Adjuvant combined systemic chemotherapy and intraperitoneal chemotherapy for locally advanced gastric cancer

Xue, Shengliu; Su, Huafang; Hu, Xiaoqu; Deng, Xia; Hu, Mei-Long; Xie, Congying

doi:10.3892/ol.2012.914

Cited by 11 publications

(5 citation statements)

References 25 publications

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“…The use of IP chemotherapy as an adjuvant or neoadjuvant treatment combined with surgery has become a current hot topic ( 21 – 27 ). Post-operative adjuvant IP chemotherapy has shown encouraging efficacy ( 21 – 23 ). However, for patients with extremely advanced gastric cancer, neoadjuvant IP chemotherapy combined with surgery requires a high degree of selectivity.…”

Section: Discussionmentioning

confidence: 99%

DCF intraperitoneal and intravenous dual chemotherapy regimen for advanced gastric cancer: A feasibility study

Feng

Chen²,

Liu³

et al. 2014

Oncology Letters

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Gastric cancer is the fourth most common type of cancer globally and accounts for the second highest cancer-associated mortality rate in the world. Current treatment strategies for gastric cancer include surgery, radiotherapy, chemotherapy and targeted therapy. Intraperitoneal (IP) chemotherapy may increase the IP concentrations of chemotherapy drugs and reduce the systemic toxicity. At present, IP chemotherapy is used to treat patients with advanced gastric cancer, which has a high rate of peritoneal recurrence. The present study evaluated the feasibility of using docetaxel, cisplatin and fluorouracil (DCF) in an IP and intravenous (IV) dual chemotherapy regimen for the treatment of advanced gastric cancer. The treatment-associated adverse reactions and preliminary efficacy were reported. The first dose level utilized the full dose of DCF: Docetaxel, day one, 45 mg/m2 (IP) and day eight, 30 mg/m2 (IV); cisplatin (DDP), day one, 75 mg/m2 (IP); and fluorouracil (FU), days one to five, 750 mg/m2 (continuous IV). A total of six patients were treated at this level and two patients withdrew due to serious adverse reactions. Taking into account that the the tolerated doses used in combination regimens for Eastern populations are lower than that of the corresponding doses for Western populations, the dosages of the three drugs were all reduced by 20% in the application of the second dose level: Docetaxel, day one, 30 mg/m2 (IP) and day eight, 30 mg/m2 (IV); DDP, day two, 60 mg/m2 (IP); and FU, days one to five, 600 mg/m2 (continuous IV). A total of 26 patients were treated at this level. The main adverse reaction was bone marrow suppression, with grade III/IV neutropenia, leukopenia and febrile neutropenia accounting for 61.5, 53.8 and 19.2% of reactions, respectively, and grade III/IV anemia and thrombocytopenia accounting for 19.2 and 15.4% of reactions, respectively. Gastrointestinal adverse reactions primarily consisted of abdominal pain, with grade III/IV abdominal pain accounting for 30.8% of reactions. Only 7.7% of the patients withdrew from the treatment. The median time to progression (TTP) was five months [95% confidence interval (CI), 1.0–9.0 months], and the median overall survival (OS) was nine months (95% CI, 7.4–10.6 months). It was concluded that the DCF regimen with reduced dosage should be applied. IP and IV dual chemotherapy for the treatment of unresectable advanced gastric cancer is tolerated and demonstrated a good initial efficacy. Strategies for mitigating and reducing the adverse gastrointestinal reactions, particularly abdominal pain, may be the focus of future studies.

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Section: Discussionmentioning

confidence: 99%

DCF intraperitoneal and intravenous dual chemotherapy regimen for advanced gastric cancer: A feasibility study

Feng

Chen²,

Liu³

et al. 2014

Oncology Letters

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“…Кроме того, как следует из результатов ранее опубликованных нами исследований, применение адъювантной ИИТХТ при лечении РЖ с высоким риском имплантационного метастазирования является адекватной мерой профилактики метахронного канцероматоза (ОР 0,2 (95% ДИ 0,11-0,37), p<0,001), но в то же время сопровождается увеличением риска развития ОЛГМ -ОР 7,5 (95% ДИ 2,2-25,0), p=0,001 [1]. Последнее обосновывает необходимость и целесообразность профилактики системного прогрессирования РЖ после проведения интраоперационной интраперитонеальной химиотерапии, что было подчеркнуто в ряде исследований, в которых интраперитонеальная химиотерапия сочеталась с АПХТ, проводившейся периоперационно [12], в послеоперационном периоде [13,14] или интраоперационно [15].…”

Section: таблица 6 оценка относительного риска прогрессирования с раз...unclassified

“…Результаты ряда опубликованных ранее исследований подтверждают перспективность комплексного подхода с интраперитонеальной химиотерапией при лечении местнораспространенного РЖ [12][13][14]20]. В частности, применение комбинации ИИТХТ с цисплатином 50 мг/л (42,0±1,0 °C, 1 час) в сочетании с 6 курсами АПХТ по схеме XELOX (оксалиплатин 130 мг/м 2 , капецитабин 1500 мг/м 2 ) в исследовании Beeharry M.K.…”

Section: таблица 6 оценка относительного риска прогрессирования с раз...unclassified

Результаты комплексного лечения рака желудка pT4a-bN0-3M0

Ревтович¹,

Krasko²,

Малькевич³

2021

Евразийский Онкологический Журнал

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Введение. Локорегионарный характер противоопухолевого действия перфузионной интраоперационной интраперитонеальной термохимиотерапии (ИИТХТ), снижая частоту и риск развития канцероматоза, не позволяет предотвратить системное прогрессирование рака желудка (РЖ) после радикального хирургического лечения. Последнее обусловливает необходимость ее комбинации с системной адъювантной полихимиотерапией (АПХТ). Оценка эффективности и целесообразности подобного подхода и была целью настоящего исследования. Материалы и методы. Материалом для исследования явились 152 радикально оперированных по поводу РЖ (III-IV тип по R. Bormann) пациента, которым в период 2008-2016 гг. были проведены: а) комплексное лечение, включающее радикальную операцию + ИИТХТ (цисплатин 50 мг/м2 + доксорубицин 50 мг/м2, 42 °С, 1 час), 68 пациентов; б) комбинация радикальной операции с ИИТХТ и системной АПХТ (оксалиплатин 100 мг/м2 (1-й день курса), капецитабин 1000 мг/м2 или тегафур 10-15 мг/кг (2 раза/сутки, 1-14-й день курса), перерыв 7 дней, 8 курсов) - группа ИПТХТ + АПХТ, 29 пациентов; в) радикальное хирургическое лечение, 55 пациентов. Для оценки отдаленных результатов лечения использованы метод множительных оценок Каплана - Мейера, многофакторный анализ (модель Кокса, модель Файна - Грея), анализ конкурирующих рисков. Результаты. Применение комплексного подхода к лечению РЖ позволило снизить в сравнении с радикальным хирургическим лечением частоту метахронной перитонеальной диссеминации (p<0,001) и метастазов в печени (p<0,001). Отмечено статистически значимое увеличение 5-летней выживаемости: общей - с 25,4±6,4% до 90,9±8,7%; скорректированной - с 27,0±6,7% до 90,9±8,7%; выживаемости, свободной от прогрессирования, - с 16,3±5,5% до 90,9±8,7%; выживаемости, свободной от диссеминации, - с 19,4±5,9% до 90,9±8,7%, при этом констатировано снижение как риска прогрессирования РЖ (после применения ИИТХТ - ОР 0,5 (95% ДИ 0,33-0,79), pCox=0,003; после ИИТХТ с системной АПХТ - ОР 0,07 (95% ДИ 0,01-0,55), pCox=0,011), так и риска развития метахронной перитонеальной диссеминации (после ИИТХТ (ОР 0,2 (95% ДИ 0,11-0,36), pFine - Gray<0,001), после ИИТХТ с системной АПХТ - pFine - Gray<0,001). Выводы. Результаты исследования свидетельствуют о целесообразности комплексного подхода к лечению РЖ pT4a-4bN0-3M0, требующего помимо выполнения радикальной операции проведения перфузионной термохимиотерапии в сочетании с адъювантной системной полихимиотерапией. Introduction. Perfusion intraoperative intraperitoneal chemotherapy (HIPEC) reduces the frequency and risks of carcinomatosis after radical surgery owing to its loco-regional impact, but it fails to prevent systemic development of gastric cancer (GC). It causes the need to supplement the treatment with systemic adjuvant polychemotherapy (APCT). The goal of this study was to evaluate the efficacy and practicability of this approach. Materials and methods. The study spanned the period from 2008 to 2016. It was based on the results of treatment of 152 GC patients (types III-IV according to the R. Bormann classification), who underwent (a) a combined treatment, including radical surgery and HIPEC (cisplatin 50 mg/m2 + doxorubicin to mg/m2, 42 °С, 1 hour) - 68 patients; (b) a complex treatment, including radical surgery, HIPEC, and systemic APCT (oxaliplatin 100 mg/m2 on the day 1 of each cycle, capecitabine 1000 mg/m2 or tegafur 10-15 mg/kg twice daily on the days 1-14 of each cycle with an interval of 7 days between the cycles, 8 cycles) - 29 patients; (c) only radical surgery - 55 patients. Long-term treatment results were assessed by means of the Kaplan - Meier estimator method, multivariate analysis (Cox and Fine - Gray models), and a competing risks analysis. Results. In comparison with radical surgery alone, this multimodal GC treatment let to reduce the frequency of metachronous peritoneal dissemination (p<0.001) and liver metastasis (p<0.001). There was a statistically significant improvement in 5-year general and adjusted survival rates - from 25.4±6.4% to 90.9±8.7% and from 27.0±6.7% to 90.9±8.7%, respectively; progression-free and dissemination-free survival rates - from 16.3±5.5% to 90.9±8.7% and from 19.4±5.9% to 90.9±8.7%, respectively. There was also a decrease both in the risk of GC progression after administering HIPEC - RR 0.5 (95% CI 0.33-0.79), pCox=0.003, and after HIPEC supplemented with APCT - RR 0.07 (95% CI 0.01-0.55), pCox=0.011, and the risk of development of metachronous peritoneal dissemination after HIPEC - RR 0.2 (95% CI 0.11-0.36), pFine - Gray<0.001, and after HIPEC jointly with APCT - pFine - Gray<0.001. Conclusion. The study results proved the practicability of the proposed multimodal approach to the management of the stage pT4a-4bN0-3M0Р gastric cancer combining radical surgery with HIPEC/APTC.

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“…2 The recurrence and metastasis are the main causes of treatment failure in the patients with advanced gastric carcinoma. 3 Therefore, the chemotherapy plays an important role in the treatment of gastric carcinoma, which cannot be ignored. Although no unified and standard therapeutic regimens for the treatment of advanced gastric carcinoma chemotherapy have been proposed up till now; however, the combinations of surgery and chemotherapy, radiotherapy, intraoperative intraperitoneal hyperthermia perfusion chemotherapy, and targeted therapies have proved to gain better effects in the clinical practices.…”

Section: Introductionmentioning

confidence: 99%

Effect of early body cavity continuous circulation hyperthermia perfusion chemotherapy combined with systemic chemotherapy (and nursing) on survival rate and serum tumor markers in patients with advanced gastric cancer

Liu

Tang

2020

Eur J Inflamm

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This study was designed to investigate the effects of early coelom continued circulatory hyperthermic perfusion chemotherapy combined with systemic chemotherapy on the survival and serum tumor markers. A total of 128 patients with advanced gastric carcinoma who have received surgical treatments were selected and were randomly divided into study group (receiving early circulatory intraperitoneal hyperthermic perfusion chemotherapy combined with systemic chemotherapy postoperatively) and control group (receiving chemotherapy alone postoperatively), with 64 cases in each. Comparison of serum tumor markers (CA724, CA242), vascular endothelial growth factor (VEGF), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), immune function indexes (CD3+, CD4+, CD8+), and 5-year survival rate was assessed. Before treatment, there was no significant difference in the serum tumor markers (CA724 and CA242) as well as the serum VEGF, MMP-2, and MMP-9 levels among the two groups ( P > 0.05). However, the above parameters in the study group were significantly lower than control group 8 weeks after the treatment ( P < 0.05). Before treatment, there was no significant difference in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups ( P > 0.05). Eight weeks after the treatment, the CD3+, CD4+ and CD4+/CD8+ in the study group were significantly higher than those in the control group ( P < 0.05), while the CD8+ levels was significantly lower than the latter group ( P < 0.05). The 2-year recurrence rate in the study group was lower than the control group ( P < 0.05). Furthermore, survival rates (1-year, 3-year and 5-year) of the study group were all higher than control group ( P < 0.05). Early circulatory hyperthermia perfusion chemotherapy combined with systemic chemotherapy contributed to the decrease in the serum tumor markers (CA724, CA242) as well as the serum VEGF, MMP-2, and MMP-9 levels, improved the immune functions. This therapeutic regimen prolonged the long-term survival conditions of the patients as well as proved the safety and effectiveness.

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Adjuvant combined systemic chemotherapy and intraperitoneal chemotherapy for locally advanced gastric cancer

Cited by 11 publications

References 25 publications

DCF intraperitoneal and intravenous dual chemotherapy regimen for advanced gastric cancer: A feasibility study

DCF intraperitoneal and intravenous dual chemotherapy regimen for advanced gastric cancer: A feasibility study

Результаты комплексного лечения рака желудка pT4a-bN0-3M0

Effect of early body cavity continuous circulation hyperthermia perfusion chemotherapy combined with systemic chemotherapy (and nursing) on survival rate and serum tumor markers in patients with advanced gastric cancer

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