Abstract
In 2006, perioperative epirubicin, cisplatin, and 5-fluorouracil (ecf), compared with surgery alone, demonstrated a significant survival benefit in resectable gastroesophageal cancers. We report the results of our experience with that protocol. The BC Cancer Agency (bcca) is a multicentre institution that treats most oncology patients for the province. Characteristics of the 83 bcca patients with localized gastric, gastroesophageal junction, or lower esophageal cancer who initiated perioperative chemotherapy either ecf or epirubicin, cisplatin, and capecitabine (ecx) from 2008 to 2011 were abstracted to an anonymous database and analyzed. Of the 83 patients in the cohort [66 men; median age: 62 years (range: 37-79 years)], 87.9% completed 3 cycles of perioperative chemotherapy, and 93.9% (n = 78) underwent an attempt at surgery (2 patients died of chemotherapy toxicities, 1 refused surgery, and 2 developed disease progression before surgery). In 11 of the surgeries (14.1%), tumours could not be resected because of unresectability (n = 1), liver metastasis (n = 1), and peritoneal carcinomatosis (n = 9). One patient died of surgical complications. The 6 patients (7.2%) who achieved a pathologic complete response are all alive and recurrence-free. Of 46 patients (55.4%) who subsequently began postoperative chemotherapy, 44.5% completed 3 cycles. Estimated median survival was 40.3 months. Weight loss was the only significant prognostic factor for worse overall survival. Our multicentre experience confirmed the feasibility of the magic protocol in a real-world scenario and showed that ecx is also an adequate regimen in the perioperative setting. Weight loss was the only significant prognostic factor for worse overall survival. All patients who achieved a pathologic complete response are recurrence-free after a median follow-up of 40.3 months.
Highlights
IntroductionIn Western populations, cancers originating in the esophagus, gastroesophageal junction (gej), and stomach represent a major health problem and are considered highly lethal diseases, with an overall 5-year mortality rate that ranges from 17% to 27%1
Of the 83 patients in the cohort [66 men; median age: 62 years], 87.9% completed 3 cycles of perioperative chemotherapy, and 93.9% (n = 78) under went an attempt at surgery (2 patients died of chemotherapy toxicities, 1 refused surgery, and 2 developed disease progression before surgery)
In Western populations, cancers originating in the esophagus, gastroesophageal junction, and stomach represent a major health problem and are considered highly lethal diseases, with an overall 5-year mortality rate that ranges from 17% to 27%1
Summary
In Western populations, cancers originating in the esophagus, gastroesophageal junction (gej), and stomach represent a major health problem and are considered highly lethal diseases, with an overall 5-year mortality rate that ranges from 17% to 27%1. Most of these patients present with latestage disease, when curative therapy is not possible[1]. Several other studies have investigated the role of adjuvant chemotherapy after curative resection, but most have failed to demonstrate any improvement in os or recurrence-free survival (rfs) in Western populations[7,8,9,10,11], prompting the evaluation of neoadjuvant approaches for locally advanced gastric cancer. We report the results of our experience with that protocol
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