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OBJECTIVE:To observe the efficacy and safety of neoadjuvant chemotherapy in advanced gastric carcinoma patients before laparoscopic minimally invasive resction.METHODS:In retrospective analysis,93 patients with advanced gastric carcinoma were divided into single group (55 cases) and combined group (38 cases).Single group received laparoscopic minimally invasive operation.Combination group was given Tetrahydrofolate injection 400 mg/m2+Oxaliplatin injection 85 mg/m2,i.v.,2 h,d1+ Fluorouracil injection 2 400 mg/m2,i.v.,46 h,d2.A treatment course lasted for 2 weeks,both received 2-4 courses of treatment and 4 weeks later received laparoscopic minimally invasive resection.Both groups received routine treatment as parenteral nutrition and preventive anti-inflammation.They were given oxaliplatin+capecitabine or gimeracil oteracil potassium capsule+oxaliplatin chemotherapy for 6 courses.Clinical efficacies and ADR of combination group were observed.Operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,complete resection and postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay and complications were observed in 2 groups.RESULTS:The objective remission rate and disease control rate of combination group were 44.8％ and 92.2％;there were 23 case time of grade Ⅰ ADR,13 case time of grade Ⅱ ADR and 3 case time of grade Ⅲ ADR.Complete resection rate of combination group was significantly higher than that of single group,with statistical significance (P＜0.05).There was no statistical significance in operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay or the incidence of complications between 2 groups (P＞0.05).CONCLUSIONS:For advanced gastric carcinoma patients before laparosapic minimally invasive resection,tetrahydrofolate,oxaliplatin and fluorouracil neoadjuvant chemotherapy show therapeutic efficacy and can improve the rate of complete resection without increasing the incidence of ADR.
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OBJECTIVE:To observe the efficacy and safety of neoadjuvant chemotherapy in advanced gastric carcinoma patients before laparoscopic minimally invasive resction.METHODS:In retrospective analysis,93 patients with advanced gastric carcinoma were divided into single group (55 cases) and combined group (38 cases).Single group received laparoscopic minimally invasive operation.Combination group was given Tetrahydrofolate injection 400 mg/m2+Oxaliplatin injection 85 mg/m2,i.v.,2 h,d1+ Fluorouracil injection 2 400 mg/m2,i.v.,46 h,d2.A treatment course lasted for 2 weeks,both received 2-4 courses of treatment and 4 weeks later received laparoscopic minimally invasive resection.Both groups received routine treatment as parenteral nutrition and preventive anti-inflammation.They were given oxaliplatin+capecitabine or gimeracil oteracil potassium capsule+oxaliplatin chemotherapy for 6 courses.Clinical efficacies and ADR of combination group were observed.Operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,complete resection and postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay and complications were observed in 2 groups.RESULTS:The objective remission rate and disease control rate of combination group were 44.8％ and 92.2％;there were 23 case time of grade Ⅰ ADR,13 case time of grade Ⅱ ADR and 3 case time of grade Ⅲ ADR.Complete resection rate of combination group was significantly higher than that of single group,with statistical significance (P＜0.05).There was no statistical significance in operation time,intraoperative blood loss,intraoperative blood transfusion,resection range,conversions to laparotomy,the number of lymph node dissection,postoperative first exhaust time,the time of fluid feeding recovery,the length of hospital stay or the incidence of complications between 2 groups (P＞0.05).CONCLUSIONS:For advanced gastric carcinoma patients before laparosapic minimally invasive resection,tetrahydrofolate,oxaliplatin and fluorouracil neoadjuvant chemotherapy show therapeutic efficacy and can improve the rate of complete resection without increasing the incidence of ADR.
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Objective To investigate the clinical efficacy of SOX and XELOX in neoadjuvant chemo-therapy for advanced gastric carcinoma .Methods Seventy-five cases with advanced gastric carcinoma were se-lected from our hospital from Feb 1,2011 to Oct 1,2015.SOX and XELOX were used to these patients treatment . The relationship between SOX and XELOX with tumor stage ,clinical curative effect evaluation ,operation ,postop-erative pathology ,adverse reaction ,survival analysis with advanced gastric carcinoma had been analyzed retrospec -tively.Results The efficacy of SOX and XELOX were 47.22%,41.03%.Compared with the two groups ,the CT curative effect evaluation,effective rate,disease control rate had no significant differences (P>0.05).The median survival time of DFS and OS were significant between the two groups (P<0.05).Conclusion The SOX and XELOX for neoadjuvant chemotherapy of advanced gastric carcinoma treatment is safety and effective , and the XELOX is better than SOX in terms of long -term effect,prognosis and clinical benefits .
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Objective To explorer the safety of D2 lymphadenectomy in open distal gastrectomy for distal gastric cancer with the surgical approach from bottom to top,from left to right and from surrounding to middle.Methods 100 advanced distal gastric cancer patients selected from General Surgery Department of Chang Hai Hospital from December 2012 to November 2013 were analyzed retrospectively.All the patients were performed D2 lymphadenectomy in open distal gastrectomy with surgical approach from bottom to top,from left to right and from surrounding to middle.The operation time,amount of bleeding,the number of lymph nodes,postoperative complications and follow-up observation were recorded.Ruselts All patients had successful operation.The operation time was 90 to 190 mins,the average (125.00 ± 21.43) mins;intraoperative blood was 90 to 400 ml,the average (178.00 ± 73.74) ml;number of lymph node dissection was 17 to 41,the average (26.00 ± 6.72).One patient suffered from abdominal hemorrhage,recoverd and discharged after conservative treatment.Conclusions Surgical approach from bottom to top,from left to right and from surrounding to middle can improve the safety of D2 lymphadenectomy for distal gastric cancer.
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Objective To compare clinical outcome and adverse reactions between the regimens SOX and XELOX for chemotherapy of advanced gastric carcinoma in Chinese population.Methods The original articles on randomized controlled trials ( RCTs) comparing the chemotherapy of SOX and XELOX in Chinese patients with advanced gastric carcinoma were recruited from the PUBMED, WANFANG, VIP and CNKI databases.The quality of the selected trials were assessed by JADAD method.Meta-analysis about the efficacy and safety of the two chemotherapy methods was performed by Rev Man 5.2.0 software ( Cochrane-information Management System) .Results Eight RCT studies were recruited in our work, including 293 patients in the SOX treatment group and 310 in the XELOX treatment group.The analysis results showed that there was no significant difference in the effect of the two chemotherapy methods (OR=1.19, 95%CI:0.86-1.64,P=0.29), and referred to the safety evaluation, the stomatitis (OR=2.29, 95%CI:1.74-4.89, P<0.0001) incidence in SOX treatment group was higher than XELOX treatment group, and in total, there was no significant difference in adverse reaction incidence of the two chemotherapy methods(OR =0.88, 95%CI: 0.66-1.19, P =0.41).Conclusion In the chemotherapy of advanced gastric carcinoma in Chinese population, there is no significant difference in clinical response rate between SOX and XELOX, and the stomatitis incidence of SOX is significantly higher than that of XELOX.
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BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. METHODS: Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. RESULTS: Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. CONCLUSIONS: FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer.
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Adult , Aged , Female , Humans , Male , Middle Aged , Anemia/etiology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Camptothecin/adverse effects , Disease Progression , Fluorouracil/adverse effects , Kaplan-Meier Estimate , Leucovorin/adverse effects , Neoplasm Staging , Organoplatinum Compounds/adverse effects , Retrospective Studies , Stomach Neoplasms/drug therapy , Treatment OutcomeABSTRACT
Objective Evaluate the diagnostic value of PET/CT in the preoperative advanced gastric carcinoma comparing with mult;-slice spiral computed tomography. Methods Thirty-nine advanced gastric carcinoma patients taking PET/CT and abstract 40 advanced gastric carcinoma patients performing MSCT before operation,were done the TNM staging, and the Results were compared with the operation histopathology. Results For diagnosing primary lesions, regional lymph nodes, N3 lymph nodes ,PET/CT was accurate in 92.3% , 66.7% and 100.0%.Instead, MSCT was accurate in 82.0% , 50.0% and 62.5%. Conclusions (1) PET/CT and MSCT have high accuracy in diagnosing primary lesions and regional lymph nodes. But for detecting the N3 lymph nodes and distant metastasis, PET/CT has higher accuracy than MSCT. PET/CT combining abdominoscopy may decrease or avoid exploratory laparotomy.
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Objective To study the clinical efficacy and adverse reactions of the preoperative neo-adjuvant chemotherapy with oxaliplatin plus fluorouracil and calcium folinate (FOLFOX) in the treatment of advanced gastric carcinoma that was difficult to undergo radical operation. Methods We enrolled 16 patients with advanced gastric carcinomas that were unable to undergo radical operation admitted to our hospital from April 2008 to October 2009. The neo-adjuvant chemotherapy regimen was oxaliplatin 130 mg/m~2 for first one, fluorouracil 500 mg/m~2 and calcium folinate 200 mg/m~2 from first day to fifth day,and one treatment course was three weeks and the patients underwent two courses.The changes of the primary lesion and the adverse reactions of the patients were observed. Results Carcinomas of 13 patients were degraded after the treatment, of which, 11 patients underwent radical resections after 4-6 weeks after operation.There were two cases of complete remission (CR) , 10 cases of partial remission (PR), three cases of stable disease(SD) and one case of progress disease(PD) , and the total effective rate was 75.0% (12/16). Adverse reactions included bone marrow suppression, diarrhea, nausea and vomiting and paresthesia, which were relieved after appropriate symptomatic treatment. Conclusions Neoadjuvant chemotherapy with FOLFOX can improve the resection rate of the advanced gastric carcinoma that is unable to undergo radical resection, and the patients' tolerability to this regimen is favorable.Thus, the regimen is worthy of generalizing.
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The extravasation of chyle into the peritoneal space usually does not accompany an abrupt onset of abdominal pain with symptoms and signs of peritonitis. The rarity of this condition fails to reach preoperative diagnosis prior to laparotomy. Here, we introduce a case of chylous ascites that presented with acute abdominal pain mimicking peritonitis caused by ovarian torsion in a 41-yr-old female patient with advanced gastric carcinoma. An emergency exploratory laparotomy was performed but revealed no evidence of ovarian torsion. Only chylous ascites was discovered in the operative field. She underwent a complete abdominal hysterectomy and salphingo-oophorectomy. Only saline irrigation and suction-up were performed for the chylous ascites. The postoperative course was uneventful. Her bowel movement was restored within 1 week. She was allowed only a fat-free diet, and no evidence of re-occurrence of ascites was noted on clinical observation. She now remains under consideration for additional chemotherapy.
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Adult , Female , Humans , Abdomen, Acute/etiology , Chylous Ascites/diagnosis , Diagnosis, Differential , Ovarian Diseases/diagnosis , Stomach Neoplasms/complications , Torsion Abnormality/diagnosisABSTRACT
Objective To review the research advancement of multimodal therapy for advanced gastric carcinoma.Methods The literatures on multimodal therapy for advanced gastric carcinoma in recent years were collected and reviewed.Results The multimodal therapy,such as preoperative chemotherapy,preoperative adjuvant chemoradiotherapy,preoperative interventional chemoradiotherapy for advanced gastric carcinoma was effective because it could increase the rate of R0 resection for the patients with advanced gastric carcinoma.And it can decrease the mortality rate after operation,extend the overall survival time and improve patients' life quality.Conclusion Multimodal therapy is a promising method for the treatment of advanced gastric carcinoma and it should be further developed.
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Objective To discuss how to improve the current status on clinical therapy for advanced gastric carcinoma. Methods Related literatures searched on Medline were collected and reviewed. Results The 5th edition of UICC/AJCC TNM staging system of gastric carcinoma is useful to evaluate the prognosis of patients with advanced gastric carcinoma followed by extended lymphadenectomy. There are many factors influencing their prognosis including disease stage, extent of lymphadenectomy, assistant therapy and so on. Conclusion It is significant for patients with advanced gastric carcinoma to undergo individualized extended lymphadenectomy and comprehensive therapy to improve their prognosis after radical gastrectomy
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Objective To explore the feasibility,safety,efficacy and mechanism of intraoperative regional chemotherapy of advanced gastric cancer. Methods The related literatures were reviewed and analyzed. Results Compared with systemic chemotherapy,intraoperative regional chemotherapy of advanced gastric cancer could increase blood drug concentration of cancerous tissue,reduce the systemic toxic side effects,increase survival rate and improve the quality of life. Conclusion Intraoperative regional chemotherapy,as an adjuvant treatment of advanced gastric cancer,has been gradually applied to clinic because of the definite curative effect,which is worth popularizing. However,it needs systemic researches and accumulation of cases.
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Background and purpose:Paclitaxel and cisplatin were demonstrated to be effective and well-tolerated for advanced gastric cancer.The clinical efficacy of hyperthermic intraperitoneal perfusion(CHPP) has been established in numerous studies in recent years.The purpose of the study was to evaluate the efficacy and toxicities of paclitaxel combined with CHPP with cisplatin in the treatment of patients with advanced gastric cancer.Methods:51 patients with advanced gastric cancer were randomized into systemic chemotherapy group(25 patients) who received paclitaxel 70 mg/m2,iv,1/wk?8wk,DDP 25 mg/m2,iv,d1-3,reapeated every 3 weeks for 4 cycles and systematic plus CHPP group(26 patients)who received paclitaxel 70 mg/m2,iv,1/wk?8wk,DDP 60 mg/m2,CHPP,d1,8,22,29,and abdomen hyperthermia treatment twice a week in the whole chemotherapy period.Results:The response rate(CR+PR),the clinical benefitial response(CBR) in systematic plus CHPP group were 65.4% and 92.3%,and those in systemic chemotherapy group were 36.0% and 68.0%.There was obviously a statistical difference between two groups(P0.05).The major toxicities were myelo-suppression and nausea/vomiting.There was no significant difference in side-effect between the two groups.Conclusions:Paclitaxel administered by weekly infusion combined with hyperthermic intraperitoneal perfusion chemotheraphy with cisplatin in the treatment of advanced gastric cancer is effective and tolerable.It is worth studying in the future.
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Purpose:To evaluate the efficacy and toxicity of the low dose 5 Fluorouracil and Cisplatin continuous infusion for treatment of advanced gastric carcinoma. Methods:A total of 21 patients were enrolled in the trial, FP therapy consisted of 5 FU (0 25/m 2/d) every day by continuous infusion and cisplatin (6 mg/m 2/d) every day by continuous infusion for 3 weeks.Results:A complete response was observed in 2 cases and a partial response in 10 cases, for and overall response rate of 57.1%. Toxic effects included leukopenia, thrombocytopenia, nauesa and vomiting.Conclusions:FP therapy is a promising regimen for patients with advanced gastric carcinoma.
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There have been some controversies on prognostic significance of lymph node (LN) micrometastasis (MM) in advanced gastric carcinomas (AGCs). The present study aimed at 1) determination of prognostic significance of MM, 2) evaluation of the relationship between MM and clinicopathological parameters, and 3) determination of LN group where MMs were frequently found. We studied 70 cases of AGC without LN metastasis on initial examination. The tumors were examined for location, size, depth of invasion, differentiation, histologic type, lymphatic invasion, and c-erbB-2 expression. To evaluate MM, pancytokeratin immunohistochemistry was performed in all LNs from 70 cases of AGCs. Among 2,203 dissected LNs from 70 patients, 37 (1.6%) LNs from 19 (27.1%) patients revealed MM. Micrometastases were seen in only group 1 and 2 LNs: none had group 3 and 4 LN involvement. The gender, age, tumor size, location of tumor, histologic type, differentiation, depth of invasion, lymphatic invasion, and c-erbB-2 expression were not significantly associated with MM status. The survival time of the MM-positive group (mean: 62 months) was significantly shorter than that of the MM-negative group (mean: 72 months) (p=0.046). The findings of this study indicate that the presence of MM in LNs is an important prognostic factor in AGC patients.
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Humans , Immunohistochemistry , Keratins , Lymph Nodes , Neoplasm Metastasis , Neoplasm MicrometastasisABSTRACT
Objective:To evaluate the role of using the double body position CT(DBP-CT)in the staging of advanced gastric cancer.Methods:We performed CT examination in 85 patients with advanced gastric cancer which were divided into the double postion group(55 cases)and the single position group(30 cases),after oral intake water agent.The preoperative CT findings of each group was compared with surgical findings respectively and the accuracy in the CT staging of advanced gastric cancer of each group was estimated.Results:The accuracy in the preoperative CT staging of double position group was 89.09%,and in single postition group was 60%.There was a significant difference(P＜0.05).Conclusion:Our findings show that the DBP-CT is surperior to the single position group in finding lesion,confineing the range of the tumour,and determing the degree of adjacent invasion.It can improve the diagnostic accuracy in the preoperative staging of advanced gastric cancers significantly.
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PURPOSE: Despite recent advances in the treatment for serosa invasive gastric carcinomas, no satisfactory outcomes are available because of early peritoneal recurrence caused by micrometastases and free floating cancer cells already existing in the peritoneal cavity. METHODS: We analyzed 103 serosa invasive gastric carcinoma patients who had recieved a surgical resection with or without IHCP from 1990 to 1995. All the patients were pathologically staged according to the UICC classification (1997): Stage II in 17 patients, IIIA in 24, IIIB in 24 and IV in 38. Under hypothermic general anesthesia (32.4- 34oC), IHCP was performed for 2 hours using 1.5% peritoneal dialysis solution mixed with l0 microgram/ml of mitomycin-C warmed at an inflow temperature over 43.5oC in 52 patients. RESULTS: 69 patients died during follow up period. The overall 5-YSR (year survival rate) was 32.8% in the IHCP group, 27.1% in the control group but this difference was not statistically significant. However, in 65 patients, except for those in stage IV, the 5-YSR was 58.6% in the IHCP group and 44.4% in the control group, this difference was statistically significant (p=0.0379). Especially in stage IIIB, the 5-YSR was significantly higher in the IHCP group than in the control group, 41.7% and 25% respectively (p=0.0417). The median survival in the IHCP group (36 mon.) was longer than the control group (22.9 mon.) due to differences in the recurrence patterns. The most common recurrence pattern in the control group was early peritoneal recurrence, but it was late local recurrence in the IHCP group. The types and the rates of complications between the two groups were not different, except for 3 patients with pancytopenia and renal insufficiency in the IHCP group. CONCLUSION: Complete cytoreductive surgery plus IHCP was a safe and effective method to prevent peritoneal recurrence and should lead to long term survival in serosa invasive gastric carcinoma patients, except for those in stage IV with distant metastases.
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Humans , Anesthesia, General , Classification , Follow-Up Studies , Mitomycin , Neoplasm Metastasis , Neoplasm Micrometastasis , Pancytopenia , Peritoneal Cavity , Peritoneal Dialysis , Recurrence , Renal Insufficiency , Serous MembraneABSTRACT
Purpose:To study the efficacy of preoperative selective intra arterial chemotherapy in advanced gastric carcinoma. Methods:Between August 1999 and November 2001, a total of 98 hospitalized patients with advanced gastric carcinoma who underwent selective intra arterial regional chemotherapy prior to surgery were recruited in this study. 60 patients with advanced gastric carcinoma on whom surgery were performed did not receive any preoperative regional anti cancer drugs between 1997 and 1998 and served as controls. The surgical resection rate and histologic investigations were compared. Results:The resection rate was 78% in regional chemotherapy group and 68% in control group. Tumor cell necrosis was investigated by postoperative pathological study and revealed that the response rate in regional chemotherapy group was 67%. Only 8 cases in control group showed mild focal necrosis. Conclusions:Preoperative regional chemotherapy in patients with advanced gastric carcinoma may enhance resection rate and destroy large numbers of tumor cells vigorously. The preliminary results are satisfying.
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Background and purpose:The majority of patients with gastric cancer are in advanced stage with either extensive invasion of tumor into the adjacent organs,lymph nodes or distant metastases when diagnosed.As a new anticancer drug of Taxanes,docetaxel has shown considerable promise in advanced gastric cancer through clinical study in these years.We conducted a clinical trial to compare the response and toxic reaction of weekly and 3-weeks'docetaxel /cisplatin/5-Fu treatment in advanced gastric cancer.Methods:80 patients were deviede into two groups.Ggroup A:Docetaxel 25 mg/m2 iv d 1,8,15,cisplatin 25 mg/m2 iv d 1-3,5-FU 500 mg/m2 iv d 1-5 q4w.Group B:Docetaxel 75 mg/m2 iv d 1,cisplatin 25 mg/m2 iv d 1-3,5-FU 500 mg/m2 iv d 1-5 q3w;The clinical responses were assessed after two cycles.Toxicity was assessed every cycle.Results:There was 1 CR in 40 cases,16 with PR,14 with SD in group A;there was 1 CR in 40 cases,17 with PR,14 with SD in group B.The overall response rates were 42.4% and 45.0% in group A and B,respectively.Grade Ⅲ/Ⅳ neatropenia were 32.5% and 77.5% in group A and B.The major non-hematologic toxicity was weakness.Grade Ⅲ/Ⅳ weakness were 22.5% and 42.5% in group A and B.Conclusions:The response rates were similar between groups A and B.The occurrence of hematological toxicity and weakness were lower in weekly treatment group.
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Placental and fetal involvement by matenal malignancy is rare. We report a case of placental metastasis from advanced gastric carcinoma in a 27 year-old woman. The patient also had disseminated bone metastasis, bone marrow involvement, malignant ascites, multiple lymphadenopathy, and disseminated intravascular coagulopathy. Cut surface of the placental body showed many, variable-sized, grayish white nodules and plaques. Light microscopic finding showed sheets of poorly differentiated adenocarcinoma in intervillous spaces. Villi were not invaded. Despite palliative chemotherapy the patient died of massive gastric cancer bleeding. But the patients child is alive and doing well with age of 11 months. We suggest that the presence of malignancy in pregnancy demands complete evaluation of the placenta and adequate follow-up of the infant for the sign of involvement.