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Introduction:
With the advent of the MAGIC trial, preoperative chemotherapy is utilized for high risk tumors in gastric cancer (T3 and higher/Node positive tumors). The regimen is often toxic and often necessitates nutritional support with the hope of downstaging these aggressive tumors. We aim to see if our population of high risk tumors receiving preoperative therapy experienced any downstaging in comparison to those who did not.

Aim: All gastric cancer cases operated on by a single surgeon in the last five years were queried. Of these, only those who had strict clinical staging with radiological imaging/EUS and who were deemed high risk were included for analysis. Clinical stage was correlated to pathologic stage with a view to see if any tumors were upstaged, downstaged or had complete pathologic response.

Results: A total of 27 patients met all criteria. Twelve patients (44%) had tumors designated as Siewert 3 and 1 patient as Siewert 2. Of the 27 patients, 15(55%) were node positive. Twenty patients (74%) were staged T3 or higher. Ten patients received no preoperative therapy. The major preoperative regimen used was Epirubicin, Cisplatin & 5FU (ECF) or a combination similar such as EOX (78%). Of those who received preoperative therapy, ten patients (58%) were downstaged. There were 4 complete pathologic responses (cPR). All these patients received either ECF or EOX. Tumor location was varied for those with cPR

Conclusions:
Complete pathologic response is obtainable in high risk gastric cancer. Downstaging of these tumors happens in 58% of the high risk gastric populace. For those who can tolerate the regimens, this should remain the standard of care until further trials establish different treatment approaches.