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



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/m(2)) and leucovorin (200 mg/m(2)) were administered by intravenous infusion on days 1-5. Intra-arterial administration of etoposide (80 mg/m(2)), oxaliplatin (80 mg/m(2)), and epirubicin (30 mg/m(2)) 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.



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).



Patients with unresectable gastric cancer may obtain a survival benefit from preoperative chemotherapy via intra-arterial and intravenous administration and subsequent surgery.
Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China.
Qi
Q
He
Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China.
Yang
Y
Li
Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China.
Long
L
Ma
Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China.
Xiang
X
Ji
Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 Zhongshan Eastern Road, Nanjing, 210002, China. liguoli15@163.com.
Guoli
G
Li
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015251:Epirubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D011379:Prognosis; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D015251:Epirubicin; D005047:Etoposide; D002955:Leucovorin; D005472:Fluorouracil
Advanced gastric cancer; Intra-arterial injection; Preoperative chemotherapy; Unresectable