Clinical Evaluation Of Intraperitoneal Perfusion Of Verapamil And Chemotherapeutic Drugs In Therapy Of Gastric Cancer

Background:The incidence and mortality of gastric cancer in China are increasing year by year.The majority of Chinese gastric cancer patients were found with advanced-stage gastric cancer at the time of first diagnosis,thereby reducing the opportunity of surgical treatment amd resulting in poor prognosis?Moreover,the scope and depth of tumor invasion,lymph nodes metastasis,primary tumor size and tumor differentiation are closely related with the prognosis post gastrectomy,which is in large due to the frequent tumor reccuence in the abdominal cavity,liver or gastric remnant 1-2 years afterthe initial treatment.Intraperitoneal chemotherapy has been shown to be effective in reducing intraperitoneal recurrence and liver metastasis in patients with gastric cancer.In order to improve the efficacy,here in this study we develop a verapamil combined intraperitoneal chemotherapy strategy as a adjuvant chemotherapy strategy in treating gastric cancer patients supplementing togastrectomy.Purpose:To assess the clinical efficacy and side effects of targeted intraperitoneal perfusion of verapamil and chemotherapeutic drugs in therapy of gastric cancer.Methods:184 gastric cancer patients that have accepted radical surgery with postoperative classification(pT1?4N2?3M0)from January 2008 to April 2014,were randomly divided into the control group(58 cases)and the study group(126 cases).For the post-gastrectomy chemotherapeuric treatment,1g of 5-fluorouracil and 40 mg/m2 of cisplatin were administrated to the patients in the control group,while 1g of 5-fluorouracil,40 mg/m2 of cisplatin and 25 mg of verapamil were given to the patients in the study group.Patients in both groups received intravenous administration of 20mg/m2 of doxorubicin 3?5 hours before the intraperitoneal chemotherapy,and 0.1 g of leucovorin 30 minutes prior to the intraperitoneal chemotherapy.The second day post intraperitoneal chemotherapy,0.1 g of leucovorin and 400mg/m2 of 5-fluorouracil were given to all patients for 3?5 days.The disease-free survival rate,overall survival rate,as well as DFS(disease-free survival),OS(overall survival),peritoneal recurrence rate,liver metastasis rate,gastric remnant recurrence rate,adverse reactions and implications were examined and recorded at either the twelve-month or the twenty-four month period post the chemotherapy treatment.Results:Significantly improved disease-free survival rate and overall survival rate,as well as statistically significant extention of median DFS and OS were observed in the study group,compared to the control group,at both the twelve-month and twenty-four month periods post chemotherapy treatment,especially for the patients in the study group with regional lymph node classification of N2 or N3,low differentiated adenocarcinoma or original tumor size>4cm.On the other hand,the intraperitoneal recurrence rate and liver metastasis rate were significantly lower in the study group,compared with the control group.Importantly,no significant change was observed for the gastric remnant recurrence rate between the control and the study groups,and no noticeable incidence of chemotherapeutic or cardiovascular side-effects were observed and reported in the verapamil-administrated study group.Notably,8 patients were diagnosed with mild abdominal pain and 3 patients with incomplete the intestinal obstruction symptom,all of whom were recovered within 1 week upon proper treatment.Conclusion:The treatment option of intraperitoneal chemotherapy combined with verapamil significantly increased the disease-free survival rate and overall survival rate,extended the median DFS and OS,reduced the recurrence rate of intra-abdominal and liver metastasis rate in the gastric cancer patients at both 12-month and 24-month post-chemotheraoy treatment periods.More importantly,no dramatic side-effects and intraperitoneal incidence of complications were observed,suggesting that intraperitoneal perfusion of verapamil combined chemotherapeutic drugs may serve as a new and improved treatment option for gastric cancer patients in clinics.