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Application of FLEEOX Preoperative Chemotherapy via Intra-arterial and Intravenous Administration in Treatment of Unresectable Locally Advanced Gastric Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The prognosis of unresectable locally advanced gastric cancer is poor. We applied preoperative chemotherapy via intra-arterial and intravenous administration to convert an initially unresectable gastric cancer to a resectable cancer.

Methods

From January 2005 to December 2010, 105 patients with unresectable locally advanced gastric cancer (T3-4N1-3M0) were selected for preoperative chemotherapy with 5-FU + leucovorin + etoposide + oxaliplatin + epirubicin (FLEEOX) regimen. 5-Fu (370 mg/m2) and leucovorin (200 mg/m2) were administered by intravenous infusion on days 1–5. Intra-arterial administration of etoposide (80 mg/m2), oxaliplatin (80 mg/m2), and epirubicin (30 mg/m2) was performed by Seldinger method on days 6 and 20, repeated two cycles. Patients who achieved partial response (PR) or complete response (CR) underwent D2 dissection, followed by four to six cycles of XELOX chemotherapy. The response rate, 1- and 3-year survival rate, and R0 resection rate were evaluated.

Results

The response rate of preoperative chemotherapy was 78.1 % (82 of 105 patients), with 7 cases of CR and 75 cases of PR, respectively. After chemotherapy, a total of 78 patients (74.3 %) underwent surgery, and 67 cases achieved R0 resection (85.9 %). The 1- and 3-year overall survival (OS) rate of all 105 patients was 71.9 and 31.7 % (median survival time, 18 months). The 1- and 3-year OS rate among the 78 patients treated with chemotherapy plus surgery was 84.5 and 40 % (median survival time, 30 months). Patients treated with chemotherapy plus surgery had significantly longer OS times than patients who underwent chemotherapy alone (P < 0.01).

Conclusions

Patients with unresectable gastric cancer may obtain a survival benefit from preoperative chemotherapy via intra-arterial and intravenous administration and subsequent surgery.

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Abbreviations

FLEEOX:

5-FU + leucovorin + etoposide + oxaliplatin + epirubicin

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

XELOX:

Oxaliplatin + xeloda

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Acknowledgments

This study is registered with the Chinese Clinical Trials Registry, ChiCTR-TRC-12002046.

Authors’ Contributions

GL-L contributed to the design and execution of the study. Y-L accrued patients and collected clinical data and specimens. Q-H, Y-L, L-M, and X-J carried out the experiments. Q-H and Y-L provided the administrative support and analyzed the data and drafted the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China

    Qi He, Yang Li, Long Ma, Xiang Ji & Guoli Li

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  1. Qi He
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  2. Yang Li
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  3. Long Ma
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  4. Xiang Ji
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  5. Guoli Li
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Correspondence to Guoli Li.

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The authors declare that they have no conflict of interest.

Ethics, Consent, and Permissions

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients before they were included in the study.

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He, Q., Li, Y., Ma, L. et al. Application of FLEEOX Preoperative Chemotherapy via Intra-arterial and Intravenous Administration in Treatment of Unresectable Locally Advanced Gastric Cancer. J Gastrointest Surg 20, 1421–1427 (2016). https://doi.org/10.1007/s11605-016-3153-8

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  • DOI: https://doi.org/10.1007/s11605-016-3153-8

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