What is the role of neoadjuvant chemotherapy in the management of gastric cancer?

Updated: Feb 24, 2020
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Neoadjuvant chemotherapy may allow downstaging of disease to increase resectability, decrease micrometastatic disease burden prior to surgery, allow patient tolerability prior to surgery, determine chemotherapy sensitivity, reduce the rate of local and distant recurrences, and ultimately improve survival. However, the choice of preoperative and postoperative chemotherapy versus postoperative chemoradiation therapy remains controversial. 

A European randomized trial demonstrated survival benefit when patients were treated with three cycles of preoperative chemotherapy (epirubicin, cisplatin, and 5-fluorouracil) followed by surgery and then three cycles of postoperative chemotherapy compared with surgery alone. The benefit was comparable to that obtained with postoperative chemoradiation in a US trial. [7] However, the Gastric Chemotherapy Group for Japan did not demonstrate a significant survival benefit with neoadjuvant chemotherapy.

A meta-analysis of 15 randomized controlled trials concluded that the addition of neoadjuvant chemotherapy to surgery reduces overall mortality at 3 and 5 years in patients with advanced gastric cancer (relative risk [RR] = 0.74 and 0.82, respectively) and reduces overall mortality at 1, 2, 3, and 5 years in patients with esophagogastric cancer (RR = 0.79, 0.83, 0.84, 0.91 respectively). In patients with esophagogastric cancer, neoadjuvant therapy reduces the overall recurrence rate (RR = 0.80). However, neoadjuvant therapy does not influence morbidity and perioperative mortality rates in either gastric or esophagogastric cancer. [42]

 


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