A pilot study of an individualized comprehensive treatment for advanced gastric cancer with para-aortic lymph node metastasis

Background: The incidence of the para-aortic lymph node metastasis (PALM) in patients with advanced gastric cancer is 6 to 33%. The prognosis is poor and the 5-year survival rate is only 12 to 23% after gastrectomy with super-extended lymph node dissection. We applied an individualized comprehensive treatment for affected patients including neoadjuvant chemotherapy via intra-arterial and intravenous administration, surgery and radiotherapy, to investigate the safety and prognostic value. Methods: Between January 2005 and December 2010, 47 advanced gastric cancer patients with PALM received 5-Fu (370mg/m) and leucovorin (200mg/m) intravenously on days 1-5, and intra-arterial infusion of etoposide (80mg/m) and oxaliplatin (80mg/m) on days 6 and 20, repeated 2cycles. Patients achieved PR or CR of the para-aortic lymph node (PAL) were performed D2 dissection, followed by 6cycles chemotherapy with XELOX regimen, oxaliplatin (130mg/m) on day 1 and xeloda (1000mg/m) on days 1 to 14 of a 28-day cycle, and radiotherapy to the region of PALM. Results: Forty-six patients completed 2cycles of neoadjuvant chemotherapy. The overall response rate of the primary tumor was 80.4% (37/46). The response rate of PAL was 76.1% (35/46). Thirty-two patients underwent D2 dissection and six cases achieved pathological complete response (pCR). The toxicity profile was well tolerable and there was no treatment-related death. The median survival time for all patients was 23months, and for nonsurgical and surgical patients were 12 and 29months (p<0.001), respectively. The 1-year, 2-year and 3-year survival rate was 70.96, 43.27 and 35.48% for all patients, and for surgical patients was 96.875, 68.75, and 40.63%. Conclusion: Advanced gastric cancer patients with PALM can obtain a survival benefit from neoadjuvant chemotherapy, subsequent surgery and radiotherapy. Trial registration: Current Controlled Trials ChiCTR-TRC-12002046.