A Clinical Study Of Neoadjuvant Chemotherapy With Improved FOLFOX6 Regimen In Advanced Gastric Carcinoma

Objective:To evaluate the efficacy and toxicity of neoadjuvant chemotherapy using the improved FOLFOX6(oxaliplatin/calcium folinate/5-fluorouracil) regimen in patients with advanced gastric carcinoma.Methods:Forty one patients whose malignant tumors were unresected radically in anticipation through the imaging study to assess with preoperative histologically confirmed and whose tumor category was cT_3-4NanyM₀ were enrolled in this study.All of these Patients received the initial treatment of the improved FOLFOX6 regimen.The intention was to administer two cycles at least of preoperative chemotherapy, which consisted of oxaliplatin at 130mg/m² intravenously(more than 2hrs) on day-1,calcium folinate at 400mg/m² intravenously on day-1,5-fluorouracil at 400mg/m² intravenously(less than 2hrs) on day-1,5-fluorouracil at 2.4g/m² intravenously continuously in 46hrs subsequently.Three weeks were a cycle for the improved FOLFOX6 regimen.These patients received two cycles of neoadjvant chemotherapy at least before the efficacy and toxicity were evaluated except that the clinical response was progressive.In this condition,the clinical response of these patients would be evaluated after one cycle.The treatment response would have been confirmed after four weeks since the chemotherapy treatment course finished.Results:41 patients accepted 132 cycles totally.The clinical efficacy rate according to RECIST criteria was 48.78%(20/41) with 0 complete response(CR) and 20 partial responses(PR).The other treatment response rates of stable disease(SD) or progressive disease(PD) were 39.02%(16/41) and 12.20%(5/41) respectively.The overall tumor control rate(responses plus stabilizations) was 87.80%(36/41).The operation was carried out in 25 cases(25/41,60.98%).20 of 25 patients(80.00%) reached radical resection(R₀) and only 5 of 25 patients(20.00%) received palliative operation(R₁ or R₂).9 of the 25 cases(36.00%) got downstaged according to postoperative pathological stage.The most common nonhemological toxicities of the improved FOLFOX6 regimen were nausea/vomiting(29/41,70.71%) and phlebitis(5/41,12.20%);the major hemological toxicities of the improved FOLFOX6 regimen were leukocytopenia(11/41, 26.83%) and anemia(10/41,24.39%).Most adverse events were in gradeâ… /â…¡in severity.There was no chemotherapy-related deaths.Conclusion:The improved FOLFOX6 regimen is one of the most effective and well-tolerated regimens as neoadjvant chemotherapy for advanced gastric carcinoma.