Neoadjuvant chemotherapy for patients with positive cytology from advanced gastric cancer

Free cancer cells from advanced gastric cancer are associated with a poor prognosis. The aim of this study was to clarify the role of neoadjuvant chemotherapy (NAC) for patients with positive cytology from advanced gastric cancer. Thirty four patients with positive cytology and no macroscopic peritoneal deposits from advanced gastric adenocarcinoma at staging laparoscopy were studied. Gastrectomy after staging laparoscopy was performed in 9 patients (Surgery group). NAC following gastrectomy after staging laparoscopy was performed in 25 patients (NAC group). The overall response rate was 24% (CR in none, PR in 6, NC in 15, PD in 4). Two of the 4 patients with PD did not undergo surgical resection. Twenty three patients in the NAC group (resection rate 92%) underwent gastrectomy, which resulted in 17 R0, four R1, and two R2 resections. Eighteen of the 23 patients (78%) in the NAC group revealed no free cancer cells at operation. There was no significant deference in the overall survival curves between Surgery and NAC groups. Five of the 17 patients performed curative operation developed recurrence (peritoneum in 1, liver in]1, brain in 1, local and peritoneum in 1, paraaortic lymph node and peritoneum in 1). NAC for patients with positive cytology could lead into no free cancer cells at a high rate, but not to improve their prognoses. An intensive chemotherapy after gastrectomy should be necessary for these patients.