vomiting, hypersensitivity reaction, diarrhea, and hand-foot-syndrome Capecitabine: **diarrhea (55%), hand-foot syndrome (15-20%), nausea/vomiting, elevations in LFT, and myelosuppression Oxaliplatin: **peripheral sensory neuropathy, nausea/vomting, diarrhea, myelosuppression

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