title: Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer.
abstract: BACKGROUND
  Locally advanced gastric cancer with extensive lymph node metastasis is usually considered unresectable and so treated by chemotherapy. This trial explored the safety and efficacy of preoperative chemotherapy followed by extended surgery in the management of locally advanced gastric adenocarcinoma.
  
  
  METHODS
  Patients with gastric cancer with extensive lymph node metastasis received two or three 28-day cycles of induction chemotherapy with irinotecan (70 mg/m(2) on days 1 and 15) and cisplatin (80 mg/m(2) on day 1), and then underwent gastrectomy with curative intent with D2 plus para-aortic lymphadenectomy. Primary endpoints were 3-year overall survival and incidence of treatment-related death.
  
  
  RESULTS
  The study was terminated because of three treatment-related deaths when 55 patients had been enrolled (mortality rate above 5 per cent). Two deaths were due to myelosuppression and one to postoperative complications. Clinical response and R0 resection rates were 55 and 65 per cent respectively. The pathological response rate was 15 per cent. Median overall survival was 14.6 months and the 3-year survival rate 27 per cent.
  
  
  CONCLUSIONS
  This multimodal treatment of locally advanced gastric cancer provides reasonable 3-year survival compared with historical data, but at a considerable cost in terms of morbidity and mortality.
authors: Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, Yokohama, Japan. yoshikawat@kcch.jp
authors: T
authors: T
authors: Yoshikawa
authors: M
authors: M
authors: Sasako
authors: S
authors: S
authors: Yamamoto
authors: T
authors: T
authors: Sano
authors: H
authors: H
authors: Imamura
authors: K
authors: K
authors: Fujitani
authors: H
authors: H
authors: Oshita
authors: S
authors: S
authors: Ito
authors: Y
authors: Y
authors: Kawashima
authors: N
authors: N
authors: Fukushima
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D006801:Humans; D000077146:Irinotecan; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin