Abstract
Background. Adenocarcinoma of the stomach and gastroesophageal junction results in substantial
morbidity, locoregional recurrence, and death. Surgical procedures, even with adjuvant
therapy, have not significantly improved survival. This study evaluated the toxicity,
response rate, locoregional control, and survival of patients with locally advanced
gastric cancer that was treated with neoadjuvant multimodality therapy. Methods. Patients with stage IIIA or early stage IV gastric adenocarcinoma received neoadjuvant
5-fluorouracil, Leucovorin, Adriamycin, and Cisplatin and underwent gastrectomy or
esophagogastrectomy with intraoperative radiotherapy (IORT; 1000 cGY) to the gastric
bed and postoperative radiation therapy. Results. Nine of 15 patients (60%) with transmural extension and/or nodal metastases received
IORT. There were 2 pathologically complete responses at the primary site. Eleven of
15 patients (73%) had tumor in perigastric lymph nodes; however, 9 of 15 patients
(60%) had mucin-filled nodes without tumor cells. Neoadjuvant treatment did not increase
operative morbidity rates. Ten of 15 patients (67%) remain free of disease (median,
27 months; range, 6-60 months). Five patients died 13 to 41 months (median, 17 months)
after diagnosis. Conclusions. Neoadjuvant multimodality therapy with neoadjuvant 5-fluorouracil, Leucovorin, Adriamycin,
and Cisplatin, radical resection with IORT, and postoperative radiation therapy is
safe, can downstage tumors, provides improved locoregional control, and appears to
cause significant tumor regression that may result in long-term survival or cure.
(Surgery 2000;128:564-71.)
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Article info
Footnotes
*Reprint requests: James L. Weese, MD, FACS, Chairman, Dept of Surgery, UMDNJ-SOM, SCC 2600; 42 Laurel Road, Stratford, NJ 08084.
**Surgery 2000;128:564-71
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Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
