Division of Oncology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2010 Apr;17(4):1024-32. doi: 10.1245/s10434-009-0838-1. Epub 2009 Nov 26.
This phase II study was conducted to evaluate the efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin and capecitabine (DXP) in patients with unresectable locally advanced and/or intra-abdominal metastatic gastric cancers.
Patients with advanced gastric cancer (AGC), clinically unresectable because of local invasion or limited intra-abdominal metastasis in para-aortic lymph nodes and/or the peritoneum based on multidetector row computed tomography, were enrolled. DXP consisted of docetaxel 60 mg/m(2) i.v. and cisplatin 60 mg/m(2) i.v. on day 1, and capecitabine 937.5 mg/m(2) twice daily p.o. on days 1-14 every 21 days. Surgery was performed after 4-6 cycles of DXP.
Thirty-six (74%) of the 49 patients enrolled underwent surgery, and 31 (63%) had an R0 resection. R0 resection was possible in 15 of 21 patients (71%) with unresectable locally advanced lesions, 12 of 17 patients (70%) with para-aortic lymph node metastasis but only 4 of 11 patients (36%) with peritoneal metastasis. Grade 3/4 toxicities included neutropenia (69%), febrile neutropenia (4%) and hand-foot syndrome (8%).
Neoadjuvant DXP may offer a reasonable chance of curative surgery in AGC patients with unresectable locally advanced or para-aortic lymph node metastasis.
本 II 期研究旨在评估多西紫杉醇、顺铂和卡培他滨（DXP）新辅助化疗在局部晚期和/或腹腔转移性不可切除胃腺癌患者中的疗效。
纳入局部晚期胃癌（AGC）患者，根据多排螺旋 CT 检查，因局部侵犯或局限于腹主动脉旁淋巴结和/或腹膜内转移而无法手术切除。DXP 方案包括多西紫杉醇 60mg/m2 静脉注射和顺铂 60mg/m2 静脉注射，第 1 天；卡培他滨 937.5mg/m2 口服，每天 2 次，第 1-14 天，每 21 天 1 个周期。DXP 化疗 4-6 周期后行手术治疗。
49 例入组患者中 36 例（74%）接受了手术治疗，31 例（63%）达到了 R0 切除。21 例局部晚期不可切除患者中 15 例（71%）、17 例腹主动脉旁淋巴结转移患者中 12 例（70%）、11 例腹膜转移患者中 4 例（36%）获得了 R0 切除。3/4 级毒性反应包括中性粒细胞减少（69%）、发热性中性粒细胞减少（4%）和手足综合征（8%）。
新辅助 DXP 可能为局部晚期或腹主动脉旁淋巴结转移不可切除的 AGC 患者提供治愈性手术的合理机会。
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