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Introduction:
Neoadjuvant chemotherapy for locally advanced gastric cancer was proposed as treatment modality to improve survival. The chemotherapy treatment effect is evaluated in the surgical specimen and divided based on the degree of dead tumor cells into 4 categories; no effect, mild effect, moderate effect, and significant effect. We present our experience with neoadjuvant chemotherapy in patients with gastric carcinoma.
Method:
25 patients with distal esophageal, gastroesophageal junction (GEJ), and gastric carcinoma who underwent neoadjuvant chemotherapy between January 2011 and August 2012 have been identified retrospectively in our cancer registry. Chemotherapy regimens and number of cycles were reviewed and the histological treatment effects were then compared.
Results:
No histological treatment effect was identified in one patient (4%) with GEJ tumor who received 3 cycles of Epirubicin, Cisplatin, and 5-Fluorouracil. Mild treatment effect was noted in 9 patients(36%); 7 patients received 2 preoperative cycles and 2 patients received 3 cycles. 9 patients (36%) were found to have moderate treatment effect; 4 of them received 2 cycles, 3 patients received 3 cycles, one received 4 cycles, and one received 5 cycles. Significant treatment effect was identified in 6 patients (24%); half of them received 2 cycles while 2 patients received 3 cycles, and one patient received 6 cycles of Oxaliplatin and Xeloda.
Conclusion:
The response of gastric cancer to preoperative chemotherapy cannot be predicted based on chemotherapy regimen or number of cycles received. 40% of patients experienced no or minimal effect. Further studies are needed to evaluate the correlation between the treatment effect grade and survival benefit.