| Objective: In recent years, the incidence of advanced gastric cancer hasincreased, radical resection is still the most effective treatment measures.However, under the premise of ensuring the quality of patients’ life, while theproblem that ensuring negative surgical margin, tumor-free intraperitonealonce plagued surgeon. With the diversification of the treatment model ofadvanced gastric cancer, seizing the timing of treatment before surgery isbecoming increasingly important, therefore, preoperative chemotherapy inclinical work has been widely carried out. However, preoperativechemotherapy has not yet formed a gold standard for indications, regimen andthe course of chemotherapy, nor the bulk of clinical trials confirmed itsefficacy, so the purpose of this study is investigating the resection rate andsurvival of preoperative chemotherapy with capecitabine andoxaliplatin(XELOX) for advanced gastric cancer, and analyzed itsmechanismto provide theoretical and clinical basis for the comprehensivetreatment of advanced gastric cancer.Methods: Select clinical data of85cases of advanced gastric cancerfrom September2010to September2011in The Fourth Hospital of HebeiMedical University. randomly divided into test group (preoperativechemotherapy NAC) and the control group (non-preoperative chemotherapyNNAC),40patients of NAC received two cycle chemotherapy of capecitabineat2000mg/㎡on days1to14,oxaliplatin at130mg/㎡intravenously on day1.Evaluating efficacy7days after the end of chemotherapy, and underwentsurgery21days after the end of chemotherapy. NNAC patients were directlysurgery, The clinical evaluation index is as follows:1Staging test group patients by helical CT, electronic endoscopy, endoscopic ultrasound or MRI before and after chemotherapy, Observedclinical downstaging.2Measuring the longest diameter of the tumor before and afterchemotherapy. To summary chemotherapy efficiency, disease control rate.3Recorded by observing adverse events, the number of days afterchemotherapy and poor wound healing incidence, summarizes the occurrenceof adverse reactions.4Combination of surgery radical degrees and postoperative pathologyupper and lower cutting edge, comparing the difference between the twogroups of patients with radical resection rate Comparing two groups ofpatients with radical resection rate.5Comparing the difference in overall survival and disease-free survivalbetween the two groups.Result:1After preoperative chemotherapy, in40cases of test group,4cases ofdisease progression,20cases of stable disease,16cases of clinicaldownstaging, Overall clinical stage has a downward trend.240cases of test group patients completed all cycles of chemotherapy,and to evaluate the efficacy.13cases of partial remission,23cases of stabledisease,4cases of disease progression. The clinical response of test group was32.5%(13/40), tumor control rate was90%(36/40).3The adverse reactions mainly were myelosuppression, nausea andvomiting, mostly degree Ⅰ-Ⅱ. After positive symptomatic treatment, allpatients improved, no chemotherapy-related deaths. The average stitches daysof the two groups were12.1±1.1days and11.8±0.9days, no statisticallysignificant difference between the two groups(P>0.05). the wound healing wasno significant difference between the two groups.4All patients underwent surgical treatment. Radical resection rate of thetwo groups were87.5%and68.9%. There is a significant statistical difference(P=0.04). 5The survival analysis showed that the overall survival and disease-freesurvival of the test group compared with the control group to extend the trend,but no statistically significant difference (P>0.05).Conclusion:1XELOX preoperative chemotherapy can reduce the clinical staging ofadvanced gastric cancer.2XELOX preoperative chemotherapy-surgery can significantly improvethe radical resection rate.3XELOX preoperative chemotherapy does not increase the risk ofsurgery and hospitalization days.4XELOX program preoperative chemotherapy has small toxicity andsecurity.5Compared with surgery alone, XELOX program preoperativechemotherapy has trend to prolong disease-free survival and overall survivaltime, that is the best choice for advanced gastric cancer. |
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