title: Low toxic neoadjuvant cisplatin, 5-fluorouracil and folinic acid in locally advanced gastric cancer yields high R-0 resection rate.
abstract: OBJECTIVE
  Neoadjuvant chemotherapy in locally advanced gastric cancer is effective, but is often associated with severe side effects, including fatal outcome. This study evaluates a combination of cisplatin, folinic acid and 5-fluorouracil (PLF) in terms of efficacy (R-0 resection rate) and toxicity.
  
  
  METHODS
  Twenty-five patients with locally advanced gastric cancer who after extensive staging were deemed not suitable for curative resection underwent neoadjuvant chemotherapy. Three or four cycles of cisplatin (50 mg/m(2) days 1 and 15), folinic acid (200 mg/m(2) days 1, 8, 15 and 22), and 5-fluorouracil (2,000 mg/m(2 ) days 1, 8, 15 and 22) were administered. Cases with progressive disease were taken off the study. Two weeks after finishing chemotherapy resection was performed and all patients were enrolled in a structured follow-up.
  
  
  RESULTS
  Of the patients, 22/25 finished chemotherapy and 20 of those underwent laparotomy. In 13/25 patients (52%) a R-0 resection and in three cases a R-1 resection were achieved. Four patients stayed irresectable. During 76 completed cycles of chemotherapy we observed five cases of WHO grade-III toxicity and no grade-IV toxicity.
  
  
  CONCLUSIONS
  The presented PLF protocol yields R-0 resection rates comparable to protocols like EAP (etoposide, adriamycin, platinum), but with a better safety profile allowing administration in an outpatient setting. Our study supports PLF as a reference neoadjuvant treatment for gastric cancer even outside of clinical studies.
authors.affiliation: Department of Internal Medicine II, Saarland University, 66421, Homburg, Germany. inmmen@uniklinik-saarland.de
authors.forename: Markus
authors.initials: M
authors.lastname: Menges
authors.forename: Carsten
authors.initials: C
authors.lastname: Schmidt
authors.forename: Werner
authors.initials: W
authors.lastname: Lindemann
authors.forename: Karsten
authors.initials: K
authors.lastname: Ridwelski
authors.forename: Werner
authors.initials: W
authors.lastname: Pueschel
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jüngling
authors.forename: Gernot
authors.initials: G
authors.lastname: Feifel
authors.forename: Martin
authors.initials: M
authors.lastname: Schilling
authors.forename: Andreas
authors.initials: A
authors.lastname: Stallmach
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage* / Q000009:adverse effects; D020360:Neoadjuvant Therapy; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil