Lasser P, Rougier P, Mahjoubi M, Bognel C, Elias D, Tigaud J M, Grandjouan S, Droz J P
Chirurgie. 1989;115(6):365-72.
Gastric adenocarcinoma locally advanced or located at the cardia, or of large size or with local lymphadenopathies are of bad prognosis. To improve the surgical results we have tested the feasibility and tumoral efficacity of pre-operative (neoadjuvant) chemotherapy. Twenty patients have been included between 6/87 and 12/88. Median age was 63 years (36-74); all patients were in good general condition (OMS 0-1). The tumors were located at the cardia in 50%. The tumor median size was 10 cm (6-19), pathological lymph nodes were seem at CAT. Scan in 10/20. The neoadjuvant chemotherapy was continuous IV, 5 FU 1 g/m2/day for 5 days + CDDP 100 mg/m2, day 1. The cycles were repeated every 4 weeks. The median number of cycles prior surgery was 2 (1-4) and depended of tolerance and efficacy. We have observed (WHO criteria). 1 CR, 12 PR (Responsible rate: 65%). 6 MR or S. One patient was non evaluable because coronary insufficiency complicating the first cycle. The neoadjuvant chemotherapy toxicity was mainly hematological. The surgical procedure was curative in 15/20 patients; palliative 4 and non feasible for progression 1. Normal rate of post-operative complications was encountered: 2 subphrenic abscess, 1 pneumopathy, 1 stercoral peritonitis. At this date 3/20 patients died (17 patients are still alive, among them 14 are NED (the overall median survival is more than 10 months). This study demonstrated the feasibility and high response rate of neoadjuvant chemotherapy in patients with locally advanced gastric carcinomas. A randomized trial is warranted to demonstrate the survival benefit.
局部进展期或位于贲门部、体积较大或伴有局部淋巴结病变的胃腺癌预后较差。为了提高手术效果，我们测试了术前（新辅助）化疗的可行性和肿瘤疗效。1987年6月至1988年12月期间纳入了20例患者。中位年龄为63岁（36 - 74岁）；所有患者一般状况良好（世界卫生组织体能状态0 - 1级）。50%的肿瘤位于贲门部。肿瘤中位大小为10厘米（6 - 19厘米），20例中有10例在CT扫描时可见病理性淋巴结。新辅助化疗采用持续静脉输注，5-氟尿嘧啶1克/平方米/天，共5天 + 顺铂100毫克/平方米，第1天。每4周重复一次周期。手术前的中位周期数为2（1 - 4），取决于耐受性和疗效。我们观察到（按照世界卫生组织标准）：1例完全缓解，12例部分缓解（缓解率：65%）。6例病情稳定或进展。1例患者因第一周期出现冠状动脉供血不足而无法评估。新辅助化疗的毒性主要是血液学方面的。20例患者中15例手术为根治性；4例为姑息性，1例因病情进展无法手术。术后并发症发生率正常：2例膈下脓肿，1例肺部疾病，1例粪性腹膜炎。截至目前，20例患者中有3例死亡（17例患者仍存活，其中14例无疾病证据（总体中位生存期超过10个月）。本研究证明了新辅助化疗在局部进展期胃癌患者中的可行性和高缓解率。有必要进行一项随机试验以证明其对生存的益处。
