Abstract
BackgroundMultimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial.MethodsBetween 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy.ResultsPostoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 % postCTx group vs. 90.0 % non-postCTx group; p = 0.038).ConclusionThese results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx.
Highlights
Multimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer
In Japan and Korea the survival rate of patients with Gastric cancer (GC) has increased over the past decade which may partially result
Patient population Data of patients having undergone preoperative CTx (preCTx) and subsequent radical surgical resection for GC at the University Hospital of Wuerzburg, Germany (Universitätsklinik Würzburg, UKW) between January 1992 and December 2013 were retrieved from the Wuerzburg Institutional Database (WID)
Summary
Multimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer. The role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial. In Japan and Korea the survival rate of patients with GC has increased over the past decade which may partially result. To improve the poor outcome rate many studies have examined various aspects of surgical techniques, including extended lymph node dissection, the addition of perioperative or intraoperative radiotherapy and the effect of neoadjuvant (preCTx) as well as adjuvant (postCTx) chemotherapy and radiochemotherapy [8,9,10,11,12,13,14,15,16,17,18,19].
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