Comparative Study Between¹²⁵I Radioactive Seed Combined With Chemotherapy And Chemotherapy Alone In The Treatment Of Liver Metastatic Gastric Cancer After Resection

Background and ObjectivesThe incidence of gastric cancer ranked fourth in malignant tumors, malignant cau-ses of death in second place. Gastric cancer is harmful to people’s health. In China, malignancies in the incidence of gastric cancer was r up to16million each yea, and the process has increased year by year trend. Early gastric cancer can cured by surg-ical resection and has a better prognosis, but there are many patients presence of dis-tant metastasis at the time of diagnosis or there are13.5%-30.0%of gastric cancer patients presentence liver metastases after surgical resection. As the main treatment for advanced gastric cancer, the standard regimen of systemic chemotherapy has not been established, but the most common regimens are5-FU or DDP-based combinati-on therapy. However, the survival of patients with liver metastases improved by che-moth erapy is still limited. For colorectal cancer liver metastases underwent surgical local excision or interventional therapy has been significantly improved patient surv-ival, therefore more and more clinical workers began to study the local treatment co-mbined with systemic chemotherapy could further improve the survival time of pat- ients with gastric cancer liver metastases and improve patients outcomes. This study was designed to compare the efficacy and adverse reaction of the radioactive1251seed implantation surgery combined with XELOX regimen and XELOX regimen alo-ne in the treatment of gastric cancer patients with liver metastases.MethodsFrom April2007to September2011, we selected48gastric cancer liver metast-asis patients after surgery who diagnosised in the First Affiliated Hospital oncology department of Nanyang Academy of Medicine. All of them are confirmed the liver metastasis of gastric cancer by CT, MRI examination or pathological biopsy and met the inclusion criterias. Then patients were randomly divided into a treatment group and a control group, and there were24patients in each group. Patients who were ass-ig ned to the treatment group were given1251seed implantation firstly, then three days after the operation, if they had no discomfort, all of them were given the XEOLX chemotherapy (oxaliplatin130mg/m2ivdrip, d1capecitabine1000mg/m2po bid dl-141course of treatment every three weeks), a total given4cycles of chemotherapy, while the control group were given XELOX regimen alone (programs were as same the former). All patients completed four cycles of chemotherapy and they conducted CT or other imaging tests to evaluate the efficacy.The general data, the short-term efficacy and adverse reactions differences of the two groups were compared. We applicated SPSS16.0statistical package for statistical analysis. Different clinical characteristics and the short-term effect between the two groups were compared using the chi-square test, statistical tests using a two-sided test, a=0.05as the level of inspection.Results1. The general data of treatment group and control group:There were13male patients and11female patients in the treatment group, and the age range was35-67years old, with a median age of57years old. There were16male patients and8female patients in the control group, and the age range was37-69years old, with a median age of58years old. Compared by the chi-square test, there was no difference in the ECOG score between the two groups of patients (p=0.827), primary tumor site (p=0.712), and tumor pathology type (p=0.683).The gener-al characters between the two groups were balance.2. The short-term efficacy between treatment group and the control group:There were4cases CR (16.7%),16cases PR (66.7%),3cases SD (12.5%),1cases PD (4.1%) in the treatment group; and there were1cases CR (4.1%),10cases PR (41.7%),8cases SD (33.3%),5cases PD (20.9%) in control group. Efficiency difference between the two sets was statistical significance (p=0.044).3. The adverse reactions between treatment group and the control group:The patients in the treatment group who were treated with1251seed implantation,7cases had liver pain,3cases had fever,4cases had hepatic subcapsular trace bleeding. But all of them could be recovery. The most common chemotherapy-related adverse reactions in the two group were myelosuppression, peripheral neurotoxicity, gastrointestinal reactions, and hand-foot syndrome. And most of the adverse reactions were grade Ⅰ or Ⅱ. After appropriate treatment,they were recoverable.There were no treatment-related deaths occur.ConclusionCompared with the simple use of the the XELOX regimen for the treatment of gastric cancer patients with liver metastases, radioactive1251seed joint XELOX regimen has a good effect, and the adverse reactions can be tolerated. The treatment plan should be used in clinical practice.