Abstract:

Currently, the results of diagnostics and treatment of gastric cancer (GC) are still not satisfactory. With the advent of modern catheters and angiographic devices, regional intra-arterial chemotherapy in patients with gastric cancer has become more often used in clinical practice.

Aim: was to improve results of treatment of patients with gastric cancer using regional intra-arterial chemotherapy (RIACT).

Material and methods: the immediate and long-term results of complex treatment of 110 patients with stomach cancer for the period 2005-2020 were analyzed. The average age of patients was 59,2 + 4,3 years. The prevalence of the tumor process according to the TNM classification was as follows: T3N0M0 - 37(33,63%) patients, T3N1M0 - 41 (37,27%) patients, and T3N2M0 - 32 (29,1%) patients. Histologically, all patients showed various forms of adenocarcinoma. At the first stage, all patients underwent neoadjuvant RIACT according to the DPF scheme (Docetaxel 75mg/m² + Cisplatin 75mg/m² + Fluorouracil 1000mg/m² on the 1st day) for 2 courses with an interval of 28 days, then surgery.

Results: the immediate results of RIACT showed the effectiveness of treatment after 2 courses of neoadjuvant intra-arterial regional chemotherapy in 93 (84,5%) patients, partial regression was noted, in 17(15,5%) patients, stabilization of the process was noted. These patients underwent a radical operation with the second stage of complex treatment - extended gastrectomy with D2 lymphadenectomy. The drug pathomorphosis of the 1-2 degree was noted in 34 (30,9%) patients, the third degree was noted in 38 (34,5%), the pathomorphosis of the fourth degree in 9 (8,1%) patients. With dynamic follow-up of patients 9(8,1%) patients lived 6 months, 63 (57,2%) patients lived 12 months, 59 (53,3%) patients lived 18 months, 57(51,8%) patients lived 24 months, 47 (42,7%) patients lived 36 months, 41 (37,2%) patients lived 48 months and 35 (31,8%) patients 60 lived months and still are alive. The median survival rate was 51,8 + 1,5 months.

Conclusions: results of neoadjuvant intra-arterial chemotherapy in the treatment of gastric cancer patients proved to be effective in 84,5% of patients. In 42,6% of patients, grade 3-4 therapeutic pathomorphosis was noted. The 3- and 5-year survival rates were 42,7% and 31,8%, respectively. The median survival rate was 51,8 + 1,5 months.

Preoperative intra-arterial chemotherapy may be the method of choice for improving the survival and quality of life of patients with gastric cancer.

References

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Abstract:

Aim: the aim of this study was to evaluate the diagnostic possibilities of the dynamic MDCT in the differential diagnosis of gastric diseases compared with conventional upper gastrointestinal barium study and endoscopy

Materials and methods: 130 patients with different gastric lesions underwent dynamic MDCT The detection rate of the gastric lesion and the diagnostic accuracy of each method were calculated by the use of surgical and histopathologic results as reference standards.

Results: diagnostic accuracies of methods in the differential diagnosis of gastric tumors with exophytic growth were: endoscopy - 91%, barium study - 50%, MDCT - 87%; in the differential diagnosis of ulceration: endoscopy - 78%, barium study - 84%, MDCT - 93%; and in the diagnosis of diffuse type of gastric cancer: endoscopy - 82%, barium study - 75%, MDCT - 100%.

Conclusion: integration of the dynamic MDCT in algorithms of diagnostics of gastric lesions can improve detection rates of stomach diseases and the accuracy of their differential diagnosis.

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