Perioperative chemotherapy for locally advanced operable gastric cancer (literature review)


  • K.D. Bakhniuk Bogomolets National Medical University, Kyiv, Ukraine; MNPE “Odessa Regional Oncology Center”, Odessa, Ukraine, Ukraine



chemotherapy, operable gastric cancer, review


Background. Gastric cancer remains the leading cause of cancer morbidity and mortality in the world. According to Globocan, in 2020 the incidence of gastric cancer was 5.6 % (1,089,103 people), with mortality of 7.7 % (768,793 people). According to the Cancer Registry of Ukraine for 2017–2018, gastric cancer is the second leading cause of death after lung cancer in men. By the time of diagnosis, almost 70 % of patients have a locally advanced or generalized tumor process, which reduces the possibi­lity of radical surgical treatment. Surgical treatment remains the main method of treatment for gastric cancer, but the prognosis is poor even after high-quality surgical treatment due to the high frequency of recurrences (20–60 %) and insufficient effectiveness of adjuvant therapy. The purpose of the study: to analyze studies that have tested various schemes of neoadjuvant treatment for gastric cancer and to present the results of key promising studies on this treatment technology. Materials and methods. We conducted a literature review that included randomized and nonrandomized clinical trials from 2010 to 2020. The search was conducted using electronic scientometric databases PubMed, Embase, Scopus, Web of Science, MedLine, Cochrane Library, as well as abstracts of the annual congresses of the American Society of Clinical Oncology and the European Society for Medical Oncology. The key words of the search were: neoadjuvant chemotherapy, perioperative chemotherapy, gastric neoplasm, gastric cancer, randomized controlled trial, treatment of gastric cancer, disseminated gastric cancer, D2 dissection. The selection criteria were: studies comparing different regimens of perioperative chemotherapy without the addition of chemoradiation therapy, targeted therapy over the past 10 years. Results. Thirty publications were found for the above-mentioned keywords. Among these sources, there were 10 randomized clinical trials, 8 non-randomized clinical trials, 4 meta-analyzes, 8 li­terature reviews. Conclusions. Analysis of these data indicates the presence of only 3 randomized controlled trials on the efficacy and safety of perioperative chemotherapy for locally advanced gastric cancer that met the selection criteria. There are shortcomings in the design of the analyzed studies: no reliable data on adequate lymph dissection, inclusion into the study of patients not only with gastric cancer, but also with other cancer sites (gastroesophageal adenocarcinoma, cancer of the lower esophagus). The above arguments suggest that the recognition of the FLOT as the only effective and safe regimen for neoadjuvant polychemotherapy in locally advanced gastric cancer is not a well-founded postulate, but requires further planned clinical trials of appropriate quality.


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Matthew Stenger Perioperative Therapy With FLOT vs ECF/ECX in Locally Advanced Gastric Adenocarcinoma. 2019 April [ASCOpost].

Cunningham D., Allum W.H., Stenning S.P., Thompson J.N., Van de Velde C.J.H., Nicolson М., Scarffe J.H., Lofts F.J., Falk S.J., Iveson T.J., Smith D.B., Langley R.E., Verma М., Weeden S., Chua Y.J. MAGIC Trial Participant Affiliations expand Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. 2006 July [PubMed].

Van Hagen P., Hulshof M.C.C.M., van Lanschot J.J.B. et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N. Engl. J. Med. 2012.

Al-Batran S., Homann N., Schmalenberg H., Kopp H. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): a multicenter, randomized phase 3 trial. Lancet. 2019 May [Pubmed].

Aggelis V., Cunningham D., Lordick F., Smyth E.C. Peri-­operative therapy for operable gastroesophageal adenocarcinoma: past, present and future. 2018 May [ESMO].

Al-Batran S.-E., Hofheinz R.D., Pauligk С., Kopp H.-G., Haag G.M., Luley K.B. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial. Lancet. 2006 December.

Van den Ende Т., Abe Nijenhuis F.A., van den Boorn H.G., Veer E.T., Hulshof M.C.C.M., Gisbertz S.S., van Oijen M.G.H., van Laarhoven H.W.M. COMplot, A Graphical Presentation of Complication Profiles and Adverse Effects for the Curative Treatment of Gastric Cancer: A Systematic Review and Meta-Analysis. 2019 July [PubMed].