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Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer

BACKGROUND: Obstruction or fullness after feeding is common in gastric cancer (GC) patients, affecting their nutritional status and quality of life. Patients with digestive obstruction are generally in a more advanced stage. Existing methods, including palliative gastrectomy, gastrojejunostomy, endo...

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Autores principales: Tang, Rui, Chen, Guo-Feng, Jin, Kai, Zhang, Guang-Qiang, Wu, Jian-Jun, Han, Shu-Gao, Li, Bin, Chao, Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10401462/
https://www.ncbi.nlm.nih.gov/pubmed/37546554
http://dx.doi.org/10.4251/wjgo.v15.i7.1283
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author Tang, Rui
Chen, Guo-Feng
Jin, Kai
Zhang, Guang-Qiang
Wu, Jian-Jun
Han, Shu-Gao
Li, Bin
Chao, Ming
author_facet Tang, Rui
Chen, Guo-Feng
Jin, Kai
Zhang, Guang-Qiang
Wu, Jian-Jun
Han, Shu-Gao
Li, Bin
Chao, Ming
author_sort Tang, Rui
collection PubMed
description BACKGROUND: Obstruction or fullness after feeding is common in gastric cancer (GC) patients, affecting their nutritional status and quality of life. Patients with digestive obstruction are generally in a more advanced stage. Existing methods, including palliative gastrectomy, gastrojejunostomy, endoluminal stent, jejunal nutrition tube and intravenous chemotherapy, have limitations in treating these symptoms. AIM: To analyze the efficacy of continuous gastric artery infusion chemotherapy (cGAIC) in relieving digestive obstruction in patients with advanced GC. METHODS: This study was a retrospective study. Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine. The oxaliplatin-based intra-arterial infusion regimen was applied in all patients. Mild systemic chemotherapy was used in combination with local treatment. The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Digestive tract symptoms and toxic effects were analyzed regularly. A comparison of the Karnofsky Performance Status (KPS) score and Stooler’s Dysphagia Score before and after therapy was made. Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival. RESULTS: All patients finished cGAIC successfully without microcatheter displacement, as confirmed by arteriography. The median follow-up time was 24 mo (95%CI: 20.24-27.76 mo). The overall response rate was 89.7% after cGAIC according to the RECIST criteria. The postoperative Stooler’s Dysphagia Score was significantly improved. Twenty-two (75.9%) of the 29 patients experienced relief of digestive obstruction after the first two cycles, and 13 (44.8%) initially unresectable patients were then considered radically resectable. The median overall survival time (mOS) was 16 mo (95%CI: 9.32-22.68 mo). Patients who received radical surgery had a significantly longer mOS than other patients (P value < 0.001). Multivariate Cox regression analysis indicated that radical resection after cGAIC, intravenous chemotherapy after cGAIC, and immunotherapy after cGAIC were independent predictors of mOS. None of the patients stopped treatment because of adverse events. CONCLUSION: cGAIC was effective and safe in relieving digestive obstruction in advanced GC, and it could improve surgical conversion possibility and survival time.
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spelling pubmed-104014622023-08-05 Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer Tang, Rui Chen, Guo-Feng Jin, Kai Zhang, Guang-Qiang Wu, Jian-Jun Han, Shu-Gao Li, Bin Chao, Ming World J Gastrointest Oncol Retrospective Study BACKGROUND: Obstruction or fullness after feeding is common in gastric cancer (GC) patients, affecting their nutritional status and quality of life. Patients with digestive obstruction are generally in a more advanced stage. Existing methods, including palliative gastrectomy, gastrojejunostomy, endoluminal stent, jejunal nutrition tube and intravenous chemotherapy, have limitations in treating these symptoms. AIM: To analyze the efficacy of continuous gastric artery infusion chemotherapy (cGAIC) in relieving digestive obstruction in patients with advanced GC. METHODS: This study was a retrospective study. Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine. The oxaliplatin-based intra-arterial infusion regimen was applied in all patients. Mild systemic chemotherapy was used in combination with local treatment. The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Digestive tract symptoms and toxic effects were analyzed regularly. A comparison of the Karnofsky Performance Status (KPS) score and Stooler’s Dysphagia Score before and after therapy was made. Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival. RESULTS: All patients finished cGAIC successfully without microcatheter displacement, as confirmed by arteriography. The median follow-up time was 24 mo (95%CI: 20.24-27.76 mo). The overall response rate was 89.7% after cGAIC according to the RECIST criteria. The postoperative Stooler’s Dysphagia Score was significantly improved. Twenty-two (75.9%) of the 29 patients experienced relief of digestive obstruction after the first two cycles, and 13 (44.8%) initially unresectable patients were then considered radically resectable. The median overall survival time (mOS) was 16 mo (95%CI: 9.32-22.68 mo). Patients who received radical surgery had a significantly longer mOS than other patients (P value < 0.001). Multivariate Cox regression analysis indicated that radical resection after cGAIC, intravenous chemotherapy after cGAIC, and immunotherapy after cGAIC were independent predictors of mOS. None of the patients stopped treatment because of adverse events. CONCLUSION: cGAIC was effective and safe in relieving digestive obstruction in advanced GC, and it could improve surgical conversion possibility and survival time. Baishideng Publishing Group Inc 2023-07-15 2023-07-15 /pmc/articles/PMC10401462/ /pubmed/37546554 http://dx.doi.org/10.4251/wjgo.v15.i7.1283 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Tang, Rui
Chen, Guo-Feng
Jin, Kai
Zhang, Guang-Qiang
Wu, Jian-Jun
Han, Shu-Gao
Li, Bin
Chao, Ming
Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title_full Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title_fullStr Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title_full_unstemmed Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title_short Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
title_sort efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10401462/
https://www.ncbi.nlm.nih.gov/pubmed/37546554
http://dx.doi.org/10.4251/wjgo.v15.i7.1283
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