Li Bin, Tang Rui, Zhang Guangqiang, Cheng Jingkai, Chao Ming, Ding Kefeng
Department of Interventional Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Gastrointest Oncol. 2022 Jun;13(3):968-976. doi: 10.21037/jgo-22-304.
Neoadjuvant chemotherapy (NAC) followed by R0 resection is regarded as a standard treatment strategy for locally advanced gastric cancer (GC); however, the response to systemic chemotherapy remains unsatisfactory. Continuous intra-arterial infusion chemotherapy (CAIC) is a new method, compared with systematic chemotherapy, it can deliver chemotherapy drugs more accurately, so as to achieve higher surgical conversion rate. This study aimed to explore the efficacy and safety of CAIC in locally advanced GC patients.
In this retrospective pilot study, four patients with histologically confirmed locally advanced GC were identified from a tertiary hospital between May 2018 and December 2018. Clinic stage was belonged to T4N1-3M0 in all cases with potential probability for surgery. All cases received three cycles of NAC by CAIC with oxaliplatin (100 mg on day 1) plus oral S-1 (80 mg/m/day twice daily for 14 days) (SOX). Contrast-enhanced computed tomography (CT) scans and pathological examinations were performed to evaluate chemotherapeutic response based on the tumor regression grade (TRG) and post-neoadjuvant pathological Tumor Node Metastasis (ypTNM) staging. All cases were regularly followed up with face-to-face interviews at outpatient, abdominal enhanced CT scan and serum tumor markers were be requested at 3-month intervals for up to 1 year postoperatively.
The obstruction was significantly alleviated after three cycles of CAIC. Contrast-enhanced CT scans showed decreased tumor volume to some extent, along with lymph node shrinkage after treatment. Radical (R0) resection was achieved in all cases. Histopathological analysis showed tumor downstaging in three cases and upstaging in one case. The tumor response to treatment demonstrated TRG1a in one case, TRG1b in one case, and TRG2 in two cases, with an overall tumor regression rate of 100%. No obvious adverse events or perioperative complications were observed during or following treatment. All cases were alive without tumor recurrence or progression after the 1-year postoperative follow-up.
Our study may shed light on super-selective CAIC as an effective method for improving the NAC response in locally advanced GC. Future studies with a larger sample sizes and long-term outcomes are required for a final conclusion.
新辅助化疗（NAC）后行R0切除被视为局部晚期胃癌（GC）的标准治疗策略；然而，全身化疗的疗效仍不尽人意。持续动脉内灌注化疗（CAIC）是一种新方法，与全身化疗相比，它能更精确地输送化疗药物，从而实现更高的手术转化率。本研究旨在探讨CAIC在局部晚期GC患者中的疗效和安全性。
在这项回顾性前瞻性研究中，2018年5月至2018年12月期间从一家三级医院确定了4例经组织学证实为局部晚期GC的患者。所有病例临床分期均为T4N1-3M0，具有手术可能性。所有病例均接受三个周期的CAIC新辅助化疗，使用奥沙利铂（第1天100mg）加口服S-1（80mg/m²/天，每日两次，共14天）（SOX方案）。进行对比增强计算机断层扫描（CT）和病理检查，根据肿瘤退缩分级（TRG）和新辅助化疗后病理肿瘤淋巴结转移（ypTNM）分期评估化疗反应。所有病例均在门诊进行定期面对面随访，术后1年内每隔3个月进行腹部增强CT扫描并检测血清肿瘤标志物。
三个周期的CAIC后梗阻明显缓解。对比增强CT扫描显示肿瘤体积有一定程度减小，治疗后淋巴结缩小。所有病例均实现了根治性（R0）切除。组织病理学分析显示3例肿瘤降期，1例肿瘤升期。治疗的肿瘤反应显示1例为TRG1a，1例为TRG1b，2例为TRG2，总体肿瘤退缩率为100%。治疗期间及治疗后未观察到明显不良事件或围手术期并发症。术后1年随访时所有病例均存活，无肿瘤复发或进展。
我们的研究可能有助于将超选择性CAIC作为改善局部晚期GC新辅助化疗反应的有效方法。最终结论需要更大样本量和长期结果的进一步研究。
