15. A Phase II study of PCF chemotherapy combined with surgical treatment of late gastric cancer

Objective: To investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of late gastric cancer.
Methods: From July 2008 to February 2011, 72 cases of late gastric cancer which can not be treated with R0 resection were prospectively analysed. Patients received 2-4 cycles of PCF regimen chemotherapy (PTX 150 mg/m² d1, CDDP 25 mg/m²/d d1- 3, CF 250 mg/m² d1-3, 5-FU 750 mg/m²/d d1-3, repeated every 3 weeks) then the primary and matastatic tumor were treated with cytoreductive surgery: Mainly treated with radical resection of gastric tumor, combined with D3 and D4 lymph node dissection, pancreaticoduodenal resection, colon resection, Ovariectomy, peritoneal resection, liver resection and tumor radio frequency, followed with another 2-4 cycles of PCF chemotherapy postoperatively. The treatment completion rate, patients’ tolerance and overall survival time were analyzed.
Results: 50 patients (69.4%) accomplished chemotherapy and surgical resection as planned (simple laparotomy, biopsy, shortcircuit operation was excluded). 42 cases had R0 resection (58.3%), and 17 cases had combined organ resection (34.0%). The non-R0 resection included palliative resection of the tumor, cytoreductive surgery of peritoneal metastases, radio frequency of liver or lung metastases, and radiotherapy of left supraclavicular lymph nodes metastasis. There was one death perioperatively. The overall response rate (CR+PR) was 72.2%. 50 patients (69.4%) planned to complete the chemotherapy and surgical resection, and 42 (58.3%) cases had R0 resection; survival analysis: The median survival time was 23.5 months (95% CI: 15.8-31.2 months). 1-year and 2-year survival rate was 67.0% and 47.0%, and the survival time of the R0 resection group was 33.7 months. The survival time of patients with surgical resection was much longer than that of the non-surgery group. (30.2 vs. 8.9 months) (P<0.01, χ²=45.27).
Conclusions: A strong and effective chemotherapy combined with tumor R0 resection can make survival benefits for patients with late gastric cancer. Chemotherapy of PCF regimen combined with surgical resection for some patients with late gastric cancer was safe and effective.