Peri-Operative FLOT Chemotherapy in Locally-Advanced Gastric and Gastroesophageal Carcinoma: Outcomes In South Asian Population

Abstract

Objective: To compare oncological outcomes of perioperative FLOT chemotherapy in terms of tumor response, tumor margin clearance and average positive number of lymph nodes retrieved in surgical resection specimens of locally advanced gastric and gastroesophageal carcinoma.

Materials and Methods:  The patients presenting in Department of General Surgery, Shifa International Hospital, Islamabad from July 2020 to March 2023 were included in the study. Out of total 108, we included 37 patients who undertook perioperative FLOT chemotherapy in for resectable, locally advanced gastroesophageal cancer. Response to therapy was assessed based on per operative findings, R0 resection and D2 lymphadenectomy and disease regression on histopathology specimens. Patients were also assessed according to post-operative recovery time, mean ICU and hospital stay, as well as post chemo and post-operative complications.

Statistical Analysis Appropriate statistical analysis was performed using SPSS version 26.

Results: There were a total 37 patients with mean age 57.21 ± 10.04 years. 4(10.8%) had well-differentiated adenocarcinoma, 19(51.4 %) had moderately-differentiated and 14(37.8%) had poorly-differentiated cancer.  Perioperative completion rate of 4 cycles of chemotherapy was 100%. 4 patients had dose reduction due to neutropenia. 100% of the patients had R0 resection. Average positive lymph nodes on histopathology were 2.04 ± 3.01 in 13 patients (35.1%). 24 out of 37 patients (64.9%) had no nodal involvement. Histopathology, evaluated for treatment response according to CAP (College of American Pathologists) -TRG criteria, 7 (18.9%) patients out of 37 showed no tumor regression. 22(59.5%) had partial response and 8(21.6%) patients had complete response.

Conclusion: Perioperative FLOT shows highly favorable results in patients with resectable, locally-advanced gastric and gastroesophageal cancer. Considering the burden of this disease in the South Asian population, an optimal therapeutic regime is an absolute requirement. Our initial data in this study provides favorable results to use of perioperative chemotherapy with the FLOT-4 regime in our population.