Division of Abdomino-pelvic Surgery, European Institute of Oncology, Via Ripamonti 435, I-20141 Milan, Italy.
World J Gastroenterol. 2010 Feb 21;16(7):868-74. doi: 10.3748/wjg.v16.i7.868.
To investigate feasibility, morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.
Patients suffering from locally-advanced (T3-4 any N M0 or any T N1-3 M0) gastric carcinoma, staged with endoscopic ultrasound, bone scan, computed tomography, and laparoscopy, were assigned to receive four 21 d/cycles of TCF (docetaxel 75 mg/m(2) day 1, cisplatin 75 mg/m(2) day 1, and fluorouracil 300 mg/m(2) per day for days 1-14), either before (Arm A) or after (Arm B) gastrectomy. Operative morbidity, overall mortality, and severe adverse events were compared by intention-to-treat analysis.
From November 1999 to November 2005, 70 patients were treated. After preoperative TCF (Arm A), thirty-two (94%) resections were performed, 85% of which were R0. Pathological response was complete in 4 patients (11.7%), and partial in 18 (55%). No surgical mortality and 28.5% morbidity rate were observed, similar to those of immediate surgery arm (P = 0.86). Serious chemotherapy adverse events tended to be more frequent in arm B (23% vs 11%, P = 0.07), with a single death per arm.
Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
研究在可切除局部进展期胃癌患者中，术前或术后给予多西紫杉醇为基础的化疗方案的可行性、发病率和手术死亡率。
通过内镜超声、骨扫描、计算机断层扫描和腹腔镜检查对局部进展期（T3-4 任何 N M0 或任何 T N1-3 M0）胃癌患者进行分期，然后将其分配接受 4 个 21 天/周期的 TCF（多西紫杉醇 75mg/m²，第 1 天；顺铂 75mg/m²，第 1 天；氟尿嘧啶 300mg/m²，第 1-14 天）治疗，治疗方案分别为术前（Arm A）或术后（Arm B）。采用意向治疗分析比较手术发病率、总死亡率和严重不良事件。
1999 年 11 月至 2005 年 11 月，共治疗了 70 例患者。在术前 TCF（Arm A）治疗后，进行了 32 例（94%）切除术，其中 85%为 RO 切除。4 例（11.7%）患者完全缓解，18 例（55%）患者部分缓解。未观察到手术死亡，发病率为 28.5%，与立即手术组相似（P = 0.86）。严重化疗不良事件在 Arm B 中更为常见（23%比 11%，P = 0.07），两组各有 1 例死亡。
在可切除局部进展期胃癌患者中，多西紫杉醇为基础的化疗后进行手术是安全的，与立即手术相比发病率相似。
