Results of aggressive treatment of XXXX .

@entity1 @entity632 @entity5 @entity1822 @entity1442 @entity3960 @entity3 @entity11004 @entity356
BACKGROUND: @entity1822 and @entity11004 and subtypes of @entity3960 . These rare @entity5 are usually treated with surgical resection. However, there is controversy regarding the optimal surgical management for these @entity5 and little information is available on the efficacy of radiation and chemotherapy in the adjuvant or palliative setting. METHODS: The records of 32 @entity1 with @entity356 or @entity11004 were reviewed. Survival data were obtained and @entity1 outcome was analyzed with respect to the type of treatment given. Four different staging systems were compared for their ability to predict survival. RESULTS: Thirty @entity1 with @entity1822 and two @entity1 with @entity11004 were followed after surgery. All 32 @entity1 were explored, and 21 curative and 11 palliative procedures were performed. Adjacent organs were included in 38% of resections. Only three @entity1 did not undergo gastric resection. Local recurrence developed in eight @entity1 after curative resection for a local control rate of 62%. Eight other @entity1 developed @entity3 for an overall recurrence rate of 76% after curative resection. Median survival of @entity1 undergoing curative resection was 40 months compared with 8 months for those having a palliative procedure. The estimated 5-year survival was 34% and 10%, respectively (p = 0.05). Twenty-five @entity1 with @entity1442 received systemic, hepatic arterial, or intraperitoneal chemotherapy. Eighty percent of @entity1 received a regimen including @entity632 . Four partial and one complete response were noted. Seven @entity1 received postoperative radiation therapy. Fourteen @entity1 underwent debulking surgery of recurrent or persistent disease in conjunction with chemotherapy. Chemotherapy, radiation therapy, and debulking surgery did not result in statistically significant prolongation of survival. Seven @entity1 remain alive, two with liver metastases. Four different staging systems for @entity356 were compared, but none of them were found to be clearly superior in predicting survival. CONCLUSIONS: Curative gastric resection was achieved in 66% of @entity1 and resulted in a significant prolongation of survival as compared with @entity1 who had a palliative procedure. Wedge resection of @entity5 or partial gastric resection appears to be an acceptable surgical approach to these @entity5 as long as negative margins can be obtained. Chemotherapy, radiation therapy and debulking surgery did not result in significant prolongation of survival in the face of @entity1442 . None of the staging systems for @entity356 currently in use is completely satisfactory. @entity5 grade and extent of disease seem to be the most important factors when determining prognosis or considering adjuvant therapy.
