Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2023; 15(7): 1283-1294
Published online Jul 15, 2023. doi: 10.4251/wjgo.v15.i7.1283
Efficacy of continuous gastric artery infusion chemotherapy in relieving digestive obstruction in advanced gastric cancer
Rui Tang, Guo-Feng Chen, Kai Jin, Guang-Qiang Zhang, Jian-Jun Wu, Shu-Gao Han, Bin Li, Ming Chao
Rui Tang, Kai Jin, Guang-Qiang Zhang, Jian-Jun Wu, Shu-Gao Han, Bin Li, Ming Chao, Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Guo-Feng Chen, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Tang R reviewed the literature and contributed to article drafting and statistical analysis; Li B was responsible for data acquisition and revision of the manuscript; Chao M was in charge of this project and responsible for the final revision of the manuscript; Chen GF was a surgeon from Department of Gastrointestinal Surgery, and was responsible for the evaluation of surgical indications of all patients; Jin K, and Zhang GQ were interventional physicians from the Department of Radiology, and participated in the diagnosis and treatment of patients; Wu JJ, and Han SG were experienced radiologists responsible for assessment of radiology response; all authors gave final approval for the version to be submitted.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Zhejiang University School of Medicine (Approval No. I2020001737).
Informed consent statement: All study participants or their legal guardian gave signed informed consent.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: Dataset available from the corresponding author at chaoming@zju.edu.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Chao, MD, Professor, Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310000, Zhejiang Province, China. chaoming@zju.edu.cn
Received: March 27, 2023
Peer-review started: March 27, 2023
First decision: May 4, 2023
Revised: May 17, 2023
Accepted: June 8, 2023
Article in press: June 8, 2023
Published online: July 15, 2023
Processing time: 107 Days and 3.3 Hours
Abstract
BACKGROUND

Obstruction or fullness after feeding is common in gastric cancer (GC) patients, affecting their nutritional status and quality of life. Patients with digestive obstruction are generally in a more advanced stage. Existing methods, including palliative gastrectomy, gastrojejunostomy, endoluminal stent, jejunal nutrition tube and intravenous chemotherapy, have limitations in treating these symptoms.

AIM

To analyze the efficacy of continuous gastric artery infusion chemotherapy (cGAIC) in relieving digestive obstruction in patients with advanced GC.

METHODS

This study was a retrospective study. Twenty-nine patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment were reviewed at The Second Affiliated Hospital of Zhejiang University School of Medicine. The oxaliplatin-based intra-arterial infusion regimen was applied in all patients. Mild systemic chemotherapy was used in combination with local treatment. The clinical response was evaluated by contrast-enhanced computed tomography using Response Evaluation Criteria In Solid Tumors (RECIST) criteria. Digestive tract symptoms and toxic effects were analyzed regularly. A comparison of the Karnofsky Performance Status (KPS) score and Stooler’s Dysphagia Score before and after therapy was made. Univariate survival analysis and multivariate survival analysis were also performed to explore the key factors affecting patient survival.

RESULTS

All patients finished cGAIC successfully without microcatheter displacement, as confirmed by arteriography. The median follow-up time was 24 mo (95%CI: 20.24-27.76 mo). The overall response rate was 89.7% after cGAIC according to the RECIST criteria. The postoperative Stooler’s Dysphagia Score was significantly improved. Twenty-two (75.9%) of the 29 patients experienced relief of digestive obstruction after the first two cycles, and 13 (44.8%) initially unresectable patients were then considered radically resectable. The median overall survival time (mOS) was 16 mo (95%CI: 9.32-22.68 mo). Patients who received radical surgery had a significantly longer mOS than other patients (P value < 0.001). Multivariate Cox regression analysis indicated that radical resection after cGAIC, intravenous chemotherapy after cGAIC, and immunotherapy after cGAIC were independent predictors of mOS. None of the patients stopped treatment because of adverse events.

CONCLUSION

cGAIC was effective and safe in relieving digestive obstruction in advanced GC, and it could improve surgical conversion possibility and survival time.

Keywords: Intra-arterial infusion chemotherapy; Intravenous chemotherapy; Interventional radiology; Digestive obstruction; Advanced gastric cancer; Response evaluation criteria in solid tumors

Core Tip: This was a retrospective study to evaluate the effectiveness of continuous gastric artery infusion chemotherapy (cGAIC) in relieving digestive obstruction in advanced gastric cancer patients. The overall response rate was 89.7% after cGAIC. A total of 75.9% of patients experienced relief of digestive obstruction after the first two cycles, and 44.8% of initially unresectable patients were then considered radically resectable. The median overall survival was 16 mo. C-arm computed tomography angiography helped to precisely confirm the tumor-feeding artery. Our new treatment can not only help relieve patients with digestive obstruction but also provide a good prognosis in treating tumors.