title: Optimal treatment change criteria for advanced gastric cancer with non-measurable peritoneal metastasis: symptom/tumor marker-based versus CT-based.
abstract: BACKGROUND
  For advanced gastric cancer (AGC) with peritoneal metastasis, decision-making regarding treatment change is often challenging because of the absence of measurable lesions. We attempted to clarify which criterion for treatment change contributes more to longer survival.
  
  
  METHODS
  We retrospectively reviewed 50 patients with non-measurable peritoneal metastasis in whom first-line chemotherapy for AGC was changed based on aggravated clinical symptoms or tumor markers (TMs), or radiologically-confirmed disease progression. Prognostic factors for overall survival (OS) were investigated.
  
  
  RESULTS
  Patients whose treatment was changed based on symptoms/TMs had significantly longer OS than patients with computed tomographic-based treatment change (p=0.04). On multivariate analysis, treatment change based on symptoms/TMs was identified as an independent prognostic factor for favorable OS (hazard ratio=0.321, 95% confidence interval=0.154-0.668, p=0.002).
  
  
  CONCLUSIONS
  The present study suggests that aggravated clinical symptoms/elevated TMs could be a sensitive predictor for disease progression in patients with AGC with non-measurable peritoneal metastasis.
authors.affiliation: Department of Gastroenterology, Osaka National Hospital, Osaka, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Japan fujitani@gh.opho.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.affiliation: Department of Gastroenterology, Osaka National Hospital, Osaka, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Nakazuru
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology, Osaka National Hospital, Osaka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Mita
authors.affiliation: Department of Surgery, Kaizuka City Hospital, Kaizuka, Osaka, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: CT; Treatment change; advanced gastric cancer; peritoneal metastasis; tumor marker