Abstract
IntroductionThe concept of neoadjuvant chemotherapy has now been widely accepted to increase the curative resection rate and the long-term survival in advanced gastric cancer (AGC) patients. However, standard chemotherapeutic regimen has not been established yet. The aim of our study was to evaluate the feasibility and efficacy of a preoperative chemotherapy in patients with unresectable AGC, combining intravenous 5-Fu and Leucovorin and intraarterial Oxaliplatin, Epirubicin, and Etoposide. MethodsUnresectable AGC patients without distant hematogenous metastasis and peritoneal dissemination were eligible for entry. Tumors with bulky nodal metastases surrounding the aortic artery, celiac artery and its branches, or invasion of adjacent structures such as pancreas, oesophagus, and the hilus of the liver were considered unresectable. The preoperative chemotherapy consisted of intravenous 5-Fu (370mg/m2) and Leucovorin (200mg/m2) on days 1-5, and intraarterial Oxaliplatin (120mg/m2), Etoposide (80mg/m2), and Epirubicin (30mg/m2) on days 6 and 20, repeated twice every 5 weeks. Chemotherapy was followed by surgery in patients who achieved complete or partial responses and whose cancers were judged to be resectable. ResultsNinety nine patients were entered into the study, and 95 patients received two cycles of preoperative chemotherapy. Response to chemotherapy was observed in 78 patients (82.1%): eight (8.4%) complete and 70 (73.7%) partial responses, and in six (7.1%) cases a complete pathological response was confirmed. No therapy-related deaths occurred, and serious adverse effects (grade 3–4) were noted in 18 (18.2%) patients. The primary tumor was resected in 75 patients (68 R0 resection and seven R1 resection). No surgical mortality and 16.9% morbidity rate were observed. For the whole group, the median survival was 25 months, and 2-year survival rate was 57.4%. The median survival for patients who received R0/R1 resection or not were 28 and 11 months, respectively. ConclusionThis combined intensive neoadjuvant chemotherapy appears to be a safe and promising treatment for patients with unresectable AGC to obtain curative resection and prolong survival.
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