Short-term Curative Effect Of SOX Regimen As Peri-operative Chemotherapy For Locally Advanced Gastric Cancer

Objective: Advanced gastric cancer is the main part of gastric cancer. themorbidity of gastric cancer is rising in recent years. Radical resection is themost effective methods for the treatment of locally advanced gastric cancer.Even if obtaining radical surgery, the patients still facing a high risk ofmetastasis and recurrence, the long-term survival rate is relatively low. Howto make locally advanced gastric cancer obtaining a biologically completeresection and improving prognosis is a difficulty for gastrointestinal surgeons.The trendencyof gastric cancer treatment is turned to multi-disciplinarycomprehensive treatment model based on surgery. Peri-operativechemotherapy is a extremely important part of multi-disciplinarycomprehensive treatment model, which could reduce the Neoplasm Staging,improve the radical resection (R0resection) rate, reduce the risk ofpostoperative recurrence and transfer, and improve prognosis in theory.Therefore, peri-operative chemotherapy is the hottopic for gastric cancertherapy research. Additionally, a standard regimen for peri-operativechemotherapy has not been decided for advanced gastric cancer. Therefore,the present study aims to investigate the curative effect of S-1plus oxaliplatin(SOX) as peri-operative chemotherapy for locally advanced gastric cancer andexplore its potential as the standard regimen.Methods: One hundred and two patients from November2011to May2013in Gastrointestinal Surgery Of The Fourth Hospital, Hebei MedicalUniversity with locally advanced gastric cancer (preoperative clinical stage ofT3-4NxM0) were enrolled and randomly divided into two groups: The SOXregimen as peri-operative adjuvant chemotherapy group(test group,50patients), the SOX regimen as post-operative chemotherapy group (controlgroup,50patients).50patients in test group received two cycles chemotherapy of S-1at150mg/m2on day1to day14, oxaliplatin at130mg/m2intravenouslyon day1. Preoperative chemotherapy sustained for2to4cycles.7days afterthe end of chemotherapy, we evaluate the efficacy, and21days afterchemotherapy patients accept standard D2radical surgery. patients in controlgroup received standard D2radical surgery directly and then receive the SOXregimen as post-operative chemotherapy after surgery. Short-term curativeefficacy and side effects of the peri-operative chemotherapy were analyzed.The rates of R0resection, surgical complication, combined multiple organresection, overall survival (OS), and disease-free survival (DFS) rates werecompared between the two groups. The clinical evaluation index in detail is asfollows:1Measuring the longest diameter of the tumor before and afterpreoperative chemotherapy in test group. Analyzing the overall response rateand disease control rate for preoperative chemotherapy.2In test group, staging patients by Multi-slice spiral CT, electronicendoscopy or MRI before and after preoperative chemotherapy, observedclinical downstaging.3Evaluating the curative efficacy of preoperative chemotherapy bytumor regression grading from postoperative pathology.4Evaluating the adverse reaction of chemotherapy by preoperativefollow-up observation.5Comparing the R0resection rate between the two groups byintra-operative situations, operation records and postoperative pathologicresults.6Comparing the operative complications rate between the two groups bycombined multiple organs resection, wound healingsituations andgeneralinfection.7Comparing the overall survival and disease free survival between thetwo groups by peri-operative follow-up observation. Result:1The test group of50cases were all receive the evaluations ofpreoperative chemotherapy curative efficacy.1cases of completeremission,20cases of partial remission,26cases of stable disease,3cases of diseaseprogression. The overall response rate was42%(21/50), the tumor controlrate was94%(47/50).2The test group of50cases were all complete preoperativechemotherapy processes. After preoperative chemotherapy,1cases of diseaseprogression,24cases of stable disease,25cases of clinical downstaging, thedownstaging rate was50%(25/50). The overall clinical stage has a downwardtendency.3All the50cases in test group could evaluate tumor regression gradingby postoperative pathology,4cases of grade4,10cases of grade1,14casesof grade2,22cases of grade3, thepathological response rate was56%(28/50),pathological complete response rate was8%(4/50).4The main adverse reactions in preoperative chemotherapy weregastrointestinal and hematologic toxicity reactions, mostly grade1-2.Symptoms improved after symptomatic treatment and no chemotherapyrelated deaths.5100%(50/50) cases of test group and84%(42/50) cases of controlgroup were all performed standard D2lymphadenectomy. The R0resectionrate was achieved in90%of patients in test group versus75%in control group(P<0.05).6In test group, the rate of surgical complications was14%(7/50), suchrate was15.4%(8/52) in control group. No statistical difference was observedbetween the2groups (P=0.844). There were no in-hospital mortality in bothof the groups.7By the follow-up deadline,98of102patients in both groups hadcompleted all follow-up visits. Two patients each from test and control groupsmissed the follow-up, thus resulting in a missing rate of4%(2/50) and3.85%(2/52), respectively. The follow-up missing rate was not statistically differentbetween the2groups (P=0.986). The median follow-up time was14.4months (range,2.8–25.4months) in test group and15.5months (range,1.7–26.3months) in control group. The average DFS was21.406months (95%CI:19.395–23.416months) in test group and20.233months (95%CI:17.798–22.667months) in control group. No statistically significant differencein the average OS was observed between the groups (p=0.536).In clinicstaging subgroup, the DFS of test group was longer than that of control groupand the Kaplan-Meier separated in the early time. No statistically significantdifference in the average OS was observed between the groups (P=0.152).Conclusion:1In SOX peri-operative chemotherapy mode(The SOX regimen aspreoperative chemotherapyâ†'Standard D2radical surgeryâ†'The SOX regimenas postoperative chemotherapy), preoperative chemotherapy achieved a higherefficacy of42%and50%of patients with local advanced gastric cancerreduced the preoperative clinical staging.2SOX regimen as preoperative chemotherapy had small toxicity, it wassecurity.3The SOX regimen as postoperative chemotherapy could significantlyimprove the R0resection rate to90%for locally advanced gastric cancer,while few surgical trauma and side effects occurred.4Patients receiving SOX peri-operative chemotherapy mode(The SOXregimen as preoperative chemotherapyâ†'Standard D2radical surgeryâ†'TheSOX regimen as postoperative chemotherapy) showed a tendency toprolonged survival time, especially for the patients with clinic staging â…¢. Itwas a safe and effective treatment mode for locally advanced gastric cancer.