title: Chemotherapy and resection for gastric cancer with synchronous liver metastases.
abstract: OBJECTIVE
  To investigate the effect of surgery and chemotherapy for gastric cancer with multiple synchronous liver metastases (GCLM).
  
  
  METHODS
  A total of 114 patients were entered in this study, and 20 patients with multiple synchronous liver metastases were eligible. After screening with preoperative chemotherapy, 20 patients underwent curative gastrectomy and hepatectomy for GCLM; 14 underwent major hepatectomy, and the remaining six underwent minor hepatectomy. There were 94 patients without aggressive treatment, and they were in the non-operative group. Two regimens of perioperative chemotherapy were used: S-1 and cisplatin (SP) in 12 patients, and docetaxel, cisplatin and 5-fluorouracil (DCF) in eight patients. These GCLM patients were given preoperative chemotherapy consisting of two courses chemotherapy of SP or DCF regimens. After chemotherapy, gastrectomy and hepatectomy were preformed. Evaluation of patient survival was by follow-up contact using telephone and outpatient records. All patients were assessed every 3 mo during the first year and every 6 mo thereafter.
  
  
  RESULTS
  Twenty patients underwent gastrectomy and hepatectomy and completed their perioperative chemotherapy and hepatic arterial infusion before and after surgery. Ninety-four patients had no aggressive treatment of liver metastases because of technical difficulties with resection and severe cardiopulmonary dysfunction. In the surgery group, there was no toxicity greater than grade 3 during the course of chemotherapy. The response rate was 100% according to the response evaluation criteria in solid tumors criteria. For all 114 patients, the overall survival rate was 8.0%, 4.0%, 4.0% and 4.0% at 1, 2, 3 and 4 years, respectively, with a median survival time (MST) of 8.5 mo (range: 0.5-48 mo). For the 20 patients in the surgery group, MST was 22.3 mo (range: 4-48 mo). In the 94 patients without aggressive treatment, MST was 5.5 mo (range: 0.5-21 mo). There was a significant difference between the surgery and unresectable patients (P = 0.000). Three patients in surgery group were still alive at the end of the cut-off date.
  
  
  CONCLUSIONS
  Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.
authors.affiliation: Department of Surgery, Qingdao Municipal Hospital, Qingdao 266011, Shandong Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
authors.forename: Ming-Quan
authors.initials: MQ
authors.lastname: Song
authors.forename: Hui-Zhong
authors.initials: HZ
authors.lastname: Lin
authors.forename: Lin-Hua
authors.initials: LH
authors.lastname: Hao
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Jiang
authors.forename: Zi-Yu
authors.initials: ZY
authors.lastname: Li
authors.forename: Yu-Xin
authors.initials: YX
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D004338:Drug Combinations; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006031:Glycosylation; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010094:Oxonic Acid / Q000627:therapeutic use; D010865:Pilot Projects; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D043823:Taxoids / Q000008:administration & dosage; D005641:Tegafur / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D043823:Taxoids; C079198:S 1 (combination); D005641:Tegafur; D000077143:Docetaxel; D010094:Oxonic Acid; D002945:Cisplatin; D005472:Fluorouracil
keywords: Chemotherapy; Gastric cancer; Liver metastases; Pilot study; Surgery