Evaluation of Preoperative Chemoirradiation with Docetaxel and Oxaliplatin in Locally Advanced Gastric Cancer

Background: Preoperative chemoirradiation therapy for gastric carcinoma is an acceptable approach. It is well-tolerated and the postoperative complication rate is acceptable. There is better RO resection achieved and the survival rates are encouraging. Preoperative chemoirradiation is expected to give a better locoregional control.Objective: This is a phase II trial evaluating the tolerance of preoperative chemoirradiation in a loco regionally advanced stomach cancer.Patients and Methods: This study included 20 patients with locally advanced gastric adenocarcinoma (stage II-III). All patients had performance status 0-2, normal liver and renal function with adequate bone marrow reserve and function. All patients were subjected to weekly Docetaxel 20mg/m2 and Oxaliplatin 50mg/m2 I V concomitantly with radiation therapy in a total dose of 45 Gy (1.8 Gy daily, 5 days a week for 5 weeks). This was followed by surgical exploration.Results: Twenty patients were included and had properly received the designed course of concurrent preoperative chemoirradiation. Median follow-up duration was 14 months with a range of 6-24 months. The tolerance to treatment was acceptable. Most of the patients had grade 0-2 of toxicity. For grade 3 toxicities; grade 3 haematological toxicities were encountered in 3 (15%) patients (One patient had neutropenia and anaemia while two patients had only neutropenia) and dirrhoca were experienced in 3 (15%) patients. Grade 4 toxicities were encountered in 3 patients (15%) who had grade 4 GIT toxicity (anorexia, nausea and diarrhoea). Alopecia was detected as grade 3 and 4 in 6 patients (30%).All patients were subsequently operated upon to achieve an RO resection in 14 patients (70%) with one mortality (5%) and 8 morbidities (40%). Three patients had complete pathological response while 4 patients had stable disease. None of the patients had progressive disease. Two year overall survival was (63%). One patient (5%) had loco-regional relapse while peritoneal metastasis was the most common mode of disease relapse in relapsed patients.Conclusion: Neoadjuvant chemoirradiation is well tolerated by most of the patients and can be safely delivered to the patients undergoing radical gastrectomy. R0 resection and survival rates were encouraging. There was neither increase in morbidity nor mortality rates with adding preoperative chemoirradiation. Preoperative chemoirradiation is expected to give a better locoregional control.