Neoadjuvant chemotherapy for resectable gastric cancer
Summary. Objective. Gastric cancer (GC) refers to tumors of poor prognosis with unsatisfactory treatment results, even in the first stage of disease. Neoadjuvant chemotherapy (NACT) may be solution to improve treatment outcomes for patients with resectable GC. However, available pilot studies of the effectiveness of NACT are based on a limited amount of data. We evaluated the effect of neoadjuvant chemotherapy on the long-term survival of patients with gastric adenocarcinoma by performing a randomized trial. Materials and methods. From 2007 to 2017 257 patients were included in the study with stage I–III of GC who received radical treatment in the National Cancer Institute. All patients were randomized into two groups after the staging of disease by abdominal cytological examination. NACT (3 cycles of ECF) followed by surgery was performed in group I of patients (104 patients), while patients in group II (153 patients) underwent only surgical treatment. Further live/dead status and the date of the last surveilance were obtained from the database of the National Cancer Register of Ukraine at the end of 2017. Survival curves were evaluated using the Kaplan — Mayer method. The outcomes of surgical treatment and long-term survival between the two groups were compared. Results. An analysis of the outcomes of surgical treatment did not reveal a significant difference in the hospital days and time of the operation (188 versus 182.5 minutes, p<0.001), the incidence of early and late surgical complications in both groups (26 (25.0%) versus 36 (23.5%), p=0.891 early, and late 8 (9.5%) versus 19 (12.4%), p=0.986). Overall survival was statistically different, the 5-year survival rate in the first group was 54.2% (95% CI 43.1–68.2) and 40.5% (95% CI 31.4–52.1, p=0.02) for the second group respectively. NACT did not show to an increase in survival in patients with stage I of GC (87.5±11.7 versus 86.3±7.7, p=0.82). Conclusions. NACT for GC improves long-term survival without increasing postoperative complications in patients with stage II–III. NACT can be recommended for patients with locally advanced T3–T4 tumors in order to improve resectability, as well as for patients with stage I cancer, taking into account the low accuracy of radiation diagnostics during staging disease. Further randomized trials are recommended for a final assessment of the effectiveness of combined treatment of GC by use of NACT.
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