Study On Modified XELOX Regimen For The Treatment Of Hepatic Metastases From Gastric And Colorectal Cancer

Part1Study on Modified XELOX Regimenfor the Treatment of Hepatic Metastases fromColorectal Cancer after SurgeryObjectiveTo explore the effectiveness, safety and influencing factors of modified XELOX for thetreatment of liver metastases from colorectal cancer (colorectal liver metastases, CLM)after surgery.MethodsDuring the period from March1st,,2006to December31,2012,64patients’ clinical datawere retrospectively analyzed，who were diagnosed with liver metastases from colorectalcancer after surgery. All the patients had been pathologically confirmed and receivedat least four courses of modified XELOX regimen. We recorded their survival time.Modified XELOX regimen means that injecting certain lipiodol mixed oxaliplatin (50mg)into hepatic artery with catheter for chemotherapy embolism, and then slowly (1hour)pumping into oxaliplatin with100mg through indwell catheter in the hepatic artery, d1;instructing patients taking capecitabine after one week (or almost10days, according to thespecific circumstances of the patient’s blood), d8-21and after3-5weeks rest on to the nextcourse of treatment. The treatment interval can be extended to8-12weeks after six courses.Liver metastases were examined by CT and/or MRI and primary tumor site bycolonoscopy every2months. RECIST was used to evaluate the objective response. The64patients were divided into two groups:group A (n=33): without postoperative intravenous chemotherapy after the surgery;group B (n=31): with postoperative intravenous chemotherapy after the surgery. We use19.0SPSS software and Kaplan-Meier methods to apply. The response rate, survival rate,overall survival (OS), progress free survival (PFS) between group A and B were compared.Cox regression model was performed to analyze the possible factors about affection of the survival time.Results1. All the64patients received321times TACE and can be evaluated. The median overallsurvival was18.0months,95%CI（16.3,19.7）, with CR17cases, PR23cases, SD19cases, PD5cases, the response rate (RR) was62.5%. The median progression-freesurvival (PFS) was10.0months,95%CI（8.2,11.8）.2. Group A: without postoperative intravenous chemotherapy after the surgery:33patients received a total of169times TACE; The median overall survival of Group Awas20.0months,95%CI（17.2,22.7）, with CR11cases, PR12cases, SD9cases, PD1cases, the response rate (RR) was69.7%.Group B:with postoperative intravenous chemotherapy after the surgery:31patients received atotal of152times TACE. The median overall survival of Group B was17.0months,95%CI（14.6,19.4）, with CR6cases, PR11cases, SD10cases, PD4cases, theresponse rate (RR) was54.8%The median progression-free survival (PFS)of bothGroup A and Group B were10.0months, the95%CI was (7.6-12.4),(5.8-14.2)respectively.3. The adverse reactions after the treatment included nausea, vomiting, pain, impairedliver function, myelosuppression, peripheral sensory neuropathy and so on, most ofwhich presented as grade Ⅰ-Ⅱ. All the adverse reactions disappeared aftersymptomatic treatment and there was no treatment-related death.17cases of Group Aoccurred nausea and vomiting and20cases of group B. The second was liver functionabnormalities, such as elevations of ALT and AST, but only lasted3-5days after TACE;bone marrow mainly presented as white blood cells and platelets decreased. There wasno significant difference in the incidence of each kind of adverse reaction exceed gradeI.4. The survival time, survival outcome were defined as the dependent variable, gender(X1), age (X2), primary tumor site (X3), lymph node metastasis (X4), tumordifferentiation (X5), chemotherapy or not (X6) as the covariate. We analyzed them bymultiple stepwise Cox regression analysis. The standard of the variables input is α= 0.10and output is α=0.20. The variable eventually enter the variable model isdifferentiation (X5), HR=2.734,95%CI (1.487,5.027), indicating that whendifferentiation download one grade, the corresponding2.734-times increased risk ofdeath.ConclusionModified XELOX regimen is effective in treating hepatic metastases from colorectalcancer after surgery, with high objective response rate.It can improve the quality of life ofpatients and the adverse reactions can be well tolerated. Part2Study on Modified XELOX Regimenfor the Treatment of Gastric and ColorectalCancer Combined with Hepatic MetastasesObjectiveTo explore the effectiveness, safety of modified XELOX for the treatment of gastric andcolorectal cancer combined with hepatic metastases.MethodsWe retrospectively analyzed the clinical data of30patients who were diagnosed as gastricand colorectal cancer combined with hepatic metastases. All the diagosis were comfirmedby biopsy of puncture, gastroscopy or colonoscopy and the patients receivedat least four courses of modified XELOX regimen during the period from August7,2006to December31,2012. XELOX was modified as follows: injecting50mg oxaliplatin intothe primary site of cancer, colorectal cancer was injected through mesenteric artery or Iliacartery and gastric was injected through left gastric artery or celiac trunk, then injectingcertain volume lipiodol mixed with oxaliplatin (50mg) into hepatic artery via catheter forchemotherapy embolization.After that, slowly(1hour) pumping into oxaliplatin100mgthrough indwell catheter in the celiac trunk or common hepatic artery,proper hepatic artery,left hepatic artery, right hepatic artery, d1; after one week,giving patients capecitabine (oralmost10days, according to the specific status of the patient’s blood), d8-21and after3-5weeks rest on to the next course of treatment. The treatment interval would be extended to8-12weeks after six courses. Liver metastases were examined by CT and/or MRI andprimary tumor site by gastroscopy or colonoscopy every2months. RECIST was used toevaluate the objective response. SPSS19.0was applied. Kaplan-Meier method was used toanalyze the survival time and Cox regression model was used to analyze the possiblefactors about affection of the survival time.Results1. All30patients received total of196times with TACE and can be evaluated. Medianover-all survival was12.0months,95%CI（9.6,14.4）, with CR2cases, PR10cases, SD8cases, PD10cases, the response rate (RR) was40.3%. Median progression-freesurvival (PFS) was4.0months,95%CI（2.2,5.8）.2. The adverse reactions after the treatment included nausea, vomiting, pain, impairedliver function, myelosuppression, peripheral sensory neuropathy and so on, most ofwhich presented as grade Ⅰ-Ⅱ. All the adverse reactions disappeared aftersymptomatic treatment and there was no treatment-related death. Nausea and vomitingoccurred in23patients, which were the highest adverse reaction. The second was liverfunction abnormalities, such as elevations of ALT and AST, but only lasted for3-5days after TACE; bone marrow suppression mainly presented as white blood cells andplatelets decreased.ConclusionModified XELOX regimen is effective in treating gastric and colorectal cancer combinedwith hepatic metastases, with high objective response rate.It can improve the quality of lifeof patients, increase opportunities for surgical resection and the adverse reactions can bewell tolerated.