Impact of neoadjuvant chemotherapy with PELF-protocoll versus surgery alone in the treatment of advanced gastric carcinoma

Abstract

BackgroundIn a retrospective study we analyzed the impact of neoadjuvant chemotherapy (CTx) with the PELF - protocol (Cisplatin, Epirubicin, Leukovorin, 5-Fluoruracil) on mortality, recurrence and prognosis of patients with advanced gastric carcinoma, UICC stages Ib-III.Methods64 patients were included. 26 patients received neoadjuvant CTx followed by surgical resection, 38 received surgical resection only. Tumor staging was performed by endoscopy, endosonography, computed tomography and laparoscopy. Patients staged Ib – III received two cycles of CTx according to the PELF-protocol. Adjuvant chemotherapy was not performed at all.ResultsComplete (CR) or partial response (PR) was seen in 20 patients (77%), 19% showing CR and 58% PR. No benefit was observed in 6 patients (23%). Two of these 6 patients displayed tumor progression during CTx. Major toxicity was defined as grade 3 to 4 neutropenia or gastrointestinal side effects. One patient died under CTx because of neutropenia and was excluded from the overall patient collective. The curative resection rate was 77% after CTx and 74% after surgery only. The perioperative morbidity rate after CTx was 39% versus 66% after resection only. Recurrence rate after CTx was 38% and 61% after surgery alone; we detected an effective reduction of locoregional recurrence (12% vs. 26%). The overall survival was 38% after CTx and 42% after resection only. The 5-year survival rates were 45% in responders, 20% in non - responders and 42% in only resected patients. A subgroup analysis indicates that responders with stage III tumors may benefit with respect to their 5-year survival in comparable patients without neoadjuvant CTx. As to be expected, non-responders with stage III tumors did not benefit with respect to their survival. The 5-year-survival was approximated using a Kaplan-Meier curve and compared using a log-rank test.ConclusionIn patients with advanced gastric carcinoma, neoadjuvant CTx with the PELF- protocol significantly reduces the recurrence rate, especially locoregionally, compared to surgery alone. In our study, there was no overall survival benefit after a 5-year follow-up period. Alone a subgroup of patients with stage III tumors appear to benefit significantly in the long term from neoadjuvant CTx.

Comparison of neoadjuvant chemotherapy followed by surgery vs. surgery alone for locally advanced gastric cancer: a meta-analysis

“…The basic features of the 20 studies involved are shown in Table 1, six for RCT and 14 for RCNT studies, with 3362 GC patients, including 1420 in the NACS group and 1942 in the SA group [10,22–39] . All studies were published between January 2000 and January 2021.…”

Induction of MAPK- and ROS-dependent autophagy and apoptosis in gastric carcinoma by combination of romidepsin and bortezomib

“…Locoregional control by radical surgical resection is the only curative treatment for GC but more than half of GC cases have metastatic tumours at diagnosis [ 1 ]. The prognosis of such cases is poor because current chemotherapy has very limited effect on the disease [ 2 ].…”

“…However, GC remains asymptomatic for a long period of time and thus more than half of the cases are diagnosed clinically with distant metastasis. For such metastatic cases, the diseases are largely incurable and the 5-year survival rate is less than 10% [ 1 ]. Cisplatin and 5-fluorouracil are the most common types of chemotherapy for metastatic GC.…”

Palbociclib induces cell senescence and apoptosis of gastric cancer cells by inhibiting the Notch pathway

“…Most patients with GC are diagnosed at an advanced stage and usually show extensive tumor infiltration and distant lymph node metastasis ( 20 , 21 ). The overall 5-year survival rate for patients with advanced GC is <10% ( 4 ). Thus, the identification of novel drugs and therapeutic targets for the treatment of GC is urgently needed.…”

“…East Asia has the highest incidence and mortality rates of GC ( 2 ). Although advances have been made in GC treatment in recent years, the 5-year survival rate for patients with advanced GC is <15% ( 3 , 4 ). Thus, the identification of novel drugs and therapeutic targets for GC treatment is urgently needed.…”