Role of Neoadjuvant Chemotherapy in Locally Advanced Carcinoma Stomach: An Analysis of the Short-Term Outcomes

Abstract

Introduction: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. We aimed to study the short term outcomes of neoadjuvant chemotherapy on the Tumor Node Metastasis (TNM) stage and the operative outcomes including R0 resection rate in locally advanced gastric cancer. Methods: We prospectively included patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) in our study. Patients in Group I were started on neoadjuvant chemotherapy (epirubicin, oxaliplatin, and capecitabine). Surgery was done following response assessment CECT. Patients in Group II underwent upfront surgery. We assessed R0 resection rate, number of harvested and metastatic lymph nodes, lymph node ratio, duration of surgery, blood loss, hospital stay and complications between two groups. Response to NACT was assessed in Group I. Results: Out of 47 patients who received NACT, two patients had complete response (4.2%), 13 had partial response (27.7%), 10 had stable disease (21.3%) and 22 patients had progressive disease (46.8%). We found no significant difference in the rate of R0 resection between the two groups (88.2% in NACT group vs 85.1% in surgery group, P=0.55). Conclusions: The rate of R0 resection does not significantly improve with neoadjuvant chemotherapy. In view of high progression rates, patient selection is required when NACT is planned in carcinoma stomach which are surgically resectable at presentation. We await survival analysis to further validate the role of NACT.

Efficacy of Neoadjuvant Chemotherapy on Locally Advanced Gastric Adenocarcinoma in Terms of Downstaging and Resectability in a Tertiary Cancer Hospital

“…Post NACT, most patients 44(59.7%) belonged to N1, next N2 17(18.9%) and 7(9.5%) down staged to N0 stage, Chi-Square test p value <0.0001,significant downstage response. This study had similar outcome with Cunningham D. et al, [23] in their MAGIC trial and FNCLCC and FFCD Multicenter Phase III trial by Ychou M et al, [24] but compatible with Sivamourane S. et al, [21] where N2 included 34 patients (56.7%) in the NACT arm and 21 patients (44.7%) in the surgery arm. N3 included 19 patients (31.7%) in the NACT arm and 21 patients (44.7%) in the surgery arm, reveals no significant downstaging effect.…”

“…Unfortunately, 5 patients (13.51%) had progressive disease (PD). Comparable with Sivacoumarane S. et al, [21] in their study, Out of 47 patients, CR was seen in two patients (4.2%), PR (27.7%), SD (21.3%) and PD (46.8%). There was no significant difference in the down-staging effect of NACT on the T stage (p = 0.88).…”

“…This study found a significant difference in the down-staging effect of NACT on the T stage (p = <0.03). Compatible with Sivamourane S. et al, [21] showed a higher proportion of T4a and T4b disease in the NACT group, poor compliance to chemotherapy due to logistic reasons in the patient population may be responsible for disease progression of their cases. The MAGIC trial in the United Kindom and the trial conducted by the Fédération Nationale des Centres de Lutte contre le Cancer (FNLCC) and Fédération Francophone de Cancérologie Digestive (FFCD) in France, have shown better outcomes of NACT with GE junction tumors in concordance with our study.…”

“…Ramachandra et al [26] reported 87% in the surgery arm and 96% in the chemotherapy arm with no statistical significance (p = 0.33). Recently, Sivacoumarane S, et al, [21] reported, no significant difference in the rate of R0 resection between the two groups (88.2% in NACT group vs 85.1% in surgery group, P=0.55). The rate of R0 resection does not significantly improve with neoadjuvant chemotherapy.…”