Results of Combined Treatment of Patients with Gastric Cancer Stages Iii-Iv

Abstract

Background: Gastric cancer is one of the most widespread malignant neoplasms in Russia and worldwide. About 60% of patients have III-IV stage at the moment of diagnosis. Main method of treatment remains still surgery, however late results of such an approach look unsuccessful. However single opinion about additional method has not been formed in international practice. In this regard problem of treatment of this nosology gains special relevance. Methods: 25 patients (10 women and 15 men) at the age of 23-69 (median 48.9 years), ECOG status 0-1 underwent combined treatment of gastric cancer III-IV stages which consists of surgery R0 plus following by 6 cycles of DCF. Chemotherapy was performed within 8 weeks after operation. Regimen DCF: Docetaxel 75 mg/m2 and Cispaltin - 75 mg/m2 intravenous for the first day, 5-Fluorouracil 375 mg/m2 + Leucovorin - 20 mg/m2 for the 1st -3rd days, interval - 21 day. Study included 12 patients III stage (T3N1-2M0), 13 patients - IV stage (T3N2-3M0-1). Results: At present all 25 patients has completed treatment and are in the process of case follow-up. In total 138 courses of the chemotherapy were performed. 17 patients (68%) completed combined treatment, 8 patients received in equal amount four and five courses. The most frequent kinds of toxicity of the chemotherapy were hematologic and gastrointestinal. Reversible neutropenia grade II-III (72%), anemia grade I-II (25%), nausea and vomiting grade II-III (61%), diarrhea grade II-III (32.2%), stomatitis grade I-II (15%) were observed. Moreover peripheral polyneuropathy (18.6%) was registered in the form of mild or moderate paresthesia, hyperesthesia and dysesthesia. G-CSF was administered increase of neutropenia grade III-IV. Antiemetic drugs, probiotics were used for abort of gastrointestinal toxicity, correction of water-electrolytic balance was performed. Vitamin prevention was used for prevention of neurotoxicity. Maximum terms of patients' follow-up are 48 months. During evaluation of progression-free survival it appeared that 17 patients (68%) of all 25 treated patients has survived without signs of progression for one year, 44% are alive in 2-years and continues follow-up, indices of three-year progression-free survival equal 36%. Progression of disease was marked due to development of remote metastasis, recurrences in the area of anastomosis were not mentioned. Out of 9 patients under observation 7 patients are with III stage of disease, 2 patients are with IV(M0) stage. Conclusion: As can be seen from the above use of adjuvant chemotherapy according to DCF regimen after major surgical treatments at patients (ECOG 0-1) with gastric adenocarcinoma with solitary metastatic lesion of regional lymph nodes allows decrease frequency of recurrences and increase three-year progression-free survival.