Research Institute of General Surgery, Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China.
Chin Med J (Engl). 2012 Mar;125(5):780-5.
Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.
A total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T2-4, N1-3, and M0-1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m2) and leucovorin (200 mg/m2) on days 1-5, and intra-arterial etoposide (80 mg/m2) and cisplatin (80 mg/m2) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.
All patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6-76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006-50.994) and 18 months (95%CI, 13.399-22.601; P<0.01), respectively.
Preliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.
术前化疗在东亚国家治疗晚期胃癌方面已得到广泛关注。然而，目前还没有确立的胃癌标准治疗方案。本研究旨在探讨静脉和动脉强化化疗联合用于晚期胃癌的术前化疗的价值。
共 56 例经组织学证实的胃癌患者，被认为是 II 期或更高期伴有转移性淋巴结，无论是否有远处转移（T2-4、N1-3 和 M0-1），均接受新辅助化疗。患者接受静脉注射氟尿嘧啶（370mg/m2）和亚叶酸（200mg/m2），第 1-5 天；静脉注射依托泊苷（80mg/m2）和顺铂（80mg/m2），第 6-20 天。在两个周期的术前化疗后，可切除肿瘤的患者接受剖腹手术。
所有患者均完成了两个周期的化疗。总缓解率为 78.57%（44 例），其中临床完全缓解率为 7.14%（4 例）。46 例患者接受了切除术，其中 21 例最初为不可切除疾病。术前可切除和不可切除疾病的 R0 切除率分别为 96.15%（25/26 例）和 66.67%（20/30 例）。病理完全缓解率为 8.70%。毒性中等，无化疗相关死亡。中位随访 31 个月（范围 6-76 个月），全组和最初可切除肿瘤患者的 5 年生存率分别为 21.8%和 42.3%。最初可切除和不可切除患者的中位生存时间分别为 41 个月（95%CI，31.006-50.994）和 18 个月（95%CI，13.399-22.601；P<0.01）。
初步结果证明，联合强化化疗是治疗晚期胃癌术前治疗的一种安全且有前途的方案。
