Department of Emergency Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2024 Nov;13(21):e70396. doi: 10.1002/cam4.70396.
The feasibility of transarterial infusion chemotherapy and embolization (TAICE) in the treatment of advanced gastric cancer remains unclear. This study explored the value of TAICE in patients with unresectable locally advanced or metastatic cancer of stomach or gastroesophageal junction (GEJ).
Patients with unresectable gastric cancer who received TAICE for tumor hemorrhage cessation were enrolled in this retrospective study. TAICE was performed using the Seldinger method. The tumor feeding artery was selected for infusion chemotherapy and then was embolized by microspheres or gelatin sponge. Patients involved in this study received one to four cycles TAICE with one to three drugs in the regimen. The possibility of surgery was evaluated after TAICE. Objective response rate (ORR), disease control rate (DCR), R0 resection rate, pathological complete remission (pCR) rate, major pathological remission (MPR) rate, progression-free survival (PFS), overall survival (OS), and safety were analyzed.
Between January 2015 and December 2020, a total of 27 patients received a median of 2 (range, 1-4) cycles of TAICE. ORR and DCR were 33.3% and 74.0%, respectively. Eighteen patients received surgery, and 15 of them underwent gastrectomy and D2 lymph node dissection, with an R0 resection rate of 83.3% (15/18). Four (26.7%, 4/15) patients achieved MPR, but none achieved pCR. The median PFS was 19.8 months (95%CI, 12.1-40.0), and the median OS was 36.1 months (95%CI, 21.0-not reached). Patients with gastrectomy had significantly longer PFS (40.0 vs. 9.5 months, p < 0.0001) and OS (not reached vs. 16.6 months, p < 0.0001) than those without gastrectomy. All the TAICE-related adverse events were manageable, with the most common being fatigue (100%), nausea (63.0%), and vomiting (55.6%). No severe surgical complications occurred.
TAICE was well-tolerated and could be a potential therapy to provide opportunity of surgery for patients with unresectable advanced gastric or GEJ cancer.
经动脉灌注化疗栓塞（TAICE）治疗局部晚期或转移性不可切除胃或胃食管交界处（GEJ）癌的可行性尚不清楚。本研究探讨了 TAICE 在不可切除的局部晚期或转移性胃或胃食管交界处（GEJ）癌患者中的应用价值。
本回顾性研究纳入了因肿瘤出血接受 TAICE 治疗以止血的不可切除胃癌患者。TAICE 通过 Seldinger 技术进行。选择肿瘤供血动脉进行灌注化疗，然后用微球或明胶海绵栓塞。患者接受 1 至 4 个周期 TAICE 治疗，方案中包含 1 至 3 种药物。TAICE 后评估手术的可能性。分析客观缓解率（ORR）、疾病控制率（DCR）、R0 切除率、病理完全缓解（pCR）率、主要病理缓解（MPR）率、无进展生存期（PFS）、总生存期（OS）和安全性。
2015 年 1 月至 2020 年 12 月，共 27 例患者接受了中位数为 2（范围，1-4）个周期的 TAICE 治疗。ORR 和 DCR 分别为 33.3%和 74.0%。18 例患者接受了手术，其中 15 例行胃切除术和 D2 淋巴结清扫术，R0 切除率为 83.3%（15/18）。4 例（26.7%，4/15）患者达到 MPR，但无患者达到 pCR。中位 PFS 为 19.8 个月（95%CI，12.1-40.0），中位 OS 为 36.1 个月（95%CI，21.0-未达到）。行胃切除术的患者 PFS（40.0 个月 vs. 9.5 个月，p<0.0001）和 OS（未达到 vs. 16.6 个月，p<0.0001）明显长于未行胃切除术的患者。所有与 TAICE 相关的不良反应均可以控制，最常见的不良反应为乏力（100%）、恶心（63.0%）和呕吐（55.6%）。无严重手术并发症发生。
TAICE 耐受性良好，可为不可切除的晚期胃或胃食管交界处（GEJ）癌患者提供手术机会。
