Clinical Efficacy Of Preoperative Regional Arterial Chemoe Mbolization Combined With Systemic Intravenous Chemot Herapy For Locally Advanced Gastric Cancer

ObjectiveTo investigate the efficacy and safety of preoperative regional arterial chemoembolization combined with systemic intravenous chemotherapy in patients with locally advanced gastric cancer.MethodsA retrospective cohort study was conducted.Clinical data of 84 patients with advanced gastric cancer who received neoadjuvant therapy before radical gastrectomy in the First Affiliated Hospital of Zhengzhou University from August 2013 to August 2017 were collected.41 patients who received preoperative regional arterial chemoembolization combined with systemic intravenous chemotherapy were selected as the study group.43 patients received systemic intravenous chemotherapy preoperatively and were selected as the control group.Before radical gastrectomy,2 groups of patients received 2-4 cycles of neoadjuvant therapy,and abdominal enhanced CT reexamination was performed 2 weeks after the end of the last cycle of chemotherapy.The efficacy of neoadjuvant therapy was evaluated according to RECIST,and the efficacy was divided into complete response(CR),partial response(PR),disease stability(SD)and disease progression(CD).If the neoadjuvant therapy is effective and meets the requirements of radical surgery,the patient will receive radical gastrectomy 4 weeks after the end of the last cycle of chemotherapy,and the patient will receive SOX regimen chemotherapy 4 weeks after the surgery.The efficacy of neoadjuvant therapy,adverse reactions to chemotherapy,postoperative complications and survival time were compared between the two groups.ResultThe efficacy of neoadjuvant therapy was evaluated according to the efficacy evaluation criteria for solid tumors(RECIST).The clinical response rate of the study group was 65.9%(27/41).The disease control rate was 95.1%(39/41).The clinical response rate in the control group was 41.9%(18/43).The disease control rate was 86.0%(37/43).The clinical response rate in the study group was higher than that in the control group(χ2=4.858,P=0.028<0.05),and the difference was statistically significant.There was no significant difference in disease control rate between the two groups(P>0.05).Adverse effects of neoadjuvant therapy were evaluated in 2 groups according to the WHO classification standard of common toxic and adverse effects of anticancer drugs.The incidence of nausea,vomiting,neurotoxicity and other adverse reactions in the study group was higher than that in the intravenous chemotherapy group(P<0.05).There was no significant difference in adverse reactions such as neutropenia,thrombocytopenia and anemia between the two groups(P<0.05).Compared with the control group,2 cases were found with gastric mucosa bleeding(grade Ⅱ);ll of the above adverse reactions were relieved after systemic symptomatic supportive therapy,and all patients were able to tolerate neoadjuvant chemotherapy,and there was no death from neoadjuvant therapy.There was no statistical significance in the incidence of postoperative complications(gastroparesis,incision infection,anastomotic fistula,thrombosis,bleeding,etc.)between the two groups.By the end of follow-up,the long-term efficacy of patients in the two groups was compared.The overall survival time and tumor-free survival time in the study group were significantly higher than those in the control group,and the differences were statistically significant.Conclusion1.Compared with systemic intravenous chemotherapy alone,regional arterial infusion chemotherapy combined with systemic intravenous chemotherapy can significantly reduce the preoperative stage,reduce the difficulty of surgery,and improve the tumor resection rate in patients with advanced gastric cancer.2.Except for adverse reactions such as nausea,vomiting and peripheral neurotoxicity,combination therapy did not increase the incidence of adverse reactions and postoperative complications compared with intravenous chemotherapy alone.3.Compared with intravenous chemotherapy alone,combination therapy can significantly improve patients’ survival time and tumor-free survival time,reduce patients’ 3-year recurrence and metastasis rate,and significantly improve patients’prognosis.