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 1. Kaidarova DR. Indicators of the Oncological Service of the Republic of Kazakhstan for 2019 (statistical and analytical materials). Almaty. - 2020. -137 [In Russ]. 2. Kaprin AD, Starinskiy VV, Petrova GV. Malignant neoplasms in Russia in 2016 (morbidity and mortality). - M.: FGBU «MNIOI after named P.A. Herzen» of the Ministry of Health of Russia. - 2018. - 250 [In Russ]. 3. https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf 4. Abdollah MH, Farhad TB, Reza M. Lack of Any Relationship of Stomach Cancer Incidence and Mortality with Development in Asia. Asian Pacific Journal of Cancer Prevention. 2016, 17(8): 3775-3781. https://doi.org/10.14456/apjcp.2016.169 5. Smyth EC, Nilsson M, Grabsch HI, et al. Gastric cancer. Lancet. 2020; 396(10251): 635-648. https://doi.org/10.1016/S0140-6736(20)31288-5 6. Zyryanov BN, Makarkin NA, Tikhonov VI, Tuzikov SA. Combined treatment with intra-arterial regional chemotherapy for locally advanced gastric cancer. Russian Journal of Oncology. 1997; 1: 17-20 [In Russ]. 7. Barone C, Cassano A, Pozzo C, et al. Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer. Oncology. 2004; 67(1): 48-53. https://doi.org/10.1159/000080285 8. Wang J, Shi H, Yang G, et al. Combined intra-arterial and intravenous chemotherapy for unresectable, advanced gastric cancer has an improved curative effect compared with intravenous chemotherapy only. Oncology Letters. 2018; 15(4). https://doi.org/10.3892/ol.2018.8068 9. Song Z, Wu Y, Yang J, et al. Progress in the treatment of advanced gastric cancer. Tumour Biol. 2017; 39(7): 1010428317714626. https://doi.org/10.1177/1010428317714626 10. Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J Gastroenterol. 2015; 21(24): 7343-8. https://doi.org/10.3748/wjg.v21.i24.7343 11. Johnston FM, Beckman M. Updates on Management of Gastric Cancer. Curr Oncol Rep. 2019;21(8): 67. https://doi.org/10.1007/s11912-019-0820-4 12. Ikegame K, Terashima M. Perioperative Chemotherapy for Gastric Cancer. Gan to Kagaku Ryoho. 2020; 47(4): 569-573.
|
authors:
|
keywords:
|
Abstract: Introduction: treatment of gastric cancer (GC) remains an urgent problem in oncology. One of the unsolved problems in treatment of gastric cancer remains the treatment of patients with liver metastases. With the development of interventional radiology, it became possible to treat gastric cancer patients with liver metastases. Aim: was to improve results of treatment of gastric cancer patients with liver metastases by using of trans-arterial chemoembolization (TACE). Material and methods: we analyzed results of 60 patients for the period 2008-2020, who suffered for metastatic liver disease, previously they received combined treatment for stomach cancer at various times. The average age of patients was 58,1 ± 5,8 years. When planning TACE, all patients had a general condition above 80% according to Karnovsky, according to ECOG 1-2. All TACE patients with liver metastatic foci were treated with Lipiodol 6-8ml + Doxorubicin 25mg/m2. The interval between TACE cycles was 1,5-2 months. Each patient received 5-6 TACE courses. Results: immediate results showed the effectiveness of treatment after 2 courses of TACE in 49 (81,7%) patients: partial regression was noted in 36 (60%) patients, and significant regression of the process was noted in 13 (21,6%) patients, stabilization of the process was noted in 11(18,3%) patients. With dynamic follow-up 37 (61,7%) patients lived 6 months, 24 (40%) patients lived 12 months, 11 (18,3%) patients lived 18 months, 8 (13,3%) patients lived 24 months, only 3 (5,0%) patients lived 36 months. The median survival rate was 15,5 ± 1,2 months. Conclusions: immediate and long-term results of the study, carrying out TACE in patients with metastases of gastric cancer to the liver was effective in 50% of patients. Currently, to improve the survival rate and quality of life of patients with metastases of gastric cancer, the technique of trans-arterial chemoembolization can be considered as an effective, low-toxic method of treatment and it can be the method of choice. References 1. Mastoraki A, Benetou C, Mastoraki S, et al. The role of surgery in the therapeutic approach of gastric cancer liver metastases. Indian J. Gastroenterol. 2016; 35(5): 331-336. https://doi.org/10.1007/s12664-016-0683-7 2. Kaidarova DR. Indicators of the Oncological Service of the Republic of Kazakhstan for 2019 (statistical and analytical materials), Almaty, 2020, -137 [In Russ]. 3. Kaprin AD, Starinskiy VV, Petrova GV. Malignant neoplasms in Russia in 2016 (morbidity and mortality). - M.: FGBU «MNIOI after named P.A. Herzen» of the Ministry of Health of Russia, 2018. - 250 [In Russ]. 4. Zhang K, Chen L. Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases. Ther Adv Med Oncol. 2020; 12: 1758835920904803. https://doi.org/10.1177/1758835920904803. 5. Granov AM, et al. Interventional radiology in oncology (ways of development and technology) - SPb.: - Foliant. - 2007. - 88-97 [In Russ]. 6. Gantsev ShKh, Arybzhanov DT, Kulakeev OK. A method of chemotherapy for gastric cancer metastases in the liver. Patent of the Russian Federation No. 2364397 dated 20.08.2009. Bul. 23 [In Russ]. 7. Chen H, Gao S, Yang XZ, et al. Comparison of Safety and Efficacy of Different Models of Target Vessel Regional Chemotherapy for Gastric Cancer with Liver Metastases. Chemotherapy. 2016; 61(2): 99-107. https://doi.org/10.1159/000440945 8. Chen H, Zhang J, Cao G, et al. Target hepatic artery regional chemotherapy and bevacizumab perfusion in liver metastatic colorectal cancer after failure of first-line or second-line systemic chemotherapy. Anticancer Drugs. 2016; 27(2): 118-26. https://doi.org/10.1097/CAD.0000000000000290 9. Sawatsubashi T, Nakatsuka H, Nihei K, Takano T. A Case of Metachronous Multiple Liver Metastases of AFP and PIVKA-Producing Gastric Cancer, Responding to Transcatheter Arterial Chemoembolization. Gan To Kagaku Ryoho. 2020; 47(2): 319-321. 10. Liu SF, Lu CR, Cheng HD, et al. Comparison of Therapeutic Efficacy between Gastrectomy with Transarterial Chemoembolization Plus Systemic Chemotherapy and Systemic Chemotherapy Alone in Gastric Cancer with Synchronous Liver Metastasis. Chin Med J. 2015; 128(16): 2194-201. https://doi.org/10.4103/0366-6999.162497 11. Xu H, Min X, Ren Y, et al. Comparative Study of Drug-eluting Beads versus Conventional Transarterial Chemoembolization for Treating Peculiar Anatomical Sites of Gastric Cancer Liver Metastasis. Med Sci Monit. 2020; 26: 922988.
Abstract: Purpose: South Kazakhstan Regional Cancer Clinic presents the immediate results of hepatic artery chemotherapy infusion and chemoembolization in patients with hepatic tumors. Material and methods: hepatic artery chemoembolization and chemotherapy infusion was performed in 70 patients (47 males, 67,1%) with hepatic tumors since 2004-2008. There were all in all 42 cases (60%) of primary hepatic carcinoma, and in 28 patients (40%) the procedure was done for liver metastatic malignancies. Hepatic artery chemotherapy infusion (HACI) was performed in 50 cases, including 32 patients (45,7%) with primary hepatic carcinoma, and 18 patients (25,7%) with metastatic foci. Hepatic artery chemoembolization (HACE) performed in 20 patients, including 10 patients (17,1%) with primary hepatic carcinoma, and 8 cases (11,4%) of metastatic malignancies. Results: significant regression of primary cancer foci and uneventful 3 years follow-up were seen in 2 patients (4,76%), partial regression of the lesion - in 6 (14,3%) of cases, tumor stabilization - in 16 (38%), and tumor progression were found in 8 (19%) of patients. 12 months survival with tumor stabilization was 33,3% (14 patients), 18 months survival - 7,14% (3 patients). Post-procedure mortality in terms of 4 to 8 months made up as high as 30,9% (13 patients). HACE procedure resulted with tumor regression in 8 of 10 patients; the effect sustained for 3-5 months already. For the present moment, 2nd and 3d HACE session is scheduled for this group of patients. Conclusions: HACI is shown to be effective in treatment of primary and to improve the quality of life in 45,2% of cases. Thus, wide use of the method could be recommended in such a complicated category of patients. HACE procedure results are also hopeful, tumor stabilization starting after the first session. References 1. Давыдов М.И., Гранов А.М., Таразов П.Г., Гранов Д.А. и др. Интервенционная радиология в онкологии (пути развития и технологии). С-Пб: Фолиант. 2007. 2. Гранов Д.А., Таразов П.Г. Рентгеноэндоваскулярные вмешательства в лечении злокачественных опухолей печени. С-Пб: Фолиант. 2002. 3. Таразов П.Г. Артериальная химиоинфузия в лечении нерезектабельных злокачественных опухолей печени (обзор литературы).Вопр. онкол. 2000; 46 (5): 521-528. 4. Таразов П.Г. Роль методов интервенционной радиологии в лечении больных с метастазами колоректального рака в печень. Практическая онкология. 2005; 6 (2): 119-126. 5. Bierman H.R., Miller E.R., Byron R.L. et al.Intra-arterial catheterization of viscera in man. Amer.J. Roentgenol. 1951; 66 (4): 555-568. 6. Chiba Т., Tokuuye K., Matsuzaki Y. et al. Proton beam therapy for hepatocellular carcinoma: A retrospective review of 162 patients. Clin. Cane. Res. 2005; 11 (10): 3799-3805. 7. Gianturco C., Anderson J.H., Wallace S. Mechanical devices for arterial occlusion. Amer.J. Roentgenol. 1975; 124 (3):428-435
