| Background:Gastric cancer is still one of highest incident cancers in the world and being the 2nd most frequent cause of death among all cancers. Gastric cancer is the most common malignant tumor in China. Surgical resection is the preferred method in the treatment of gastric cancer. For the higher rate of recurrence and metastasis,5-year survival rate of the patients was about 25% overall. Therefore, adjuvant chemotherapy of locally advanced gastric cancer after surgery has great significance for eradication of residual tumor cells, reduction of the risk of recurrence and elongation of survival, and treatment options of patients will have a direct impact on survival. In the past few decades, people have done a large number of clinical trials in the adjuvant treatment for advanced gastric cancer. In recent years, many new anticancer drugs have been used in the treatment of gastric cancer. The recent study in Melbourne, Australia, Peter MacCallum Cancer Center LIM and other studies suggested that the use of sequential chemotherapy consist of oxaliplatin or cisplatin plus 5-FU, taxane-based chemotherapy and irinotecan plus 5-FU may improve survival and reduce the incidence of drug resistance, suggesting that carry out the sequential therapy in the future should be considered for first-line treatment rather than Strengthen the intensity of treatment. Because of the alternating drug application, the accumulation of the drug in the body is avoided; the toxicity is reduced greatly without affecting the therapeutic effect. Sequential chemotherapy is expected to become a new model of effective adjuvant chemotherapy.Objective:To explore the efficacy and safety applications of sequential chemotherapy in the adjuvant treatment for advanced gastric cancer.Methods:The clinical data of 88 patients with advanced gastric cancer treated by FOLFOX4 or sequential chemotherapy in our Hospital Cancer Center during Jan 2006 and Dec 2010 were analyzed to compare the curative effect and the side effects of the two strategies.42 patients received 6 courses of sequential treatment program and 46 patients received 6 courses of traditional FOLFOX4 treatment program.Results:The follow-up time ended March 30,2011, the median follow-up time of all the patients was 14.4 months (3.0-27.0 months), median follow-up time in FOLFOX4 groups and in sequential group is 15.8 months (3.0-27.0 months) and 12.0 months (4.5-26.0 months) respectively. There was no lost case. In sequential group,5 patients progressed, the 2-year disease-free survival rate was 88.10%. In FOLFOX4 group,8 patients progressed, the 2-year disease-free survival rate was 82.61%. There was no difference between the two groups (P=0.556). The incidence of hematological toxicity, nausea and vomiting and peripheral nerve toxicity in the sequential chemotherapy group was lower than that in FOLFOX4 group, however, The incidence of diarrhea, hair loss in the sequential chemotherapy group was higher than that in FOLFOX4 group.Conclusion:(1) Efficacy:This study showed that the efficacy of sequential chemotherapy was just as FOLFOX4 regimen. Because of short duration of the study, we can not clear whether there was difference in the overall survival. Next we should observe large sample size, hoping to find the optimal postoperative adjuvant chemotherapy strategy of gastric cancer. (2) Side Effects:The side effects of hematological toxicity, nausea, vomiting and peripheral nerve toxicity in sequential chemotherapy group were lower than those in FOLFOX4 group, however, diarrhea, hair loss were higher than those in FOLFOX4 group. (3) Sequential chemotherapy was more suitable for the advanced gastric cancer patients than FOLFOX4 regimen.
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