title: Perioperative chemotherapy for resectable gastroesophageal cancer: a single-center experience.
abstract: BACKGROUND
  Multimodal treatment for locally advanced gastric cancer has been reported to improve disease-free survival when compared to surgery alone. We aimed to clarify the efficacy and safety of perioperative chemotherapy for locally advanced gastric cancer patients treated in daily clinical practice.
  
  
  METHODS
  Patients diagnosed with locally advanced gastric cancer were treated with perioperative chemotherapy and surgery. The primary end point was the complete resection (R0) rate. Secondary end points were disease-free survival (DFS), overall survival (OS), toxicity, radiological response rate, pathological response rate and downstaging rate. We also looked for prognostic and predictive factors for DFS, OS, pathological complete response and the R0 rate.
  
  
  RESULTS
  Forty patients were found eligible for this retrospective analysis. At diagnosis, 52.5% of patients were classified as stage II and 47.5% were stage III. Forty percent of patients completed three preoperative cycles and three postoperative cycles. A tolerable toxicity related to chemotherapy was found. Thirty-nine patients underwent surgery: 80% reached a complete resection (R0), down-staging was detected in 57.5% and 17.5% had a pathologically complete response. The median time of disease-free survival was 34.05 months (95%CI 25.6-42.4), and the median time of overall survival was 39.01 months (95%CI 30.8-47.1). We found that the presence of comorbidities were independent predictive factors for the pathologic response, while the chemotherapy schedule and the clinical response could independently predict a complete resection.
  
  
  CONCLUSIONS
  Our results support that perioperative chemotherapy for locally advanced gastric cancer can be safely delivered in daily clinical practice, obtaining an improvement of the pathologic response and the complete resection of gastric cancer.
authors.affiliation: Department of Oncology, Principe de Asturias Universitary Hospital, Alcalá University, Alcalá de Henares, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Molina
authors.forename: A
authors.initials: A
authors.lastname: Lamarca
authors.forename: B
authors.initials: B
authors.lastname: Martínez-Amores
authors.forename: A
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: A
authors.initials: A
authors.lastname: Blázquez
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: J
authors.initials: J
authors.lastname: Granell
authors.forename: M
authors.initials: M
authors.lastname: Álvarez-Mon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D019990:Perioperative Care / Q000379:methods; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis
keywords: Gastric cancer; Neoadjuvant chemotherapy; Perioperative treatment; Predictive factors; Prognostic factors