Exclusive neoadjuvant chemotherapy in locally advanced resectable gastric and gastro-esophageal junction adenocarcinoma.
BACKGROUND
Perioperative chemotherapy improves the prognosis of patients with locoregionally advanced resectable gastric and gastro-esophageal junction adenocarcinoma. Nevertheless, only 50% of operated patients could receive the postoperative component chemotherapy. An exclusive preoperative chemotherapy is therefore an interesting strategy. We report the clinical course of patients with operable gastric and gastroesophageal junction adenocarcinoma treated with an intention of exclusive preoperative chemotherapy.


METHODS
The medical records of all consecutive patients with an operable gastric or gastroesophageal junction adenocarcinoma and treated with an intention of exclusive preoperative chemotherapy were analysed.


RESULTS
Between 1999 and 2014, 90 eligible patients were identified. Fifty-eight patients (64%) presented with clinical T3-T4 tumour and 63 (70%) had a lymph node involvement. Eighty (90%) patients were treated with 4 cycles of preoperative chemotherapy containing docetaxel, 5-fluorouracil (5FU) and a platinum salt. All patients had surgery with a D2 lymphatic dissection and R0 resection rates in 91% and 88% respectively. Median progression-free survival was 6.1 years (95% confidence intervals (CI): 1.6, NC) with median overall survival of 8.1 years (95% CI: 4.1, NC).


CONCLUSIONS
Our study suggests that an exclusive neoadjuvant approach when associated with a D2 lymph node dissection in resectable gastric and gastro-esophageal junction adenocarcinoma appears a feasible strategy with encouraging survival.
Department of Medical Specialities, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland. Electronic address: Eugenio.Fernandez@hcuge.ch.
Eugenio
E
Fernandez
Department of Medical Specialities, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland.
Wulfran
W
Cacheux
Department of Medical Specialities, Division of Gastroenterology, University Hospital of Geneva, Geneva, Switzerland.
Jean-Louis
JL
Frossard
Department of Medical Specialities, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland.
Thibaud
T
Koessler
Department of Gynaecology and Obstetric, University Hospital of Geneva, Geneva, Switzerland.
Magali
M
Abou
Department of Medical Specialities, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland.
Michael
M
Moniez
Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland.
Olivier
O
Huber
Department of Pathology, University Hospital of Geneva, Geneva, Switzerland.
Giacomo
G
Puppa
Department of Medical Specialities, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland.
Arnaud
A
Roth
D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000628:therapy*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000628:therapy*; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D013557:Switzerland; D043823:Taxoids / Q000008:administration & dosage; D055815:Young Adult
D043823:Taxoids; D000077143:Docetaxel; D005472:Fluorouracil
Advanced; Cancer; Chemotherapy; Esogastric; Neoadjuvant