Objective To investigate the efficacy and toxicity of neoadjuvant regional arterial chemotherapy in the treatment of advanced gastric cancer. Methods The clinical data of 158 patients with advanced gastric cancer and with the same clinical stages who were admitted to Renji Hospital of Shanghai Jiaotong University from February 2002 to May 2005 were retrospectively analysed. Preoperative regional arterial chemotherapy was applied to 76 patients (test group) and the remaining 82 patients only received surgical treatment (control group). The chemotherapy regimen was epirubicin (50 mg/m2) + cisplatin (60 mg/m2) + 5-fluorouracil (1000 mg/m2).This regimen was modified to oxaliplatin (130 mg/m2) + 5-fluorouracil (1000 mg/m2) since 2003, and surgery was performed 6-11 days after the chemotherapy. All patients received postoperative intravenous chemotherapy.The clinical effects, radical resection rate, operative complications and long-term survival of the two treatment methods were evaluated. All data were analysed using the chi-square test and Kaplan-Meier analysis. Results The radical resection rate was significantly higher at 86% (65/76) in the test group compared with 71% (58/82)in the control group ( x2 = 5.01, P ＜ 0. 05 ). The toxicity of the chemotherapy in the test group was mild. The postoperative complication rate was 20% (15/76) in the test group and 16% (13/82) in the control group, with no significant difference between the two groups (x2 = 0.41, P＞0.05). The median survival time was 41 months in the test group and 23 months in the control group. The 5-year overall survival rate was higher in the test group (44.6%) than that in the control group (29.1%) (x2 =3.95, P＜0. 05). Conclusions Neoadjuvant regional arterial chemotherapy is well tolerated by patients with advanced gastric cancer. It is also effective for increasing the radical resection rate and improving the long-term survival.

Gastric cancer is one of the most common malignancies in China, which remains in high incidence and mortality. At present, radical surgery remains the cornerstone of multidisciplinary treatment in advanced gastric cancer, but is not the only one. In order to improve prognosis, it is necessary for surgeons to realize and emphasize the idea of comprehensive treatment. Accurate preoperative TNM staging is a prerequisite for selecting reasonable therapeutic modality. Based on standard surgery, multimodal treatments involving (neo-) adjuvant chemotherapy, radiotherapy or molecular target agents still need to be optimized for the best oncologic outcome with minimal morbidities. As to metastatic and late cases, personalized strategy is being acknowledged to prolong survival time and improve quality of life. A deeper understanding of high heterogeneity and biological characteristics of gastric cancer should be carried out, and multidisciplinary team collaboration is quite important to achieve an optimal treatment mode both standardized and individualized, which will benefit every patient.
Chemotherapy, Adjuvant ; China ; Combined Modality Therapy ; Humans ; Neoplasm Staging ; Prognosis ; Quality of Life ; Stomach Neoplasms ; therapy