PURPOSE: Perioperative chemotherapy improves survival outcomes in locally advanced (LA) gastric cancer. MATERIALS AND METHODS: We retrospectively analyzed patients with LA gastric cancer who were offered perioperative chemotherapy consisting of epirubicin, oxaliplatin, and capecitabine (EOX) from May 2013 to December 2015 at Tata Memorial Hospital in Mumbai. RESULTS: Among the 268 consecutive patients in our study, 260 patients (97.0%) completed neoadjuvant chemotherapy, 200 patients (74.6%) underwent D2 lymphadenectomy, and 178 patients (66.4%) completed adjuvant chemotherapy. The median follow-up period was 17 months. For the entire cohort, the median overall survival (OS), 3-year OS rate, median progression-free survival (PFS), and 3-year PFS rate were 37 months, 64.4%, 31 months, and 40%, respectively. PFS and OS were significantly inferior in patients who presented with features of obstruction than in those who did not (P=0.0001). There was no difference in survival with respect to tumor histology (well to moderately differentiated vs. poorly differentiated, signet ring vs. non-signet ring histology) or location (proximal vs. distal). Survival was prolonged in patients with an early pathological T stage and a pathological node-negative status. In a multivariate analysis, postoperative pathological nodal status and gastric outlet obstruction on presentation significantly correlated with survival. CONCLUSIONS: EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resection, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial.
Capecitabine* ; Chemotherapy, Adjuvant ; Cohort Studies ; Disease-Free Survival ; Drug Therapy* ; Epirubicin* ; Follow-Up Studies ; Gastrectomy ; Gastric Outlet Obstruction ; Humans ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms* ; Survival Analysis* ; Survival Rate

Silk fibroin/xanthan composite was investigated as a suitable biomedical material for controlled drug delivery, and blending ratios of silk fibroin and xanthan were optimized by response surface methodology (RSM) and artificial neural network (ANN) approach. A non-linear ANN model was developed to predict the effect of blending ratios, percentage swelling and porosity of composite material on cumulative percentage release. The efficiency of RSM was assessed against ANN and it was found that ANN is better in optimizing and modeling studies for the fabrication of the composite material. In-vitro release studies of the loaded drug chloramphenicol showed that the optimum composite scaffold was able to minimize burst release of drug and was followed by controlled release for 5 days. Mechanistic study of release revealed that the drug release process is diffusion controlled. Moreover, during tissue engineering application, investigation of release pattern of incorporated bioactive agent is beneficial to predict, control and monitor cellular response of growing tissues. This work also presented a novel insight into usage of various drug release model to predict material properties. Based on the goodness of fit of the model, Korsmeyer–Peppas was found to agree well with experimental drug release profile, which indicated that the fabricated material has swellable nature. The chloramphenicol (CHL) loaded scaffold showed better efficacy against gram positive and gram negative bacteria. CHL loaded SFX55 (50:50) scaffold shows promising biocomposite for drug delivery and tissue engineering applications.
Chloramphenicol ; Diffusion ; Drug Liberation ; Fibroins ; Gram-Negative Bacteria ; Porosity ; Silk ; Tissue Engineering