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Vol. 26, Art. 5 (pp. 96-122)    |    2025       

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Сombined treatment of patients with locally advanced outlet obstructive gastric cancer: interim results of the clinical trail

*Svechkova A.A., Khamid A.H., Vovin K.N., Zakharenko A.A.

First Pavlov State Medical University of St. Petersburg
197022, Russia, Saint Petersburg, L'va Tolstogo str. 6/8;

Brief summary

Background. In 30% of patients with gastric cancer, tumor stenosis is diagnosed, in which case it is often impossible to carry out the preoperative stage of treatment in full, which significantly affects oncological results. Current clinical guidelines do not offer a single standardized approach to the treatment of patients with tumor obstruction of the stomach in the case of a locally advanced process. A promising method of influencing the tumor, as part of the therapeutic and symptomatic action, is photodynamic therapy in combination with drug therapy. Objective. Optimization of treatment tactics for patients with locally advanced gastric cancer complicated by subcompensated tumor stenosis, by using a combined approach to preoperative treatment. Materials and methods. The study included 64 patients in a 1:1 ratio, the characteristics of the groups are comparable. In addition to standard treatment, 2 sessions of endoscopic photodynamic therapy were performed in the study group. The primary endpoint is the time of evacuation of the contrast agent from the stomach. Secondary endpoints: assessment of nutritional status, degree of stenosis, body mass index, sarcopenia index, therapeutic tumor pathomorphosis, perfusion computed tomography parameters, tumor response according to RECIST 1.1 criteria, bed-day, toxic complications of drug therapy. Results. The median time of contrast evacuation after treatment in the study group decreased by 9 hours, while in the control group it did not change, p = 0.0001. The degree of stenosis according to the GOOSS scale significantly decreased in the study group and increased in the control one, p = 0.041. The index of nutritional deficiency decreased by 2 points in the study group and did not change in the control one, p = 0.018. The number of patients with insufficient body weight also decreased to 3 (9.4%) people in the study group and increased to 5 (15.6%) patients in the control one, p = 0.025. The average tumor blood flow volume in the study group decreased by 3.4 ml/100g, in the control group it remained virtually unchanged, p = 0.027. The vascular wall permeability index in the tumor area in the main group decreased by 10.5 ml/100g/min, in the control group it remained unchanged, p = 0.011. The tumor pathomorphosis index was higher in the study group, p = 0.017. No differences in drug toxicity criteria were found, however, delays in the treatment cycle and the introduction of leukopoiesis stimulants were more common in the control group. These data indicate greater recanalization of tumor stenosis, improved nutritional status of the patient, better tolerability of systemic treatment in the study group without increasing toxicity with comparable short-term oncological results. Conclusions. Combination treatment of locally advanced gastric cancer complicated by subcompensated stenosis at the neoadjuvant stage showed greater efficacy with comparable toxicity.


Key words

gastric cancer; endoscopic photodynamic therapy; malignant gastric outlet obstruction; combined treatment

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