The authors declare that they have no competing interests.
MF: participated in the design of the study and its coordination, carried out the surgical treatment, and helped to draft the manuscript. GJ: conceived the study, participated in the design of the study and its coordination, carried out the chemotherapy treatment, and helped to draft the manuscript. OA: participated in the design of the study and carried out the pathological study. M-BA: participated in the design of the study and carried out the surgical treatment. S-VJ: participated in the design of the study and carried out endoscopic ultrasound. MP: participated in the design of the study and its coordination. MMA: participated in the design of the study and its coordination, carried out the surgical treatment. RJA: carried out the pathological study. CR: participated in the design of the study and helped to draft the manuscript. LFJ: conceived the study, carried out the surgical treatment, participated in the design of the study and its coordination, and helped to draft the manuscript. All authors have read and approved the final manuscript
We assessed the effectiveness of perioperative MAGIC-style chemotherapy in our series focused on the tumor regression grade and survival rate.
We conducted a retrospective study of 53 patients following a perioperative regimen of epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/X). Forty-four (83 %) neoplasias were located in the stomach and 9 (17 %) were located at the esophagogastric junction. Perioperative chemotherapy completion, resection, TNM staging, the tumor regression grade (Becker’s classification) and survival were analyzed.
Forty-five patients (85 %) completed the 3 preoperative cycles. R0 resection was achieved in 42 (79 %) patients. Thirty-five (66 %) patients completed the 3 postoperative cycles. Nine carcinomas (17 %) were considered major responders after preoperative chemotherapy. With multivariate analysis, only completion of perioperative chemotherapy (HR: 0.25; 95%CI: 0.08 – 0.79; p = 0.019) was identified as an independent prognostic factor for disease-specific survival. However, the protective effect of perioperative therapy was lost in patients with ypT3-4 and more than 4 positive lymph nodes (HR: 1.16; 95%CI: 1.02 – 1.32; p = 0.029). The tumor regression grade (major vs minor responders) was at the limit of significance only with univariate analysis. The 5-year overall and disease-specific survival rates were 18 % and 22 % respectively.
The percentage of major responder tumors after preoperative chemotherapy was low.
Completion of perioperative ECF/X chemotherapy may benefit patients with gastric carcinomas that do not invade the subserosa with few positive lymph nodes.
Gastric Cancer. NCCN Clinical Practice Guidelines in Oncology. V1.2013. www.nccn.org.
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- Tumor regression and survival after perioperative MAGIC-style chemotherapy in carcinoma of the stomach and gastroesophageal junction
Miguel Angel Morcillo
Juan Antonio Ruiz
- BioMed Central
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