Neoadjuvant chemotherapy with CPT-11 and cisplatin downstages locally advanced gastric cancer

Elliot Newman, Stuart G. Marcus, Milan Potmesil, Sanjeev Sewak, Herman Yee, Joan Sorich, Mary Hayek, Franco Muggia, Howard Hochster, V. Velanovich, K. Kelly, M. Zenilman, V. Fink, C. Pellegrini

Research output: Contribution to journalArticlepeer-review

Abstract

We examined the role of neoadjuvant therapy in downstaging locally advanced gastric cancer. Preoperative staging was performed with a combination of CT scans, endoscopic ultrasonography and/or laparoscopy, and laparoscopic ultrasonography. Patients with T ≥3 tumors and/or node-positive disease by preoperative clinical staging were eligible for entry. Neoadjuvant therapy consisted of two cycles of CPT-11 (75 mg/m2) with cisplatin (25 mg/m2) weekly four times every 6 weeks. This was followed by resection with D2 lymph node dissection and two cycles of intraperitoneal chemotherapy with floxuridine and cisplatin. Twenty-two patients were entered into the study (4 with T3N0 disease and 18 with T3N1 disease). Induction chemotherapy was well tolerated with major toxicities being neutropenia and diarrhea. A median of 78%/75% of the planned dosage of CPT-11/cisplatin was delivered. Two patients withdrew consent during the first cycle and were lost to follow-up. One patient progressed to stage IV disease during induction chemotherapy and did not undergo surgery. Nineteen patients underwent surgery. One patient had undetected stage IV disease (liver) and underwent a palliative R2 resection. Of the 18 remaining patients, 17 had curative R0 resections and one had a palliative R1 resection. A median of 21 lymph nodes (range 1 to 121) were examined histologically. There was one postoperative death. Surgical morbidity did not appear to increase after the neoadjuvant regimen. The median postoperative length of hospital stay was 9 days (range 3 to 75 days). Postoperative pathologic staging yielded 16% T3 lesions compared to 85% before treatment based on clinical staging; postoperative American Joint Committee on Cancer staging yielded 37% stage IIIA disease compared to 70% stage IIIA before treatment. With a median follow-up of 15 months, median survival has not yet been reached. We conclude that CPT-11-based neoadjuvant therapy downstages locally advanced gastric cancer. Further follow-up is necessary to determine the ultimate impact of this combination therapy on recurrence and survival.

Original languageEnglish (US)
Pages (from-to)212-223
Number of pages12
JournalJournal of Gastrointestinal Surgery
Volume6
Issue number2
DOIs
StatePublished - 2002

Keywords

  • Downstaging
  • Gastric cancer
  • Neoadjuvant therapy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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