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10.1245/s10434-008-9982-2
Annals of Surgical Oncology 15:2146-2152 (2008)
© 2008 Society of Surgical Oncology
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Original Article

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

Roberto Persiani, MD1, Stefano Rausei, MD1, Carmelo Pozzo, MD2, Alberto Biondi, MD1, Carlo Barone, MD2, Ferdinando C. M. Cananzi, MD1, Giovanni Schinzari, MD2 and Domenico D’Ugo, MD, FACS1

1 1st General Surgery Unit, Department of Surgery, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy
2 Unit of Medical Oncology, Department of Internal Medicine, Catholic University of Rome, Largo A. Gemelli 8, 00168 Rome, Italy

Correspondence: Address correspondence and reprint requests to: Stefano Rausei, MD; E-mail: s.rausei{at}libero.it

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.

Key Words: Locally advanced gastric cancer • EEP chemotherapy • Preoperative chemotherapy • Pathologic response






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