18F-FDG PET/CT对进展期胃癌治疗前评估的可行性

Conformal radiation therapy combined with XELOX chemotherapy for management of abdominal lymph node metastasis in patients with gastric cancer after surgery

AIM: To investigate the effect of conformal radiation therapy combined with XELOX (capecitabine plus oxaliplatin) chemotherapy in the treatment of abdominal lymph node metastasis in patients with gastric cancer after surgery.

METHODS: Forty patients who developed abdominal lymph node metastasis after surgery for gastric cancer were randomly divided into either a control group (n = 19) or a treatment group (n = 21). The treatment group was given conformal radiation therapy combined with chemotherapy with XELOX (xeloda + oxaliplatin), and the control group received XELOX chemotherapy only. Clinical efficacy, postoperative survival rate and adverse reactions were compared between the two groups. The levels of interleukin-2 (IL-2) and interleukin-6 (IL-6) in peripheral blood of all subjects were measured by ELISA preoperatively and postoperatively.

RESULTS: Total response rate was significantly higher in the treatment group than in the control group (82.0% vs 52.7%, χ² = 3.65, P < 0.05). The 1- and 2-year postoperative survival rates were also significantly higher in the treatment group than in the control group (61.9% vs 42.1%, 52.3% vs 21.1%, both P < 0.05). The incidence of adverse reactions (bone marrow suppression, gastrointestinal reactions, anemia, and liver function damage) showed no significant difference between the two groups (P > 0.05). Six months after the treatment, peripheral blood levels of IL-6 were decreased and those of IL-2 were increased in two groups, and the difference was significant (both P < 0.05).

CONCLUSION: Conformal radiation therapy combined with XELOX chemotherapy can significantly improve curative effect and postoperative survival in gastric cancer patients with postoperative abdominal lymph node metastasis, and is associated with tolerable side effects.

FDG PET/CT diagnosis of clinically occult gastric cancer

AIM: To investigate the use of fluorodeoxyglucose (FDG) positron emission tomography ( PET)/CT imaging in diagnosis of clinically occult gastric cancer.

METHODS: The imaging data for 26 patients with clinically occult gastric cancer who underwent FDG PET/CT imaging were reviewed retrospectively. They were hospitalized for metastatic tumors and therefore underwent FDG PET/CT for detecting carcinoma of unknown primary origin. They were finally diagnosed with gastric cancer by endoscopy (n = 24) or laparoscopy (n = 2). Based on imaging manifestations, the patients were divided into three groups: easily diagnosed, suspected, and hardly diagnosed.

RESULTS: PET imaging showed 57.7% (15/26) of intensively positive cases, 23.1% (6/26) of positive cases, and 19.2% (5/26) of negative cases. CT imaging showed 76.9% (20/26) of intensively positive cases, 11.5% (3/26) of positive cases, and 11.5% (3/26) of negative cases. The percentages of easily diagnosed, suspected, and hardly diagnosed patients were 53.8% (14/26), 34.6% (9/26) and 11.5% (3/26), respectively.

CONCLUSION: FDG PET/CT imaging can help diagnose clinically occult gastric cancer in about 88.4% of patients.