Perioperative chemotherapy in locally advanced gastric cancer in Chile: from evidence to daily practice.

Bettina Müller,Juan Pablo Miranda,Jeannie Slater,Martin Buchholtz,Felipe Reyes,Jorge Arancibia,Mauricio Cerda,Carlos Benavides,José A Sola,Patrick Werner,Mary Anne Stevens,Wanda Fernandez,Carlos García,Alejandro Corvalan,Rodrigo Ascui

doi:10.3332/ecancer.2021.1244

Abstract

Gastric cancer (GC) is a leading cause of cancer death in Chile. Although recommended in international guidelines since 2006, perioperative chemotherapy was not available to patients in the public health system in Chile until 2016. We conducted an observational study to assess the feasibility of this strategy in public hospitals in Chile (Observational Study of Perioperative Chemotherapy in Locally Advanced Gastric Cancer – PRECISO). Patients with locally advanced, operable GC were offered to receive preoperative chemotherapy with Epirubicin + Cisplatin + Capecitabine (ECX) for three cycles followed by curative surgery. Staging included abdominal CT scan and laparoscopy if peritoneal carcinomatosis was suspected. Postoperative ECX for three cycles was recommended. Between August 2010 and March 2013, 110 patients were screened and 61 enrolled. Median age was 62 years (23–76 years) and most patients had good performance status at baseline (Eastern Cooperative Oncology Group performance status score (ECOG) 0: 42, ECOG 1: 19). Tumour site was proximal in 32 (52%) and medial and distal in 29 (48%) patients. All but four patients (n = 57, 93%) completed three cycles of preoperative chemotherapy. Fifty-six patients were operated and 54 (89%) had a curative resection. Thirty-three patients (54%) had pT0-2, and 18 (30%) had pN0 tumours, with two patients achieving a complete response. As of 20 December 2020, 39 patients died, 32 due to GC, one within 30 days of surgery, two due to intestinal obstruction at 5 and 3 months after surgery and four due to other causes. Five-year survival rate was 38%. We conclude that perioperative chemotherapy is feasible in public hospitals in Chile and should be offered to patients with locally advanced GC.

Highlights

Worldwide, gastric cancer (GC) is one of the leading cancers in incidence, being fourth and seventh in males and females, respectively
We conducted an observational study to assess the feasibility of this strategy in public hospitals in Chile (Observational Study of Perioperative Chemotherapy in Locally Advanced Gastric Cancer – PRECISO)
We conclude that perioperative chemotherapy is feasible in public hospitals in Chile and should be offered to patients with locally advanced Gastric cancer (GC)

Summary

Introduction

Gastric cancer (GC) is one of the leading cancers in incidence, being fourth and seventh in males and females, respectively. GC represents the third (males) and fifth (females) most common cause of cancer deaths globally [1]. Despite the decline in age-standardised incidence and mortality rates due to GC in the last decades, given changes in age distribution and population growth, especially in low- and middle-income countries, the absolute numbers of new cases and deaths are rising [2]. More than 5,000 persons are diagnosed with GC in Chile, representing a major public health problem [1]. At the time of diagnosis, the majority of patients present locally advanced or metastatic disease, while early lesions are diagnosed in less than 10% of cases [3]. Surgery achieving R0 resection is the cornerstone for a curative treatment, but even in high volume centres, the curative resection rates are low (62.4%); and 5-year survival rates after surgery are dismal, as shown in a series of 423 patients from a single institution with 33% of all patients operated being alive at 5 years [4]

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Results

Conclusion