Intensified preoperative treatment doable in advanced gastric cancer patients

Treatment with perioperative cisplatin-capecitabine (CX) with preoperative chemoradiation (CRT) is feasible in patients with advanced gastric cancer (GC) in real-world settings of a public-sector hospital from a low-middle-income country, a study has shown.

“Disease progression during preoperative therapy allows patients destined for early clinical evidence of disease dissemination to avoid futile surgery, as opposed to a surgery-first strategy, without an overt increase in surgical morbidity or mortality, with encouraging R0 resection rates,” the authors said.

Twenty-eight potentially resectable locally advanced GC patients received neoadjuvant chemotherapy (two cycles of CX at three weekly intervals), followed by preoperative CRT 45 Gy/25 fractions/5 weeks and concurrent capecitabine, followed by surgical resection and three adjuvant cycles of CX between January 2017 and December 2018.

Neoadjuvant CT was initiated in all patients (100 percent), preoperative CRT in 18 (64 percent), and surgery in 13 (46 percent). Decreasing patient numbers at each treatment step was caused by disease progression (n=12, 43 percent) or other reasons, such as treatment-related toxicity (n=3, 11 percent).

The R0 resection rate was 92 percent (12/13), and a median of 18 nodes were obtained after D2 nodal clearance in 92 percent of patients (12/13). The rates of grade 3, 4, and 5 toxicities were 20 percent, 4 percent, and 4 percent, respectively. The median radiotherapy dose/duration was 45 Gy/5.4 weeks.

Eleven patients (39 percent) initiated adjuvant CT, and seven (25 percent) received the third cycle. No tumour was observed in three of 13 (23 percent) operated patients, or 11 percent of the intention-to-treat population (3/28). The median survival was 12 months, and the 1- and 2-year survival rates were 53 percent and 32 percent, respectively.

“The standard of care for resectable GCs includes perioperative CT or postoperative CRT strategies,” the authors said.