title: Comparing Efficacy of Preoperative neo-Adjuvant Chemotherapy and Surgery versus Surgery Alone in Patients with Resectable Gastroesophageal Cancer.
abstract: BACKGROUND
  Recent researches have led to find strategies to prevent relapse and to improve survival for gastric cancer patients, including preoperative neo-adjuvant approaches. However, the efficacy of some neo-adjuvant regimens including 5-fluorouracil, cisplatin, and docetaxel have been less investigated. The present study evaluated the outcome and mid-term survival of patients with gastric cancer who undergoing this regimen.
  
  
  METHODS
  In a randomized double-blinded controlled trial performed at the Firoozgar hospital in Tehran in 2011-12, 61 patients were randomly assigned to treatment (32 to neo-adjuvant chemotherapy with docetaxel, cisplatin and 5-fluorouracil (5-FU) before surgery and 27 to surgery alone). The present study tried to assess the efficacy of neoadjuvant chemotherapy regarding improvement of mid-term survival, complications, and R0 resection status.
  
  
  RESULTS
  The two groups were matched in terms of gender, mean age, cancer location, and TNM staging. However, R0 resection in the former group was 85.7%; while this indicator in the isolated surgery group was significantly lower (61.5%). Regarding WHO performance, no significant difference was observed across the two groups. Patients in neo-adjuvant chemotherapy group were followed for mean follow-up time 10.32 months and those who categorized in isolated surgery group were followed for mean follow-up time 10.88 months. Mid-term mortality rate in the two groups was 14.3% and 15.4%, respectively (p = 0.866). In this regard, 3-, 6-, and 9-month survival rate in neo-adjuvant chemotherapy group was 96.4%, 89.3%, and 85.7%, respectively. These survival rates in the surgery group were 92.3%, 88.5%, and 84.6%, respectively. Multivariable logistic regression analysis showed that among all study variables, only R0 resection status could predict mid-term mortality.
  
  
  CONCLUSIONS
  Neo-adjuvant chemotherapy and surgery compare to surgery alone more improve R0 resection status, but mid-term survival rate is similar in the two regiments. R0 resection status can effectively predict appropriate mid-term survival in undertreated patients.
authors: Assistant professor of Medical Oncology and Hematology, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Ali
authors: A
authors: Basi
authors: Internist, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Shahab
authors: S
authors: Sohrabkhani
authors: Associated professor of Gastroenterology, Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Farhad
authors: F
authors: Zamani
authors: Associated professor of Surgery, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Masoud
authors: M
authors: Baghai-Wadji
authors: Resident of internal Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
authors: Neda
authors: N
authors: Rabiei
authors: Assistant professor of Medical Oncology and Hematology, Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Seyyed-Mohsen
authors: SM
authors: Razavi
authors: Assistant professor of Gastroenterology, Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences (IUMS), Tehran, Iran.
authors: Hossein
authors: H
authors: Ajdarkosh
keywords: Chemotherapy; Gastroesophageal junction; Mortality; Surgery