| Objective Gastric cancer is a common malignancy in our country. There are squamous cell carcinoma, adenosquamous cell carcinoma, and neuroendocrine carcinoma in gastric cancer. Among them, adenocarcinoma is the most common pathology type in gastric cancer. The curative treatment of stomach adenocarcinoma requires gastric resection. However, the high rate of relapse after resection makes it important to consider adjuvant treatment for patients with stomach cancer. The regimen of single agent of S-1or combination of oxaliplatin and capcitabin has been proved to improve overall survival or relapse free survival as adjuvant chemotherapy for patients with gastric cancer. The combination of oxaliplatin and S-1is effective in patients with advanced gastric cancer. The purpose of this study is to analyze the safety and compliance of this combination as adjuvant chemotherapy in patients with gastric cancer. Primary gastric small cell carcinoma (SCC) is a rare and aggressive disease for which the standard treatment has not been established. We also did a retrospective study to review the natural history of gastric SCC among a cohort of Chinese patients with specific emphasis on clinicopathologic features, response to treatment and survival.Methods71cases of gastric cancer treated with oxaliplatin plus S-1as adjuvant chemotherapy in Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) from JAN2010to JAN2012were retrospectively reported. We analyzed the types and incidence rates of adverse events that related to chemotherapy and followed up all the patients. All cases of gastric SCC treated at our institute from Jan-1990to Dec-2011were reviewed and analyzed retrospectively. Statistical analyses were performed using Fisher’s exact test.Results Among the71cases,17were treated with oxaliplatin biweekly, while54with oxaliplatin triweekly. The most common adverse events were neutropenia (78.0%), nausea/vomiting(71.8%),anorexia (69%). The most frequent grade3/4toxicities were neutropenia (18.3%), thrombocytopenia (14.1%),anorexia (7.0%)and nausea/vomiting (5.6%).7(87.5%)of the8patients previously treated with neoadjuvant chemotherapy experienced thrombocytopenia in postoperative adjuvant chemotherapy, and50%of them experienced grade3/4thrombocytopenia. The rates of grade3/4adverse events in patients older than65years old were similar to that in younger patients. Meanwhile, a total of19patients from11,603cases (0.16%) of all gastric cancers treated during the past20years were identified, which represents the largest single-institute experience in Chinese people. over two decades. The median age was61years (range,38-73years) and the patients were predominantly men (17male;2female). Using the latest AJCC Staging Criteria, the majority of the patients (68.4%) were Stage Ⅲ. Two patients received neoadjuvant chemotherapy, all patients underwent surgery. The median overall survival time (MST) was19.5months (95%CI17.5-21.6months). The1-,3-and5-year overall survival rates were77.3%,44.2%and22.1%, respectively. The MST of48.5months for cases who received postoperative adjuvant chemotherapy was superior to that of19.0months for cases who did not (P=0.026).Conclusions The combination of oxaliplatin and S-1was well tolerated when used as adjuvant chemotherapy in patients with gastric cancer. Neutropenia, thrombocytopenia, nausea/vomiting and anorexia were the major treatment-related adverse events. Patients who received neoadjuvant chemotherapy didn’t tolerate this regimen as postoperative adjuvant chemotherapy well. This combination has a manageable tolerability profile in adjuvant setting in patients older than65years old.Our data of19cases indicates that gastric SCC patients can be treated effectively with combined modality of treatment, despite the aggressive nature of gastric SCC. Systemic therapy, based on chemotherapy with surgery, is recommended. |
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