Chemotherapy and resection for gastric cancer with synchronous liver metastases.
AIM
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.


CONCLUSION
Perioperative weekly DCF and SP achieved a good response, and combined with surgery, they could improve prognosis of GCLM.
['Chen|Lei|L|', 'Song|Ming-Quan|MQ|', 'Lin|Hui-Zhong|HZ|', 'Hao|Lin-Hua|LH|', 'Jiang|Xiang-Jun|XJ|', 'Li|Zi-Yu|ZY|', 'Chen|Yu-Xin|YX|']
D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D002945:Cisplatin D000077143:Docetaxel D004338:Drug Combinations D005260:Female D005472:Fluorouracil D006031:Glycosylation D006801:Humans D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D009362:Neoplasm Metastasis D010094:Oxonic Acid D010865:Pilot Projects D013274:Stomach Neoplasms D043823:Taxoids D005641:Tegafur D016896:Treatment Outcome
Chemotherapy Gastric cancer Liver metastases Surgery Pilot study