ObjectiveTo evaluate the therapeutic effect and adverse reaction of paclitaxel liposome combined with continuous infusion of large-dose 5-fluorouracil(5-fu) in treatment for advance gastric cancer(AGC). MethodsFrom May 2009 to August 2012, 63 consecutive patients with AGC in this hospital were enrolled in this study. All the patients were given chemotherapy including paclitaxel liposome and continuous infusion of large-dose(2.5 g/m2) 5-fu. The efficacy and toxicity of this regimen were observed. ResultsThere was no patient who could not tolerate adverse reaction related to such regimen. Five cases achieved complete response and 31 cases achieved partial response, the overall response rate was 57.1%(36/63). Hematologic toxicity included gradeⅢ/Ⅳleucopenia 8 cases(12.7%) and neutropenia 10 cases(15.9%), while there was no occurrence of gradeⅢ/Ⅳanemia or thrombopenia. Non-hematologic toxicity was fairly mild. ConclusionsPaclitaxel liposome is safe, well tolerated, highly targeted, and has long duration of effect. Paclitaxel liposome combined with continuous infusion of large-dose 5-fu is safe and effective in treatment for patients with AGC.
Objective To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.
ObjectiveTo evaluate the prognostic significance of serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factors-Ⅰ (IGF-Ⅰ) in advanced gastric cancer patients who were treated with oxaliplatin/5-fluorouracil (FOLFOX). MethodsNinety-six advanced gastric cancer patients who were treated with FOLFOX in our hospital between March 2007 to August 2010 were enrolled in this study. All of the patients were treated with oxaliplatin (85 mg/m2) as a 2-hour infusion on day 1, and leucovorin (20 mg/m2, about 10 min) on day 1 and day 2, followed by a 5-fluorouracil bolus (400 mg/m2) and 22 hours of continuous infusion of 600 mg/m2. Treatment was repeated in 2-week intervals, and patients received 4 chemotherapy cycle in total. The levels of serum VEGF and IGF-Ⅰ were measured using enzyme-linked immunoassays. The relationship between serum levels of VEGF/IGF-Ⅰ and the clinicopathological characteristics of patients, the relationship between serum levels of VEGF/IGF-Ⅰ and prognosis of patients, were analyzed. ResultsThe serum levels of VEGF and IGF-Ⅰ were (464.4±57.4) pg/mL and (33.5±7.3) ng/mL, respectively. The serum level of VEGF was related with surgical history, Lauren's classification, TNM staging before treatment, and pathological type (P < 0.05), and serum level of IGF-Ⅰ was related with TNM staging before treatment and number of transferred organs (P < 0.05). The serum levels of VEGF and IGF-Ⅰ in stable disease (SD) +progressive disease (PD) patiens were higher than those of complete response (CR) +partial response (PR) patients (P < 0.05). The results of Cox proportional hazard regression model showed that, effect of chemotherapy (HR=1.764, P=0.006), number of transferred organs (HR=1.662, P=0.015), serum level of VEGF (HR=1.834, P=0.012) and IGF-Ⅰ (HR=1.855, P=0.008), were all significantly related with time to progression (TTP); serum level of VEGF (HR=2.205, P=0.002) and IGF-Ⅰ (HR=1.931, P=0.004) were all significantly related with overall survival (OS). ConclusionLevels of serum VEGF and IGF-Ⅰ are independent prognostic factors in patients with advanced gastric cancer who were treated with FOLFOX chemotherapy.
ObjectiveTo systematically review the efficacy and safety of neoadjuvant chemotherapy containing tegafur gimeracil oteracil potassium (S-1) combined with surgery in the treatment of advanced gastric cancer.MethodsWe searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to February 2017, to collect randomized controlled trials (RCTs) about neoadjuvant chemotherapy containing S-1 combined with surgery in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 971 advanced gastric cancer patients were included. The results of meta-analysis showed that the neoadjuvant chemotherapy containing S-1 combined with surgery group was superior to the control group in R0 resection rate (OR=2.75, 95%CI 1.91 to 3.95, P<0.000 01), 2 year survival rate (OR=1.72, 95%CI 1.01 to 2.93, P=0.05) and 3 year survival rate (OR=1.64, 95%CI 1.12 to 2.41, P=0.01), while there were no statistical differences in response rate (OR=1.33, 95%CI 0.70 to 2.51, P=0.39), 1 year survival rate (OR=1.50, 95%CI 0.64 to 3.53, P=0.35) and the incidence of postoperative complications (OR=1.00, 95%CI 0.66 to 1.51, P=0.98).ConclusionNeoadjuvant chemotherapy containing S-1 combined with surgery can improve the R0 resection rate, 2-year survival rate and 3-year survival rate without increase postoperative complications rate. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the relationship between methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism and efficacy of fluorouracil-based chemotherapy in patients with advanced gastric cancer (AGC). MethodsComputer retrieval in China Journal Full-text Database, Chinese Science and Technology Periodical Database, Wanfang database, Chinese Biomedical Literature Database, PubMed, EMbase, Cochrane Library and Web of Science Database (from their establishment to May 28, 2013) was performed to include case-control studies on MTHFR gene C677T polymorphism and sensitivity to fluorouracil-based chemotherapy in patients with advanced gastric cancer. Statistical analysis was done by using RevMan 5.1 software. ResultsSeven case-control studies with 775 patients were included. The meta-analysis showed that among MTHFR C677T genotypes, for TT vs. CC, OR=4.63, 95%CI (1.23, 17.4); and for CC+CT vs. TT, OR=0.21, 95%CI (0.06, 0.78). Subgroup analysis of Asian group showed that for TT vs. CC, OR=32.99, 95%CI (11.40,95.42); and for CC+CT vs. TT, OR=0.04, 95%CI (0.02, 0.10). Sensitivity analysis performed according to different detection methods showed that for TT vs. CC, OR=6.03, 95%CI (1.53, 23.72); and for CC+CT vs.TT, OR=0.17, 95%CI (0.04, 0.68). ConclusionPolymorphism of MTHFR C677T gene may be associated with sensitivity to fluorouracil-based chemotherapy in patients with AGC.
Objective To systematically evaluate the safety and efficacy of trastuzumab combined with chemotherapy for HER-2 positive patients with advanced gastric cancer. Methods We searched ClinicalTrails.gov, PubMed, EMbase, Web of Science, The Cochrane Library (Issue 5, 2016), CNKI, CBM, WanFang Data, VIP and major meeting proceeding databases (ASCO and ESMO) from inception to May 2016, to collect randomized controlled trials (RCTs) or non-RCTs about trastuzumab combined with chemotherapy versus chemotherapy alone for advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed by using RevMan 5.3 software. Results Nine studies involving 1 034 HER-2 positive patients were included, of which three were RCTs and the other six were non-RCTs. Meta-analysis results indicated that the trastuzumab combined with chemotherapy group (the trial group) was superior to the chemotherapy alone group (the control group) in complete remission (OR=2.76, 95%CI 1.40 to 5.44,P=0.003), partial remission (OR=1.81, 95%CI 1.40 to 2.33,P<0.000 01), overall response rate (OR=2.09, 95%CI 1.63 to 2.68,P<0.000 01) and disease control rate (OR=2.20, 95%CI 1.63 to 2.98,P<0.000 1), while there was no statistical significances in stable disease (OR=0.87, 95%CI 0.66 to 1.14,P=0.31). In terms of safety, the incidence of diarrhea (OR=1.51, 95%CI 1.10 to 2.06,P=0.01) and erythra (OR=4.35, 95%CI 1.25 to 15.10,P=0.02) in the trial group were higher than the control group. However, other adverse reactions were no significant differences in two groups. Conclusion Compared with chemotherapy alone, trastuzumab combined with chemotherapy in the treatment of HER-2 positive patients with advanced gastric cancer can significantly improve response rate, but it may increase the incidence of diarrhea and erythra. Because of the limited quality and quantity of the included studies, the above conclusion needs to be verified by conducting more high quality studies.
Objectives To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Methods We searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to March 2017, to collect randomized controlled trials (RCTs) on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 RCTs involving 984 advanced gastric cancer patients were included. The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in ORR (RR=1.21, 95%CI 1.02 to 1.43, P=0.03), DCR (RR=1.13, 95%CI 1.01 to 1.26, P=0.03), 1-year survival rate (RR=1.26, 95%CI 1.01 to 1.56, P=0.04) and 2-year survival rate (RR=3.03, 95%CI 1.59 to 5.75, P=0.000 7), while there was no statistical difference between two groups in the incidence of grade Ⅲ to Ⅳ adverse events. The results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate (RR=2.56, 95%CI 1.06 to 6.19, P=0.04), but there were no statistical differences in ORR (RR=1.13, 95%CI 0.88 to 1.45, P=0.34), DCR (RR=1.02, 95%CI 0.85 to 1.21, P=0.84) and 1-year survival rate (RR=1.29, 95%CI 0.92 to 1.80, P=0.14). The results of sensitivity analysis indicated that the overall outcomes might be affected by the risk bias of included studies. The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade Ⅲ to Ⅳ adverse events. Conclusions Compared with epirubicin based regimens, docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo observe the clinical curative effect of interventional chemotherapy in the treatment of advanced gastric cancer. MethodsThirty advanced gastric cancer patients underwent arterial infusion chemotherapy and embolization treatment between January and December 30, 2013. The treatment was carried out every three weeks. We evaluated the clinical results after the third treatment. The clinical improvement was assessed based on alleviation of such symptoms as epigastric pain, poor appetite, nausea, vomiting and fecal occult blood. The tumor size was evaluated through abdominal CT examination. ResultsAbdominal pain relieved in 19 out of 28 patients (67.9%); appetite improved in 18 out of 24 patients (75.0%); vomiting relieved in 15 out of 16 cases (93.8%); and fecal 9 out of 12 patients with positive occult blood turned to negative (75.0%). The total effective rate was 83.3%, and 8 patients accepted interventional therapy after operation. The survival rates during the 6, 12 and 24-month follow-up were respectively 85.0%, 65.0%, and 25.0%. ConclusionsInterventional chemotherapy and embolization treatment are effective for advanced gastric cancer, which can relieve symptoms and lower tumor stage. Some patients have a second chance of operation, which can be an effective method in the treatment of advanced gastric cancer.
Objective To evaluate the efficacy and toxicity of the combination of S-1 and oxaliplatin in the first-line chemotherapy of patients with advanced gastric cancer. Methods From March 2012 to April 2013, 57 patients in the First Affiliated Hospital of Guangxi Medical University were enrolled in this study. Oxaliplatin was administered at 130 mg/m2 on day 1, while S-1 was administered orally (< 1.25 m2: 40 mg twice per day; 1.25-1.50 m2: 50 mg twice per day; > 1.50 m2: 60 mg twice per day) for 14 days. The response was evaluated every two chemotherapy cycles. Results The objective response rate was 52.6%, and the disease control rate was 84.2%. The median time to progression was 5.8 months, and the median survival time was 13.5 months. The major grade 3/4 hematological toxic effects were neutropenia (12.3%) and thrombocytope nia (12.3%), and the grade 3/4 non-hematological toxic effects were vomiting, fatigue and sensory neuropathy. The rate of clinical benefit response was 71.9% (41/57). Conclusion The regimen of oxaliplatin and S-1 shows precise efficacy and good tolerance against advanced gastric cancer, and it is worthy of promotion and application in the future.
ObjectiveTo evaluate clinical effect of neoadjuvant chemotherapy combined with laparoscopic gastrectomy in treatment of local advanced gastric cancer. MethodsThe clinical data of 24 patients with local advanced gastric cancer undergoing 2 courses of FLEEOX neoadjuvant chemotherapy from July 2012 to July 2015 were analyzed. The efficacy of neoadjuvant chemotherapy based on radiographic results was evaluated. The gastrectomy was performed on week 2 after neoadjuvant chemotherapy. Patients were treated with XELOX regimen as adjuvant chemotherapy after laparoscopic gastrectomy. Results① Complete response occurred in 4 cases (16.6%), partial response in 18 cases (75.0%), stable disease in 1 case (4.2%), disease progressive in 1 case (4.2%). The total effective rate of neoadjuvant chemotherapy was 91.6% (22/24). ② The serum tumor markers CEA, CA19-9, and CA125 levels after neoadjuvant chemotherapy were significantly lower than those before neoadjuvant chemotherapy (P < 0.001) and reached normal levels. ③ Two courses of neoadjuvant chemotherapy and laparoscopic exploration were completed successfully in these 24 patients. Two patients with intraabdominal metastasis were underwent palliative gastrojejunostomy, the other 22 patients were underwent laparoscopic D2 radical gastrectomy. The operative time was (236±45) min, the intraoperative blood loss was (150±50) mL, the number of lymph node dissected was 17.4 ± 5.3, the postoperative gastrointestinal function recovery time was (3.1±0.8) d. ④ There was no death due to surgery. One case suffered anastomotic leakage, 1 case intestinal obstruction, and 1 case pulmonary infection after surgery. The postoperative complications were cured by conservative treatment. ⑤ The haematological adverse events included anemia (9 patients), leukopenia (14 patients), thrombocytopenia (8 patients), aminotransferase abnormality (5 in elevated ALT, 6 in elevated AST), the most common toxicity was nausea (19 patients), 10 patients suffered nerve toxicity. All the patients were relieved after treatment. ⑥ The patients were followed up for 4-39 months, 1 case died of cachexia as the result of extensive abdominal metastasis, 1 case died of liver failure as the result of multiple liver metastases, 1 case was death as the result of brain metastasis, 1 case was death as the result of the other cause, the other 20 patients were alive. ConclusionsThe preliminary results of limited cases in this study show that FLEEOX neoadjuvant chemotherapy combined with laparoscopic gastrectomy for local advanced gastric cancer is safe and effective. It has advantages of minimal invasion and fast recovery.