title: [Preliminary experience in treatment of locally advanced gastric adenocarcinoma with peri-operative chemotherapy].
abstract: OBJECTIVE
  Gastric Cancer (GC) is a poor prognosis neoplasm and it is often diagnosed at advanced stage. Neoadjuvant Chemotherapy (NAC) may increase the possibility of complete surgical resection and improve Overall Survival (OS).
  
  
  METHODS
  Since November 2006, six patients with gastric adenocarcinoma, diagnosed by endoscopy, endoscopic ultrasonography and total body 18FDG-PET-CT, were enrolled in a program of peri-operative chemotherapy, according to the following inclusion criteria: cT2N+M0 or cT3-4NxM0, age < 75 years, Karnofsky Performance Status > 60%, absence of hepatic, renal and bone marrow failures. The patients undergo three cycles of pre-operative and post-operative chemotherapy based on Epirubicine, Cisplatin, and 5-Fluorouracil (ECF) as MAGIC Trial proposed. Fifteen days after the end of pre-operative chemotherapy the patient undergoes endoscopic ultrasonography and total body 18FDG-PET-CT to evaluate the tumor response to treatment, and then he is addressed to surgery. Thirty days after surgery he starts the post-operative chemotherapy.
  
  
  RESULTS
  All patients completed the pre-operative chemotherapy. Five patients underwent D2 subtotal gastrectomy and only one patient D1 total gastrectomy. No peri- and post-operative mortality and morbidity were observed. One month after surgery all patients started chemotherapy. During post-operative chemotherapy two patients developed subclavian vein thrombosis, one patient developed renal failure.
  
  
  CONCLUSIONS
  Although surgical resection remains the key component in the treatment of GC, it is clear that improved outcome will depend on a multidisciplinary treatment. NAC is associated with appreciable toxicity and it may improve the OS, allowing the downstaging of the primary tumor and increasing its resecability, as shown by MAGIC trial.
authors.affiliation: Università degli Studi di Perugia, "Ospedale Santa Maria della Misericordia", Perugia.
authors.forename: L
authors.initials: L
authors.lastname: Graziosi
authors.forename: W
authors.initials: W
authors.lastname: Bugiantella
authors.forename: M
authors.initials: M
authors.lastname: Gunnellini
authors.forename: N Abu
authors.initials: NA
authors.lastname: Qweider
authors.forename: E
authors.initials: E
authors.lastname: Cavazzoni
authors.forename: A
authors.initials: A
authors.lastname: Donini
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*