PCF chemotherapy combined with surgical treatment of  advanced gastric cancer.

113 Background: Local advanced gastric cancer that could not receive R0 resection or gastric cancer with distant metastasis usually received palliative chemotherapy or entered into a number of clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From July 2008 to February 2011, 72 cases of local advanced gastric cancer that cannot be treated with R0 resection (T4N2~3M0) or gastric cancer with single organ metastases (M1) were prospectively analysed. Patients received 2-4 cycles of PCF chemotherapy (PTX 150mg/m2, d1, CDDP 25mg/m2, d1-3, CF 250 mg/m2, d1-3,5-FU 750 mg/m2, d1-3, repeated every 3 weeks), then the primary and metastatic tumor were treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with D3 and D4 lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, peritoneal resection, liver resection, and tumor radio frequency, followed with another 2-4 cycles of PCF chemotherapy. The treatment completion rate, patients’ tolerance, and overall survival (OS) time were analyzed. Results: 50 patients (69.4%) accomplished chemotherapy and surgical resection as planned. 42 cases had R0 resection (58.3%). The postoperative complication rate was 6.0%. Grade 3/4 toxic effects included bone marrow suppression (30.6%) and gastrointestinal reaction (40.3%), the overall response rate (CR+PR) was 72.2%. Survival analysis: the median survival time was 23.5 months. 1-year and 2-year survival rate was 67.0% and 47.0%. The OS of patients with surgical resection was much longer than that of the non-surgery group. (30.2 vs. 8.9 months) (p <0.01). The OS of local advanced group was 30.3 months, and was significantly longer than 17.6 months of the distant metastasis group (p <0.01); however, it had no significant difference compared to 28.2 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single organ metastasis.