title: A pilot study of an individualized comprehensive treatment for advanced gastric cancer with para-aortic lymph node metastasis.
abstract: BACKGROUND
  The incidence of the para-aortic lymph node metastasis (PALM) in patients with advanced gastric cancer is 6 to 33 %. The prognosis is poor and the 5-year survival rate is only 12 to 23 % after gastrectomy with super-extended lymph node dissection. We applied an individualized comprehensive treatment for affected patients including neoadjuvant chemotherapy via intra-arterial and intravenous administration, surgery and radiotherapy, to investigate the safety and prognostic value.
  
  
  METHODS
  Between January 2005 and December 2010, 47 advanced gastric cancer patients with PALM received 5-Fu (370 mg/m(2)) and leucovorin (200 mg/m(2)) intravenously on days 1-5, and intra-arterial infusion of etoposide (80 mg/m(2)) and oxaliplatin (80 mg/m(2)) on days 6 and 20, repeated 2 cycles. Patients achieved PR or CR of the para-aortic lymph node (PAL) were performed D2 dissection, followed by 6 cycles chemotherapy with XELOX regimen, oxaliplatin (130 mg/m(2)) on day 1 and xeloda (1000 mg/m(2)) on days 1 to 14 of a 28-day cycle, and radiotherapy to the region of PALM.
  
  
  RESULTS
  Forty-six patients completed 2 cycles of neoadjuvant chemotherapy. The overall response rate of the primary tumor was 80.4 % (37/46). The response rate of PAL was 76.1 % (35/46). Thirty-two patients underwent D2 dissection and six cases achieved pathological complete response (pCR). The toxicity profile was well tolerable and there was no treatment-related death. The median survival time for all patients was 23 months, and for nonsurgical and surgical patients were 12 and 29 months (p < 0.001), respectively. The 1-year, 2-year and 3-year survival rate was 70.96, 43.27 and 35.48 % for all patients, and for surgical patients was 96.875, 68.75, and 40.63 %.
  
  
  CONCLUSIONS
  Advanced gastric cancer patients with PALM can obtain a survival benefit from neoadjuvant chemotherapy, subsequent surgery and radiotherapy.
  
  
  BACKGROUND
  Current Controlled Trials ChiCTR-TRC-12002046 .
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No.305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: He
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No.305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Long
authors.initials: L
authors.lastname: Ma
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No.305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, No.305 East Zhongshan Road, Nanjing, 210002, China. liguoli15@163.com.
authors.forename: Guoli
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001011:Aorta / Q000473:pathology*; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007261:Infusions, Intra-Arterial; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010071:Oxaloacetates; D010865:Pilot Projects; D018714:Radiotherapy, Adjuvant / Q000379:methods; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil