Neoadjuvant chemotherapy with FLOT for locally advanced gastric cancer: A single-center experience from Vietnam
Nội dung chính của bài viết
Tóm tắt
Neoadjuvant chemotherapy (NACT) with the FLOT regimen (5-Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) has shown promising results for locally advanced gastric cancer (LAGC). This study aimed to evaluate the initial treatment outcomes of LAGC patients receiving neoadjuvant FLOT at Hanoi Oncology Hospital. A descriptive cohort study was conducted on 35 patients with LAGC (cT3-4 and/or cN2-3, M0) treated with neoadjuvant FLOT between October 2021 and February 2024. Clinical data, radiological and histopathological responses, surgical outcomes, and adverse events were retrospectively and prospectively collected and analyzed. The median age was 62 years, with a male-to-female ratio of 4.8:1. The majority presented with epigastric pain (80%) and tumors located in the antrum (68.6%). Among all patients, 91.4% were cT4 (62.8% cT4b), and 97.1% had lymph node metastasis on imaging. Thirty patients (85.7%) completed 4 FLOT cycles. Radiologically, 50% had partial response (PR), 43.3% had stable disease (SD), and 6.7% showed progression. Of the 32 patients who underwent surgery, 29 (90.6%) had radical resection with an R0 rate of 100%. Pathologic complete response (pCR) was observed in 6.7% of cases. The postoperative lymph node-negative rate (ypN0) was 25%. Neoadjuvant chemotherapy using the FLOT regimen demonstrated favorable disease control, enabling high R0 resection rates in patients with locally advanced resect able gastric cancer. These results support the use of FLOT in carefully selected Asian populations with LAGC, although further studies with larger sample sizes and long-term follow-up are warranted.
Chi tiết bài viết
Từ khóa
FLOT, neoadjuvant chemotherapy, gastric cancer, R0 resection, locally advanced cancer, Vietnam
Tài liệu tham khảo
2. Ajani JA, D’Amico TA, Bentrem DJ, et al. Gastric Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw JNCCN. 2022;20(2):167-192.
3. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet Lond Engl. 2019;393(10184):1948-1957.
4. Lordick F, Carneiro F, Cascinu S, et al. Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol. 2022;33(10):1005-1020.
5. Schwartz LH, Litière S, de Vries E, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer Oxf Engl 1990. 2016;62:132-137.
6. Common Terminology Criteria for Adverse Events (CTCAE). Published online 2009:79.
7. Fujitani K, Mano M, Hirao M, et al. Posttherapy nodal status, not graded histologic response, predicts survival after neoadjuvant chemotherapy for advanced gastric cancer. Ann Surg Oncol. 2012;19(6):1936-1943.
8. Lorenzen S, Blank S, Lordick F, et al. Prediction of response and prognosis by a score including only pretherapeutic parameters in 410 neoadjuvant treated gastric cancer patients. Ann Surg Oncol. 2012;19(7):2119-2127.
9. Park SR, Lee JS, Kim CG, et al. Endoscopic ultrasound and computed tomography in restaging and predicting prognosis after neoadjuvant chemotherapy in patients with locally advanced gastric cancer. Cancer. 2008;112(11):2368-2376.
10. Lowy AM, Mansfield PF, Leach SD, et al. Response to neoadjuvant chemotherapy best predicts survival after curative resection of gastric cancer. Ann Surg. 1999;229(3):303-308.
11. Liu K, Li G, Fan C, et al. Adapted Choi response criteria for prediction of clinical outcome in locally advanced gastric cancer patients following preoperative chemotherapy. Acta Radiol Stockh Swed 1987. 2012;53(2):127-134.
12. Kurokawa Y, Shibata T, Sasako M, et al. Validity of response assessment criteria in neoadjuvant chemotherapy for gastric cancer (JCOG0507-A). Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc. 2014;17(3):514-521.
13. Lee SM, Kim SH, Lee JM, et al. Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer. Abdom Imaging. 2009;34(4):430-440.
14. Schulz C, Kullmann F, Kunzmann V, et al. NeoFLOT: Multicenter phase II study of perioperative chemotherapy in resectable adenocarcinoma of the gastroesophageal junction or gastric adenocarcinoma-Very good response predominantly in patients with intestinal type tumors. Int J Cancer. 2015;137(3):678-685.
15. Lorenzen S, Pauligk C, Homann N, et al. Feasibility of perioperative chemotherapy with infusional 5-FU, leucovorin, and oxaliplatin with (FLOT) or without (FLO) docetaxel in elderly patients with locally advanced esophagogastric cancer. Br J Cancer. 2013;108(3):519-526.
16. Becker K, Mueller JD, Schulmacher C, et al. Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer. 2003;98(7):1521-1530.