Incidence of gastric cancer is ranked fourth in the most common malignancy in the world, there are about 1 million of the new cases annually. Ranks second in male cancer mortality, fourth in the ranks among women.
As we all know, the adequacy of local control is the key to treat gastric cancer. The incidence rate of the incidence of primary gastric cancer liver metastases is 4% to 14%. Gastric cancer liver metastases is still incurable, patients with 5-year survival rate is only 10%.
Gastric cancer liver metastases, often accompanied with peritoneal dissemination, lymph node metastasis or tumor direct violation of other organs, so few reports about the resection of liver metastases of gastric cancer. Compared with colorectal cancer, the vast majority of gastric cancer liver metastases often prompts the disease has been widely spread. A report shows that in gastric cancer patients with liver metastases, only 1/5 of the patients line liver metastases resection. The survival rate of liver resection is relatively poor, 2/3 of patients with intrahepatic recurrence. Such a high relapse rate in surgery within 2 years means that there is a potential intrahepatic metastases in hepatectomy.
According to pharmaceutical raw materials suppliers, many new drugs such as oxaliplatin, taxane, irinotecan and S-1 and so on for patients with advanced gastric cancer provide a more effective and safe treatment option. Studies have shown that the effective rate of 5-FU + calcium folinate (CF) with oxaliplatin combination chemotherapy is 38% to 54%, overall survival is 8 to 11 months, and good security. The effective of taxane treat advanced gastric cancer was 11% to 24%. Another study showed that single-agent irinotecan in the treatment of gastric cancer was 20%. Various chemotherapy containing irinotecan showed a better relieve rate. What’s more, the irinotecan price ismoderate, can be widely used.
S-1 is a fluorouracil derivative oral anticancer drug, compared with 5-FU has the following advantages: (1) can maintain a high blood concentration and improve anticancer activity; (2) significantly reduce drugtoxicity; (3) getting drugs convenient. In Japan, S-1 in 1999, has been approved it in the treatment of advanced gastric cancer. In Japan, more than 80% of the advanced gastric cancer chemotherapy use the S-1, its efficiency up to 44.6%. Clinical trials have shown that the effective rate of S-1 for gastric cancer with liver metastasis was 25% to 31%.
Recently, a clinical trial conducted by oncologists show that S-1 single-agent efficacy was not inferior to 5-FU alone drug; irinotecan combined with cisplatin was no better than use 5-FU alone. Analysis showed that irinotecan can significantly prolonged progression-free survival and overall survival associated with liver metastasis or lymph node metastasis in patients with irinotecan plus cisplatin. In addition, studies have shown that the first-line treatment for advanced gastric cancer, S-1 plus cisplatin is more effective than the S-1 single drug. Therefore, S-1 plus cisplatin has become one of the standard first-line treatment of advanced gastric cancer program in Japan. In S-1 combined with docetaxel clinical trials, types and histopathological types of gastric cancer involving the organ does not affect the efficacy of the program, wherein the overall response rate of gastric cancer liver metastases was 64.7%.
In addition, countries in the treatment of advanced gastric cancer chemotherapy are not the same. Such as the United States is often used docetaxel + cisplatin +5- FU, Europe often used epirubicin + cisplatin +5- FU or epirubicin + oxaliplatin + capecitabine, while South Korea is recommended cisplatin + capecitabine. But the efficacy of the above methods in gastric metastasis has not been reported.
Source:http://www.cospcn.com
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