Multimodal treatment (prolonged neoadjuvant chemoradiotherapy in accelerated hyperfractionating regimen followed by D2 gastrectomy) for locally advanced gastric cancer: feasibility and safety assessment

In this paper, we assess feasibility and safety of the novel therapeutic modality in the multimodal treatment of locally gastric cancer. The treatment program included perioperative neoadjuvant chemoradiotherapy in the accelerated hyperfractionation regimen: twice-daily fractions of 1 Gy+1.5 Gy with 5-6 hour interval between the fractions, total tumor dose - 45 Gy; concurrent delivery of capecitabine: 925 mg/m2, twice-daily, 12 hour interval between drug intakes; intravenous administration of oxaliplatin: 85 mg/m2, 3 week interval between the administrations. After 4-6 week interval followed by the perioperative treatment, the follow-up examination included X-ray imaging, CT scan, gastroscopy, tumor markers tests, was performed. If the disease progression was not confirmed, the patients underwent radical surgery, including extended and combined interventions. The treatment tolerability was satisfactory, the toxicity of side effects for most cases was not higher than grade 2. Successful treatment outcomes were in 87% of cases. The presented treatment with the use of perioperative neoadjuvant therapy made it possible to increase the frequency of radical (R0) gastrectomies and subtotal resections (89%). It did not adversely affect the course of the postoperative period. There were no deaths among postoperative patients. The results demonstrate the feasibility, safety and satisfactory tolerability of the combined treatment of gastric cancer. The efficiency of the treatment is close to that reported previously by other authors.