489. Gastric and Oesophageal Cancer Survival in Palliative Setting - a Multi-Disciplinary Treatment Review

Abstract

Background. Perioperative MAGIC regimen with ECF (epirubicin, cisplatin and 5-fluorouracil) or EOX (epirubicin, oxaliplatin and capecitabine) is being increasingly used to treat localized and resectable gastric carcinoma in many European hospitals. We analyzed feasibility, morbidity and mortality, resection and final staging obtained with this schema. Materials and Methods. Patients with gastric and esophagogastric junction carcinomas with stage II or higher and initially resectable were included from 2006 to 2010. An upper endoscopy and a CT scan were done in every patient. Endoscopic ultrasound was also performed in 21 patients. Staging laparoscopy was selectively performed depending on the findings of CT scan and endoscopic ultrasound. Patients followed a partial or total gastrectomy or Ivor Lewis esophagectomy with lymphadenectomy D1 + beta after 3 cycles of ECF or EOX. The items analyzed were completion, morbidity and mortality of the preoperative chemotherapy, curative resection, surgical morbidity and mortality, peritoneal lavage cytology, tumor regression (according to Rodel~ Os grading) and pathology findings, and completion of the postoperative chemotherapy. Results. Thirty six patients corresponding to 26 gastric and 10 esophagogastric junction carcinomas were included. During de preoperative phase 1 patient died due to pulmonary embolism. Preoperative chemotherapy was completed in 90% of patients with grade 3/4 toxicities in 27% of them. Peritoneal carcinomatosis at the time of surgery precluded resection in 1 patient. Also 3 more patients showed very few peritoneal nodules (<3). A R2 resection was performed in 1 patient. Seven esophagectomies, 3 partial gastrectomies and 24 total gastrectomies were performed. Curative R0 resection was obtained in 30 patients (83%). Surgical morbidity and mortality were 18% and 3% (1 patient). Positive peritoneal lavage was diagnosed in 2 patients. Tumor regression higher than 90% was observed in 5 patients (14%). pN1 was detected in 6 patients (17%) and pN2 or pN3 in 14 patients (39%). Postoperative chemotherapy was completed in 83% of patients with grade 3/4 toxicities in 32% of patients. Conclusions. A high percentage of R0 resections can be achieved with MAGIC regimen, although the percentage of positive pN detected is important. Completion of the preoperative chemotherapy is high.