Second-line chemotherapy for patients with advanced gastric cancer

The first choice for treating patients with metastatic gastric cancer is chemotherapy, and combination therapy with fluorouracil, platinum, and trastuzumab has been established as the standard first-line chemotherapy. For further improvement of treatment outcomes, it is important to develop second- and third-line chemotherapy. In the first decade of this century, irinotecan and taxanes, cytotoxic agents, and various molecular targeted agents began to be developed as second-line therapy. Treatment with paclitaxcel weekly in combination with ramucirumab targeting vascular endothelial growth factor receptor 2 has become the first choice for second-line therapy. Immune checkpoint inhibitors are now being developed, and the current treatment strategies for advanced gastric cancer may undergo major changes in the future. This review summarizes the transitions and future prospects of clinical developments for second-line therapy in patients with advanced gastric cancer.     

Early postoperative intraperitoneal chemotherapy with mitomycin C, 5-fluorouracil and cisplatin for advanced gastric cancer

OBJECTIVE: The long-term survival of patients who undergo surgery for stage IV gastric cancer is poor, due to metastatic spread of the tumor. Intraperitoneal chemotherapy (IPT) as a possible treatment for peritoneal dissemination has been investigated in a number of different tumors. The aim of this study was to investigate the toxicity and impact of early postoperative IPT on the survival of patients with advanced gastric cancer. METHODS: Between 1993 and 1997, a total of 91 patients with stage IV gastric cancer who underwent potentially curative or palliative resection received intraperitoneal mitomycin C before closure of the abdominal wound. 5-Fluorouracil and cisplatin were administered intraperitoneally on postoperative days 1-4, and this was repeated at 4-week intervals. RESULTS: All patients received a median of 3 IPT perfusions. There were 24 (26.4%) postoperative complications and 1 (1.1%) mortality. The most frequent hematologic toxicity (grade 3-4) was leukopenia. The major nonhematologic toxicities (grade 3-4) were emesis and nephrotoxicity. After a median follow-up period of 26 months, 14 patients remain alive without evidence of recurrence, whereas 75 patients died due to recurrence or progression of disease. The median survival period for all 91 patients was 15.4 months. When survival according to the residual tumor was analyzed, median survival was 36.0 months in the R0 (curative resection) group, 20.6 months in the R1 group (margins of resected specimens showing microscopic residual tumor or diameter of each residual tumor less than 3 mm) and 9.0 months in the R2 group (macroscopic residual tumor larger than 3 mm) (p < 0.001). CONCLUSIONS: IPT was found to be safe, and it appears to improve the prognosis in patients with minimal residual tumors. However, complete cytoreductive surgery is mandatory for achieving the beneficial effect of IPT.     

进展期大肠癌术后早期腹腔灌洗化疗

目的了解进展期大肠癌术后早期腹腔灌洗化疗对防治腹腔内复发和肝脏转移的价值。方法选择１９９０年～１９９７年经手术及病理证实的１０２例侵及浆膜或腹腔癌胚抗原增高的大肠癌,随机分成腹腔灌洗化疗组５４例,静脉化疗组４８例。腹腔灌洗化疗组于手术当日开始用４３～４５℃的双蒸馏水１５００～２０００ｍｌ加５Ｆｕ１ｇ、ＭＭＣ１０ｍｇ行腹腔灌洗,连续应用６次;静脉化疗组用５Ｆｕ１ｇ、ＭＭＣ８ｍｇ每日静滴１次,连续６次;两组各用６次后改为口服呋喃氟脲嘧啶,总量为４０ｇ。结果静脉化疗组腹腔内复发１２例,肝脏转移６例;腹腔灌洗化疗组腹腔内复发２例,肝脏转移２例。两组未见并发症。结论术后早期腹腔灌洗化疗对防治进展期大肠癌腹腔内复发和肝脏转移有明显疗效,而且方法简单,安全、实用     

Noncurative resection for advanced gastric cancer.

Between 1965 and 1985, 489 patients with advanced gastric cancer who were treated with gastric resection and in whom tumor cells remained after the operation were defined as cases of a "noncurative resection." The clinicopathological features and prognosis of these patients were examined and two groups were prepared: locally advanced cancer and cancer with a distant metastasis. In locally advanced cancer cases, tumor cells remained in the neighboring organs, lymph nodes, and/or resected margins; in those with distant metastasis, peritoneal dissemination and/or liver metastasis were present regardless of whether or not the metastasis was removed, with or without locally noncurative factors. Serosal invasion was prominent and high rates of lymph node metastasis and lymphatic involvement were evident in both groups. The survival rate for patients with locally advanced gastric cancer was better than that of patients with distant metastasis (P < 0.01). Survival time in patients with locally advanced cancer can be lengthened by resecting all of the primary tumor and as much of the metastatic lesions as possible, even if the surgical management is "noncurative." Aggressive postoperative chemotherapy for patients with distant metastasis from a gastric cancer is to be recommended.     

Palliative chemotherapy for advanced gastric cancer.

BACKGROUND: More than two-thirds of patients diagnosed with gastric cancer will have unresectable disease. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review the clinical trials utilizing cytotoxic chemotherapy in patients with advanced gastric cancer. METHODS: A computerized (Medline) search was carried out to identify papers published on this topic between 1966 and 2003. Only articles with an English abstract were reviewed, and studies only presented in abstract form were not included in the analysis. RESULTS: A total of 101 trials were subsequently identified. Four randomized trials compared palliative chemotherapy with best supportive care in 174 patients with advanced gastric cancer. Effectiveness and side-effects were evaluated in 73 phase II studies and 24 randomized phase III trials. CONCLUSION: Analysis of results shows chemotherapy to be superior to best supportive care alone. Combination chemotherapy compared with monochemotherapy is associated with significantly higher overall (complete plus partial) response rates but nevertheless results in similar survival. ECF (epirubicin, cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for advanced gastric cancer, whereas among the newer combinations, irinotecan- or taxane-based regimens have also given promising results. In patients with a poor performance status, consideration could be given to leucovorin-modulated 5-fluorouracil alone. Prognosis for the majority of patients, however, remains poor, as increases in survival were moderate at best.     

Efficiency of adjuvant immunochemotherapy following curative resection in patients with locally advanced gastric cancer

Background Despite curative resection, 50%–90% of gastric cancer patients die of disease relapse. Although some clinical trials have indicated that chemotherapy and immunochemotherapy may be effective modalities, more recent studies have not been able to define the standard treatment for advanced gastric cancer. The present study evaluated the effect of adjuvant immunochemotherapy with the use of BCG (bacille Calmette-Guérin) and FAM (5-fluorouracil, adriamycin, mitomycin C) chemotherapy on the survival of patients with locally advanced resectable gastric cancer.Methods A total of 156 patients with stage III or IV gastric cancer who had undergone curative resection were randomly assigned to three treatment groups: BCG + FAM (immunochemotherapy), FAM (chemotherapy), and control (surgery only). Treatment was continued for 2 years or until death. Further postsurgical follow up was carried on for up to 10 years.Results Overall 10-year survival was 47.1% for the immunochemotherapy group (P < 0.037 vs FAM and P < 0.0006 vs control), 30% for the chemotherapy group (vs control, NS), and 15.2% for the control group. In patients with pT2/T3 primary tumors, 10-year survival was 55.3% for BCG + FAM vs 28.2% for FAM (P < 0.01) and 14.6% for the control group (P < 0.00018). BCG + FAM signifi-cantly improved the survival of patients with intestinal-type but not diffuse-type cancer. Immunochemotherapy was well tolerated.Conclusion This study, based on a limited number of patients, indicates that adjuvant immunochemotherapy (BCG + FAM) may prolong the survival of gastric cancer patients after curative gastrectomy; in particular, in patients with pT2/T3 tumors and intestinal-type primary tumors. There was no survival benefit from FAM adjuvant chemotherapy.     

Serum carcinoembryonic antigen level increases correlate with tumor progression in patients with differentiated gastric carcinoma following noncurative resection

Serum carcinoembryonic antigen (CEA) levels were determined serially in 30 preoperative and postoperative patients with differentiated and 47 with undifferentiated gastric cancers. Macroscopic noncurative resection of the stomach was done for those patients. There was no difference between survival curves in the differentiated and undifferentiated cases, and the 50% survival was 13.1 months for the differentiated group and 12.5 months for the undifferentiated group. Preoperative serum CEA levels were 10.4 +/- 5.2 ng/ml for the differentiated and 4.0 +/- 1.6 ng/ml for the undifferentiated cases, and CEA-positive rates were 20.0% for the differentiated and 14.9% for the undifferentiated cases. There was no difference in preoperative CEA values with regard to tissue types. In the course of tumor progression, CEA levels increased during the first postoperative year in the differentiated cases and related reciprocally to decreases in survival rates. Little change was noted in the undifferentiated cases. Therefore, the serial postoperative assay of serum CEA levels has predictability with regard to tumor progression in patients with a differentiated gastric cancer.     

Early gastric cancer mimicking advanced gastric cancer.

The clinicopathological features of 37 early gastric cancers mimicking advanced gastric cancer were reviewed retrospectively, and were compared with 596 other early gastric cancers and 126 mp gastric cancers, defined as gastric cancer invading the muscularis propria of the stomach. A greater tumour size (P < 0.005), submucosal invasion (P < 0.005), lymph node and lymph vessel invasion (P < 0.005) and vascular invasion (P < 0.025) were found more frequently in early gastric cancers mimicking advanced gastric cancers than in other early gastric cancers. There were no significant differences in the clinicopathological findings between early gastric cancers mimicking advanced gastric cancers and mp gastric cancers. Patients with early gastric cancers mimicking advanced gastric cancers showed a lower survival rate than patients with other early gastric cancers, but a higher survival than those with mp gastric cancers. The macroscopic appearance of an advanced gastric cancer was an indicator of massive submucosal invasion and lymph node metastasis in early gastric cancer. As early gastric cancers mimicking advanced gastric cancers showed similar clinicopathological findings to mp gastric cancers, these cancers should be treated as mp gastric cancers.     

Postprogression survival for first-line chemotherapy in patients with advanced gastric cancer

BackgroundWith the increasing availability of active agents, the importance of postprogression survival (PPS) has been recognised for several malignancies. However, little is known of PPS in advanced gastric cancer.Patients and methodsA literature search identified 43 randomised trials in chemotherapy-naive patients with advanced gastric cancer. We partitioned overall survival (OS) into progression-free survival (PFS) and PPS, and then examined the correlation between median OS and either median PFS or median PPS. The correlation between differences in OS (ΔOS) and those in PFS (ΔPFS) between trial arms was also investigated.ResultsThe average median OS was significantly longer in recent (2006 and later) trials than in older (2005 and earlier) trials (10.60 versus 8.64 months, P < 0.001), as was the average median PPS (5.34 versus 3.74 months, P = 0.001). Median PPS was correlated with median OS for all trials (r = 0.732), and this correlation was more pronounced in recent trials (r = 0.850). By contrast, the correlation between median PFS and median OS was less pronounced in recent trials (r = 0.282), as was that between ΔPFS and ΔOS (r = 0.365).ConclusionAn increase in median PPS was found in accordance with an increase in median OS in recent trials compared with older trials for patients with advanced gastric cancer.     

Neoadjuvant chemotherapy for patients with positive cytology from advanced gastric cancer

Free cancer cells from advanced gastric cancer are associated with a poor prognosis. The aim of this study was to clarify the role of neoadjuvant chemotherapy (NAC) for patients with positive cytology from advanced gastric cancer. Thirty four patients with positive cytology and no macroscopic peritoneal deposits from advanced gastric adenocarcinoma at staging laparoscopy were studied. Gastrectomy after staging laparoscopy was performed in 9 patients (Surgery group). NAC following gastrectomy after staging laparoscopy was performed in 25 patients (NAC group). The overall response rate was 24% (CR in none, PR in 6, NC in 15, PD in 4). Two of the 4 patients with PD did not undergo surgical resection. Twenty three patients in the NAC group (resection rate 92%) underwent gastrectomy, which resulted in 17 R0, four R1, and two R2 resections. Eighteen of the 23 patients (78%) in the NAC group revealed no free cancer cells at operation. There was no significant deference in the overall survival curves between Surgery and NAC groups. Five of the 17 patients performed curative operation developed recurrence (peritoneum in 1, liver in]1, brain in 1, local and peritoneum in 1, paraaortic lymph node and peritoneum in 1). NAC for patients with positive cytology could lead into no free cancer cells at a high rate, but not to improve their prognoses. An intensive chemotherapy after gastrectomy should be necessary for these patients.     

卡培他滨维持化疗在晚期或术后复发转移胃癌患者中的效果观察

目的 观察卡培他滨维持化疗在晚期或术后复发转移胃癌患者中的临床效果.方法 选取行全身化疗的70例晚期胃癌患者,按照随机抽签1:1分为研究组和对照组,每组35例.对照组患者接受常规支持治疗,研究组患者接受卡培他滨维持化疗,比较两组患者的临床疗效.结果 研究组患者的中位总生存期长于对照组,差异有统计学意义(P﹤0.05)....     

进展期胃癌术后腹腔温热化疗278例回顾分析

目的总结进展期胃癌根治术后腹腔温热化疗的疗效。方法回顾在1990年代后收治的进展期胃癌根治术后患者,比较腹腔温热化疗组(治疗组)和常规静脉治疗组(对照组),治疗组采用腹腔温热化疗 常规静脉治疗,对照组采用常规静脉化疗,两组治疗方案及剂量均相同。分析两组患者化疗毒副作用、腹腔复发率和生存率。结果两组毒副作用差异无显著性;治疗组腹腔复发率低于对照组,治疗组3年生存率高于对照组,差异有显著性(P<0.05)。结论胃癌根治术后腹腔温热化疗可提高生存率,预防腹腔复发,改善患者的生存质量。     

Evolving chemotherapy for advanced gastric cancer

Gastric cancer is the fourth most commonly diagnosed cancer and is the second leading cause of cancer death worldwide. More than 50% of patients undergo surgery, but even after a curative resection, 60% of patients relapse locally or with distant metastases. Despite the fact that many advances have occurred in the management of gastric cancer, it continues to carry a poor prognosis, amplifying the importance of palliative chemotherapy. When compared with best supportive care alone, combination chemotherapy yields a significant advantage in the management of advanced gastric cancer. However, no single regimen has emerged or been accepted as clearly superior over another. Numerous phase II studies have demonstrated promising results with newer agents including irinotecan, docetaxel, capecitabine, S-1, and oxaliplatin. Recently reported phase III results with these agents now demonstrate positive developments in the treatment options for patients with advanced gastric cancer.     

含紫杉醇方案治疗晚期胃癌的临床观察

  目的 评价两种含紫杉醇（TAX）方案治疗晚期胃癌的临床疗效及安全性。方法 31例病理证实的晚期胃癌患者接受两种含紫杉醇方案化疗，即：紫杉醇+５-氟尿嘧啶（TF方案）19例；紫杉醇+顺铂（TP方案）12例。使用过5-氟尿嘧啶类药物的患者入TP组，其余入TF组，21 d为1周期，连用2周期后评价疗效。结果 31例患者均可评价疗效与不良反应，TF方案有效率为47.4 ％，TP方案有效率为41.7 ％，总有效率为45.2 ％，临床受益率（CBR）为80.6 ％。副作用主要是白细胞减少，发生率58.1 ％，Ⅲ度以上占9.7 ％；胃肠道反应发生率为38.7 ％。结论 含紫杉醇方案有确切疗效，CBR高，不良反应可耐受，对多次使用含5-氟尿嘧啶及衍生物方案化疗过的患者，选用TP方案仍有效。     

D2 plus radical resection combined with perioperative chemotherapy for advanced gastric cancer with pyloric obstruction

A patient with advanced gastric cancer complicated with pyloric obstruction was treated using D2 + radical resection combined with perioperative chemotherapy, and had satisfying outcomes. The perioperative chemotherapy regimen was Taxol and S1 (tegafur, gimeracil, and oteracil). Three cycles of neoadjuvant chemotherapy were delivered before surgery, and three cycles of adjuvant therapy after surgery. PR was achieved after chemotherapy. D2 + dissection of stations 8p, 12b, 12p, 13 and 14v lymph nodes was performed on September 10, 2012.Key Words: Advanced gastric cancer, pyloric obstruction, D2 + lymph node dissection, perioperative chemotherapyD2 lymph node dissection has become the standard surgical approach for advanced gastric cancer (1-3). However, in the case of lower stomach cancer complicated by pyloric obstruction, the lymphatic drainage and pattern of metastases are different due to the anatomical restriction, and a higher rate of metastases into the hepatoduodenal ligament and the posterior area of the pancreatic head are often seen (4). Perioperative chemotherapy can significantly improve the survival of patients (5,6). This video describes the procedure of D2 + radical resection combined with perioperative chemotherapy for a patient with lower gastric cancer complicated by pyloric obstruction, as follows. The treatment was successful.A 53-year-old woman was admitted on June 3, 2012 due to “upper abdominal fullness with dull pain for 3 months, with intermittent nausea and vomiting for 10 days.” Gastroscopy suggested a huge, solid ulcer at the antrum close to the pylorus, involving the pylorus and resulting in pyloric stenosis. Endoscopic biopsies suggested poorly differentiated adenocarcinoma of the gastric antrum. CT: huge tumor in the antrum, considered as gastric antral carcinoma, infiltrating through the serosa with metastases to multiple lymph nodes surrounding the stomach and superior area of the pancreas. Tumor markers: CA199 402.15 U/mL. Clinical diagnoses: cancer of the gastric antrum involving the pylorus, complicated by partial pyloric obstruction, staging T4aN2M0. Three cycles of preoperative chemotherapy were delivered on June 9, July 2 and July 28, 2012, using the regimen of Taxol 240 mg/dL and S1 60 mg bid po d1-14, repeated for three weeks. After the chemotherapy courses, the CT scan suggested significantly reduced volume of the antral tumor, and lymph nodes around the stomach and the pancreas were not as obvious as before. PR was achieved following chemotherapy. Radical gastrectomy with D2 + lymph dissection was performed under general anesthesia for the distal gastric cancer resection on September 10, 2012.During the surgery (Video 1), the patient was placed in a supine position. Following general anesthesia, a middle upper abdominal incision of 3 cm was made from the xiphoid down to the umbilicus. The wound was well protected, and abdominal exploration was conducted to confirm that there were no peritoneal and liver metastases. A piece of gauze was gently padded posterior to the pancreas to prevent tearing. Kocher’s separation: the peritoneum was divided at the lateral border of the duodenum and the duodenum was freed. The incision continued downwards to the hepatic flexure of the colon to expand the surgical field. Sharp dissection was performed along the posterior region of the duodenum and the pancreas to reveal the inferior vena cava, the beginning part of the left renal vein, and the right ovarian vein. The anterior lobe of the transverse mesocolon and the pancreatic capsule were completely separated to the hepatic flexure of colon on the right side and to the lower pole of the spleen on the left side, so that the omental bursa could be completely removed.Open in a separate windowVideo 1D2 plus radical resection combined with perioperative chemotherapy for advanced gastric cancer with pyloric obstructionThe lymph nodes in the inferior area to the pylorus were dissected along the course of the middle colon vein towards its root, and the superior mesenteric vein (SMV) anatomy, as well as the gastrointestinal vein trunk and accessory right colic vein, was freed from the inferior region of the pancreatic neck. The station 14v lymph nodes were dissected around the SMV. The separation continued towards the pylorus to free the right gastroepiploic vein and the anterior superior pancreaticoduodenal vein. The structure of the gastrointestinal vein trunk formed jointly by the right gastroepiploic vein, anterior superior pancreaticoduodenal vein and accessory right colic vein was clearly visible. The right gastroepiploic vein was ligated and cut before its junction with the pancreaticoduodenal vein. The gastroduodenal artery was isolated at the junction of the duodenum and the pancreatic head. The separation continued towards the pylorus to free the right gastroepiploic artery, which was then ligated and cut at the root. The inferior pyloric artery from the gastroduodenal artery was then separated. The inferior pyloric artery was ligated and cut, and the lower edge of the duodenum and the pylorus was completely denuded to for the complete dissection of the station number 6 lymph nodes.The left gastroepiploic artery was separated, ligated and cut from the lower pole of the spleen, followed by dissection of the station number 4sb lymph nodes. The fascia over the upper edge of the pancreas was opened to reveal the splenic artery, for the dissection of the station number 11p lymph nodes. It should be noted that there were several curves along the splenic artery to the splenic hilum, especially the largest one of 3 to 4 cm to the root, which was hidden behind the pancreas with lymph nodes inside that should not be omitted. After dissection of the station number 11p lymph nodes, the separation was continued towards the left diaphragmatic muscle to dissect the lymph nodes to the left of the celiac artery.The stomach was flipped down to the inferior side, and the anterior peritoneum of the hepatoduodenal ligament was opened. The proper hepatic artery and the right gastric artery were divided, and the latter was ligated and cut at the root. The station number 5 lymph nodes were dissected. The supraduodenal vessels were transected, and the upper edge of the duodenal bulb was completely denuded. The duodenum was transected 3 cm below the pylorus (with a Tyco 60 mm linear stapler), with the duodenal stumps closed with reinforced stitching.Denuding and dissection of the hepatoduodenal ligament: the lymph nodes surrounding the proper hepatic artery (number 12a) were dissected, and the artery was retracted with retraction bands to divide the left and right hepatic arteries. Since the hepatic branch and plexus of the vagus nerve were completely removed, there would be an extremely high risk of cholecystitis and gallstones after surgery, so gallbladder was removed as well. The common bile duct was separated, and the surrounding lymph nodes were dissected (number 12b). Caution was made to protect the supplying vessels to the common bile duct. The portal vein to the posterior area was separated, and the surrounding lymph nodes (number 12p) were dissected.Dissection of lymph nodes posterior to the pancreatic head (number 13): these lymph nodes often attached closely to the pancreatic head in a flat shape. An electrocautery was required in the sharp separation, with caution to avoid the retroduodenal artery. In some cases, these lymph nodes would be closely adhesive to that small artery, so it could be separated first to prevent bleeding. The stations number 13, 12b and 12p were pushed to the right through the Winslow’s hole and retracted from the left side of the hepatoduodenal ligament. These lymph nodes were then separated along the common hepatic artery and the upper edge of the splenic vein towards the celiac trunk. The stations number 8a and 8p were dissected en bloc. The coronary vein was divided from the posterior region close to the root of the common hepatic artery, and then ligated and transected. The lymph nodes to the right of the celiac artery (number 9) were then dissected along the plane of the right crus of the diaphragm. The left gastric artery was denuded from the periphery, ligated and cut at the root, and station number 7 lymph nodes were dissected. The separation was continued along the right crus of the diaphragm towards the cardia to dissect the lymph nodes on its right and posterior side (number 1). The greater and lesser curvatures of the stomach were denuded using Ligasure (Tyco, energy platform), and the stations number 3 and 4d lymph nodes were dissected. The stomach was then transected 5 cm from the upper edge of the tumor with a Tyco 100 mm linear stapler, and 2/3 of the distal stomach was removed together with the lymph nodes.Reconstruction: Billroth II gastrojejunostomy (Tyco 25 mm circular stapler) was performed in combination with Braun’s anastomosis.The whole operation lasted 2 hours and 50 minutes, with intraoperative blood loss of 100 mL and no blood transfusion. The patient was able to ambulate four days after surgery. Liquid diet was prescribed on the 5th day, and semi-liquid diet was prescribed on the 7th day. The patient was discharged eight days after surgery. Postoperative pathology: chronic inflammation with ulceration in the mucosa of the posterior wall of the antrum, with a small amount of degenerated adenocarcinoma with interstitial fibrosis in the mucosal and serosal layers; lymph nodes 0/36 (subcomplete remission).Three cycles of adjuvant chemotherapy were delivered on October 26, November 22 and December 16, 2012 after surgery, using the regimen of Taxol 240 mg/dL and S1 60 mg bid po d1-14, repeated for three weeks. No sign of recurrence was observed during the nine months of postoperative follow-up. The tumor marker CA199 has remained at a low level.     

Problems with intraoperative hyperthermic peritoneal chemotherapy for advanced gastric cancer.

BACKGROUND: Intraoperative hyperthermic peritoneal chemotherapy (IHPC) after total gastrectomy for advanced, serosa-penetrating gastric cancer has been demonstrated in several studies to reduce the incidence of peritoneal carcinosis and to prolong survival. METHODS: In a prospective pilot study, nine patients with advanced gastric cancer were selected to receive IHPC with Mitomycin and Cisplatin after total gastrectomy and systematic lymphadenectomy. RESULTS: All patients had nodal, and four patients distant, metastases. Six patients (66%) suffered from post-operative complications including renal failure, pancreatitis, pancreatic fistula and anastomotic dehiscence. Thirty-day mortality was zero. Six patients died within 3-10 months after surgery. Five of these deaths were related to peritoneal carcinosis and one patient died from cardiac failure 3 months after surgery. Three patients, respectively, have been alive for 12, 20 and 24 months at present, with suspected peritoneal tumour in the last patient. The 2-year probability of survival among our patients receiving IHPC is 29%. CONCLUSION: Intraoperative hyperthermic peritoneal chemotherapy carries a high risk of peri-operative complications and was not able to prevent or delay peritoneal tumour recurrence in patients with advanced gastric cancer.     

奥沙利铂联合卡培他滨一线治疗进展期胃癌的临床疗效观察

背景与目的：奥沙利铂联合卡培他滨（XELOX方案）是治疗进展期胃癌（advanced gastric cancer,AGC）的有效方案,但是该方案作为一线方案治疗AGC患者的疗效和安全性尚不确定。本研究旨在探讨XELOX方案作为一线方案治疗AGC的疗效及安全性。方法：33例既往未接受过化疗的AGC患者采用XELOX方案化疗．奥沙利铂130mg／m^2,静脉滴注2h,d1;卡培他滨2000mg／m^2,分2次口服．d1～14,21天为一个周期。患者最多接受8个周期化疗。结果：33例患者共接受159个周期的化疗,中位化疗周期数为5个。31例患者可评价疗效,其中完全缓解1例（3．2％）,部分缓解16例（51．6％）,稳定8例（25．8％）,进展6例（19．4％）。客观有效率54．8％（95％可信区间37．3％-72．3％）,临床获益率80．6％（95％可信区间66．7％～94．5％）。平均随访10．5个月,中位疾病进展时间5．9个月（95％可信区间4．7～7．1个月）,中位生存时间10．4个月（95％可信区间7．9～12．9个月）。常见不良反应有骨髓抑制、外周神经毒性、胃肠道反应、手足综合征等,经对症治疗后均好转．无治疗相关性死亡。结论：XELOX方案一线治疗AGC疗效显著,耐受性良好。