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7-Year Survival Results of Perioperative Chemotherapy with Epidoxorubicin, Etoposide, and Cisplatin (EEP) in Locally Advanced Resectable Gastric Cancer: Up-to-date Analysis of a Phase-II Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Perioperative chemotherapy is considered an effective treatment option for patients with gastric carcinoma. We report the results after a 7-year follow-up of a study aimed at evaluating a perioperative chemotherapy protocol in a group of patients with locally advanced gastric cancer (LAGC).

Methods

Between February 1996 and May 2000, 24 patients with LAGC underwent D2-gastrectomy after three preoperative cycles of chemotherapy (Epidoxorubicin, Etoposide, Cisplatinum). Three further cycles were planned after surgery. Differences among groups were evaluated using the chi-square test. Survival rate was calculated after a 7-year follow-up, and differences were assessed using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model.

Results

A total of 24 patients received preoperative chemotherapy and underwent surgical resection. Of these, 17 (71%) received postoperative treatment. The main toxicity was grade 3–4 neutropenia. Curative resection (R0) was achieved in 83.3% of patients. No pathologic complete responses were documented, but tumor downstaging was obtained in 10 of 24 patients (41.7%). Overall median survival was 40 months, and 7-year survival rate was 46%. At univariate and multivariate analysis, R0 resection and tumor diameter were the most important prognostic factors.

Conclusion

Long-term results in our series show a survival benefit for LAGC patients treated by perioperative chemotherapy and D2-gastrectomy when compared with previously studied controls who had surgery with postoperative chemotherapy alone. The high rate and prognostic impact of R0 resection in this study stressed the role of the therapy during the preoperative phase.

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Authors and Affiliations

  1. 1st General Surgery Unit, Department of Surgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy

    Roberto Persiani MD, Stefano Rausei MD, Alberto Biondi MD, Ferdinando C. M. Cananzi MD & Domenico D’Ugo MD, FACS

  2. Unit of Medical Oncology, Department of Internal Medicine, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy

    Carmelo Pozzo MD, Carlo Barone MD & Giovanni Schinzari MD

Authors
  1. Roberto Persiani MD
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  2. Stefano Rausei MD
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  3. Carmelo Pozzo MD
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  4. Alberto Biondi MD
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  5. Carlo Barone MD
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  6. Ferdinando C. M. Cananzi MD
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  7. Giovanni Schinzari MD
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  8. Domenico D’Ugo MD, FACS
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Correspondence to Stefano Rausei MD.

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Persiani, R., Rausei, S., Pozzo, C. et al. 7-Year Survival Results of Perioperative Chemotherapy with Epidoxorubicin, Etoposide, and Cisplatin (EEP) in Locally Advanced Resectable Gastric Cancer: Up-to-date Analysis of a Phase-II Study. Ann Surg Oncol 15, 2146–2152 (2008). https://doi.org/10.1245/s10434-008-9982-2

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  • DOI: https://doi.org/10.1245/s10434-008-9982-2

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