| Objective To determine whether neoadjuvant chemotherapy shows additional clinical benefit in patients with surgery followed by adjuvant chemotherapy.Methods Retrospectively 45 pathologically confirmed and advanced stage (stage IIIA, IIIB and IV M0) gastric caner patients were divided into 2 groups. The patients in group A accepted the 2-4 cycle of neoadjuvant chemotherapy. The regimen was consisted of 5-Fluorouracil (5-Fu) 500mg/m2 d1-3+Calcium Folinate ( CF ) 200mg/m2 d1-3+ Etoposide (VP-16) 100mg/m2 d1-3+ Oxalipaltin (Oxa) 100mg/m2d1 (ELF +Oxa) , 21days a cycle. The operation was performed after 3 weeks of the last neoadjuvant chemotherapy. If disease got complete response, partial response or stable disease after neoadjuvant chemotherapy, the post-operation chemotherapy remained the same regimen as neoadjuvant chemotherapy. If the disease progressed, the post-operation chemotherapy regimen would be changed into Epirubicin 6080mg/m2 + Paclitexal 175mg/m2 (EPI+PTX). The patients in group B received the operation of removal gastric tumor masses, and the post-operation chemotherapy (with regimen of ELF+Oxa) was then performed. The short and long clinical effects of the two groups were observed.Results The curative resection rate in group A 80.0%(16/20)was higher than that in group B 68.0%(17/25), but no statistically significant(P>0.05). No post-operative death occurred. Recent complications caused by surgery in group A was10.0%(2/20),as well as 16.0%(4/25) in group B(P>0.05) The most common hematologic toxicity was neutropenia. grade 3-4 neutropenia were 40.0%(8/20) in group A and56.0%(14/25) in group B; preoperative and postoperative neutropenia in group A were 25.0%(5/20) and 42.1%(8/19). The most common non-hematologic toxicity was nausea/vomiting, grade 3-4 nausea/vomiting were 5.0%(1/20)in group A and 4.0%(1/25) in group B respectively. Peripheral neuropathy was noted 5.0%(1/20) in group A and 8.0%(2/25) in group B. The grade 3-4 side effects of chemotherapy in two groups were similar, as well as preoperative and postoperative side effects in group A. The DFS and MST in group A were 15.3±2.3 months and 26.6±2.8 months. It's longer than that in group B, which were 9.6±1.2 months(P<0.05) and 16.6±1.7 minths(P<0.05).Conclusion Neoadjuvant chemotherapy significantly improved the DFS and MTS .These results may suggest that neoadjuvant chemotherapy should be considered in patients with advanced gastric cancer. And these worth to be further prospective studied in big sample in the future. |
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