Postoperative Adjuvant Intraperitoneal Cancer Combined With Intravenous Chemotherapy For Analysis

Objective:1. To analyze the clinical efficacy of postoperative gastric cancer which treat by combined with intravenous chemotherapy (study group) and simple intravenous chemotherapy (control group).2. To observe the disease-free survival (DFS) and overall survival (OS) of two groups.3. To compare the differences of peritoneal metastasis rate and liver metastasis rate of two groups.4. To compare the incidence of adverse reactions.Materials and Methods:There were 108 cases of gastric cancer from 2005.11.1-2007.12.31 hospitalized Oncology Department of Anhui Provincial Hospital which accepted adjuvant chemotherapy. Information in all cases by The Statistics Office could provide the information in all cases.1. Inclusion criteria:Ⅰ. after radical gastrectomy,Ⅱ. pathologically confirmed tumor invasion of serosa and / or lymph node metastasis,Ⅲ. histological type according to WHO 2000 type, stage at the 2010 Association of American Cancer (AJCC) published The PTNM programs are generally,Ⅳ. completed the chemotherapy regimen (6 courses),Ⅴ. were used in chemotherapy of oxaliplatin (L-OHP), 5 - fluorouracil (5-Fu), leucovorin (CF).2. Clinical data: 56 cases of study group: 32 males and 24 females, aged 24-71 years, median age 52 years. Serosal invasion and lymph node metastasis were 40 cases, serosal invasion without lymph node metastasis were 8 cases, lymph node metastasis without serosal invasion were 8 cases, and the average lymph node for checked was 13.8. 52 cases of control group: 28 males and 24 females, aged 23-70 years, median age 54 years. Serosal invasion and lymph node metastasis were 34 patients, serosal invasion without lymph node metastasis were 7 cases, lymph node metastasis without serosal invasion were 11 cases, and the average lymph node for checked was 13.5.3. Treatment: study group program: Oxaliplatin (L-OHP) 125mg/m~2 iv infusion d1 ,5-Fu 500mg/m~2 intraperitoneal injection of d1, 500mg / m~2 intravenously d2-5, leucovorin (CF) 200mg intravenous infusion d1-5, combined with intravenous chemotherapy for 3 cycles of intraperitoneal intravenous group program after 3 cycles. Control group program: L-OHP 125mg/m~2 infusion d1 ,5-Fu 500mg/m~2 iv bolus d1-5, CF 200mg intravenous infusion d1-5.4. The method of peritoneal injection: before abdominal puncture ,ask the patients to urinate, supine position, to puncture the anti-Michael's point after routine disinfection, 9 needle inserted perpendicularly into the abdominal cavity, Withdrawing without gas, liquid nor blood, Patients have no discomfort after the reaction, the first rapid infusion saline 1000ml, the precise observation of liquid into the abdominal cavity after reperfusion 5-Fu 500mg/m~2 + saline 500ml.5. Outcome measures: To observe the disease-free survival (DFS) and overall survival (OS) of two groups ; the recurrence of peritoneal and liver metastasis rate within 3 years.6. Follow-up and review: follow-up through inpatient, outpatient and telephone. In the first year, patients were followed-up for every 3 months, 2 years after the review once every 6 months, including blood, urine, stool, biochemistry, tumor markers CEA, CA199, B-abdominal, CT, PET-CT and endoscopy .7. Statistical methods: Using SPSS 13.0 software package to Kaplan-Meier method to estimate the survival function differences between two groups of survival data, compared with using log rank test. Two groups of peritoneal recurrence rate, metastasis rate compared byχ~2 test.Results:1. To survive loss of study group 7 cases, 4 cases of control group lost follow-up. Follow-up data as the end of the value lost with the survival analysis. The DFS of study group was 20.9±1.3 months, the median DFS was 19.0 months, while the DFS of control group was 17.1±1.2 months, the median DFS was 16.0 months. After test, there was a statistically significant difference. The OS of study group was 36.1±1.4 months while the OS of control group was 35.9±1.3 months, there was no significant difference.2. The peritoneal recurrence rate within 3 years were 25.0% and 44.2% of study group and control group,while liver metastasis rates were 8.9% and 23.1%. The difference was statistically significant.3. Adverse reactions: two recent cases of chemotherapy-related adverse reactions were myelosuppression, gastrointestinal reactions. Peripheral nerve toxicity and hair loss can be tolerated. Group of 15 patients with mild abdominal pain, symptomatic treatment and more ease in three to four days. 4 cases of low fever. Follow-up period associated with chemotherapy was not found serious complications of chemical peritonitis and intestinal obstruction. Conclusion:1. Peritoneal chemotherapy combined with intravenous chemotherapy could extend over 3 months in DFS, patients can get benefit.2. Peritoneal combined with intravenous chemotherapy could reduce the rate of peritoneal recurrence and liver metastasis rate over intravenous chemotherapy alone.3. The method of intraperitoneal chemotherapy is simple. There was no serious adverse events associated with intraperitoneal chemotherapy.