Copyright
©2010 Baishideng. All rights reserved.
World J Gastroenterol. Feb 21, 2010; 16(7): 868-874
Published online Feb 21, 2010. doi: 10.3748/wjg.v16.i7.868
Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer
Roberto Biffi, Nicola Fazio, Fabrizio Luca, Antonio Chiappa, Bruno Andreoni, Maria Giulia Zampino, Arnaud Roth, Jan Christian Schuller, Giancarla Fiori, Franco Orsi, Guido Bonomo, Cristiano Crosta, Olivier Huber
Roberto Biffi, Fabrizio Luca, Division of Abdomino-pelvic Surgery, European Institute of Oncology, 20141 Milan, Italy
Nicola Fazio, Maria Giulia Zampino, Division of Medical Oncology, European Institute of Oncology, 20141 Milan, Italy
Antonio Chiappa, Bruno Andreoni, Division of General and Laparoscopic Surgery, European Institute of Oncology, 20141 Milan, Italy
Arnaud Roth, Department of Oncosurgery, Geneva University Hospitals, 1211 Geneva, Switzerland
Jan Christian Schuller, Statistics Unit, SAKK (Swiss Group for Clinical Cancer Research), 3000 Bern, Switzerland
Giancarla Fiori, Cristiano Crosta, Division of Endoscopy, European Institute of Oncology, 20141 Milan, Italy
Franco Orsi, Guido Bonomo, Interventional Radiology Unit, European Institute of Oncology, 20141 Milan, Italy
Olivier Huber, Department of Surgery, Geneva University Hospitals, 1211 Geneva, Switzerland
Author contributions: All authors provided substantial contriÂbutions to the conception and design of the study, and also to acquisition and interpretation of data, gave approval of the version to be published; Biffi R contributed to the study design and wrote the manuscript; Biffi R, Luca F, Chiappa A, Andreoni B and Huber O performed the surgical procedures and were involved in editing the manuscript; Fazio N, Roth A and Zampino MG provided medical oncology treatments and contributed to the study design; Fiori G and Crosta C provided endoscopic ultrasonography assessment and critical review of the obtained data; Orsi F and Bonomo G performed CT scans, revised the data and co-ordinated all imaging studies; Schuller JC contributed to the study design, performed statistical analysis and provided important intellectual content.
Supported by Sanofi-Aventis
Correspondence to: Roberto Biffi, MD, Director, Division of Abdomino-pelvic Surgery, European Institute of Oncology, Via Ripamonti 435, I-20141 Milan, Italy. roberto.biffi@ieo.it
Telephone: +39-2-57489609 Fax: +39-2-94379215
Received: November 3, 2009
Revised: December 11, 2009
Accepted: December 18, 2009
Published online: February 21, 2010
AIM: To investigate feasibility, morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.
METHODS: Patients suffering from locally-advanced (T3-4 any N M0 or any T N1-3 M0) gastric carcinoma, staged with endoscopic ultrasound, bone scan, computed tomography, and laparoscopy, were assigned to receive four 21 d/cycles of TCF (docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and fluorouracil 300 mg/m2 per day for days 1-14), either before (Arm A) or after (Arm B) gastrectomy. Operative morbidity, overall mortality, and severe adverse events were compared by intention-to-treat analysis.
RESULTS: From November 1999 to November 2005, 70 patients were treated. After preoperative TCF (Arm A), thirty-two (94%) resections were performed, 85% of which were R0. Pathological response was complete in 4 patients (11.7%), and partial in 18 (55%). No surgical mortality and 28.5% morbidity rate were observed, similar to those of immediate surgery arm (P = 0.86). Serious chemotherapy adverse events tended to be more frequent in arm B (23% vs 11%, P = 0.07), with a single death per arm.
CONCLUSION: Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
