The role of neoadjuvant (NAD) chemotherapy (CHT) in patients with locally advanced gastric cancer (LAGC) is validated. However, some important limitations emerged from the literature, including patient selection, quality of surgery, and pathologic response evaluation. Neoadjuvant CHT for LAGC has been evaluated with a focus on safety and efficacy of the preoperative approach in terms of patient compliance, surgical outcomes, and pathologic response.
Ninety-one patients with gastric adenocarcinoma were prospectively observed. All patients received computed tomography scan and laparoscopy staging. Ten patients with LAGC (including 2 with LAGC suspected for cM+/lapM+) had been recruited in the preoperative ECF/EOX CHT protocol and were compared with 61 patients who underwent surgery alone.
The overall compliance for the preoperative CHT group was higher than compliance for adjuvant CHT observed in both the NAD CHT group and the surgery alone group. There were 2 treatment shifts to FOLFOX in the preoperative regimen. In the preoperative CHT group, D2-gastrectomy was possible only in 6/10 of cases, with a R0 resection rate of 67% (versus 64% in the LAGC patients treated by surgery alone). The postoperative mortality and morbidity were 0% and 17% in the NAD CHT group versus 2% and 26% in the surgery alone group. The overall pathologic response rate after NAD CHT was 83% (5/6).
Staging and CHT management problems can negatively affect patient outcomes. In the LAGC setting, when well applied, NAD CHT could be considered a valuable treatment option.
Tumori 2015; 101(5): 511 - 516
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsStefano Rausei, Georgios D. Lianos, Ilaria Proserpio, Laura Ruspi, Federica Galli, Francesco Frattini, Alberto Mangano, Francesca Rovera, Luigi Boni, Dimitrios H. Roukos, Graziella Pinotti, Gianlorenzo Dionigi
- • Accepted on 14/01/2015
- • Available online on 22/04/2015
- • Published in print on 09/09/2015
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- Rausei, Stefano [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
- Lianos, Georgios D. [PubMed] [Google Scholar] 2
- Proserpio, Ilaria [PubMed] [Google Scholar] 3
- Ruspi, Laura [PubMed] [Google Scholar] 1
- Galli, Federica [PubMed] [Google Scholar] 1
- Frattini, Francesco [PubMed] [Google Scholar] 1
- Mangano, Alberto [PubMed] [Google Scholar] 1
- Rovera, Francesca [PubMed] [Google Scholar] 1
- Boni, Luigi [PubMed] [Google Scholar] 1
- Roukos, Dimitrios H. [PubMed] [Google Scholar] 2
- Pinotti, Graziella [PubMed] [Google Scholar] 3
- Dionigi, Gianlorenzo [PubMed] [Google Scholar] 1
Department of Surgery, University of Insubria, Varese - Italy
Department of Surgery, Ioannina University School of Medicine, Ioannina - Greece
Department of Oncology, University of Insubria, Varese - Italy