P-296 Neoadjuvant chemotherapy in locally advanced cardia tumor

Abstract

The gastroesophageal junction (GEJ) and gastric cardia are anatomical sites with a high incidence of Adenocarcinoma. In Iran, gastric cancer is ranked as the most prevalent malignancy amongst men and third amongst women. Additionally, it has the highest mortality rate of all malignancies in Iran(WHO). Neoadjuvant chemotherapy has proven efficient in decreasing tumor size and lymph node involvement, thus facilitating the process of surgery, reducing tumor recurrence, and increasing the life span. This study investigates the tumor response to neoadjuvant chemotherapy and feasibility of surgery following it and patients' tolerance to FLOT regimen in locally advanced gastric cardia cancers. This cross-sectional study enrolled 28 patients with cardia adenocarcinoma referred to Bouali Hospital for 14 months. The inclusion criteria were locally advanced adenocarcinoma of the cardia confirmed by pathology report and endosonography (EUS), performance status(PS) < 2 (ECOG criteria), and the patient’s consent to the treatment. Patients with T3 or T4 with or without lymph node involvement and T1 or T2 with lymph node involvement were categorized as locally advanced A chemotherapy regimen (FLOT) was administered for three cycles before surgery, each lasting 48 hours and two weeks apart. Two to three weeks after the third cycle of chemotherapy, all patients were reassessed by endoscopy and EUS for tumor response to neoadjuvant chemotherapy. Among the 28 participants, 19 (67.9%) were male, and 9 (32.1%) were female. The mean age was 64.42 (SD=13.71) years. All patients in the study had T3 (71.1% ) and T4 (28.6%), while after receiving chemotherapy, only 7.2% of patients had T3 and T4 (p-value 0.005). FLOT regimen was relatively well tolerated. Serious complications that made us interrupt or postpone the treatment were not seen. Leukopenia and fever occurred 6-10 days post-chemotherapy in 11 patients. We could do surgery for 26 of our patients. One patient denied doing an operation, and the other had a problem with anesthesia. Neoadjuvant chemotherapy with FLOT regimen is relatively well tolerated in our patients with locally advanced gastric adenocarcinoma and, in most cases, decreased the cardia tumor's size and lymph node involvement.