PREOPERATIVE CHEMOTHERAPY FOR STAGE III-IV GASTRIC-CARCINOMA - FEASIBILITY, RESPONSE AND OUTCOME AFTER COMPLETE RESECTION

Despite extensive resection and systematic lymphadenectomy the prognos is of patients with locally advanced gastric carcinoma remains poor. T he effect of preoperative outpatient chemotherapy with etoposide, doxo rubicin and cisplatin was evaluated prospectively in 30 patients who h ad been shown by preoperative staging (including endosonography and su rgical laparoscopy) to have gastric carcinoma stages IIIA, IIIB or IV. Haematological side-effects were common and necessitated hospitalizat ion in 13 of 30 patients. Complete clinical response to neoadjuvant th erapy was observed in eight of 27 evaluable patients. Resection was pe rformed in 27 of 30 patients, with complete macroscopic and microscopi c tumour removal in 24. There were no deaths and no major morbidity fo llowing operation. On multivariate analysis complete clinical response (P<0.01) and complete tumour resection (P<0.01) were the major indepe ndent predictors of long-term survival after neoadjuvant chemotherapy. Actuarial survival after complete tumour removal was superior with ne oadjuvant therapy compared with results in an age-, sex- and tumour st age-matched control population who had primary resection (P=0.07). Rec urrence occurred in 17 of 23 evaluable patients who had complete tumou r removal, with relapse in the tumour bed or area of lymphatic drainag e in 11. These data show that neoadjuvant therapy in patients with loc ally advanced gastric carcinoma is feasible and appears to increase th e rate of complete tumour removal. More powerful and less toxic regime ns are, however, required to improve the response rate and to delay or avoid recurrence after neoadjuvant chemotherapy.