The Role of Preoperative Chemotherapy in Patients with Inoperable Metastatic or Locally Advanced Gastric Cancer

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. MATERIALS AND METHODS: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was 15.3+/-15.5 (1~56) months. RESULTS: In 15 patients with distant metastasis, 2 (13.3%) showed complete response (CR), 10 (66.7%) partial response (PR), 2 (13.3%) stable disease (SD), and 1 (6.7%) progressive disease (PD). The clinical response rate was 80.0%. Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. CONCLUSION: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.