Publication:
The new era of total neoadjuvant FLOT therapy for locally advanced, resectable gastric cancer: a propensity-matched comparison with standard perioperative therapy

dc.contributor.coauthorSaglam, Sezer
dc.contributor.departmentSchool of Medicine
dc.contributor.kuauthorBalık, Emre
dc.contributor.kuauthorGürses, Bengi
dc.contributor.kuauthorKarahacıoğlu, Duygu
dc.contributor.kuauthorKarahan, Salih Nafiz
dc.contributor.kuauthorLaçin, Şahin
dc.contributor.kuauthorÖzata, İbrahim Halil
dc.contributor.kuauthorÖzoran, Emre
dc.contributor.kuauthorRencüzoğulları, Ahmet
dc.contributor.kuauthorSaka, Burcu
dc.contributor.kuauthorSelçukbiricik, Fatih
dc.contributor.kuauthorTaşkın, Orhun Çığ
dc.contributor.kuauthorUymaz, Derya Salim
dc.contributor.schoolcollegeinstituteSCHOOL OF MEDICINE
dc.date.accessioned2025-03-06T20:59:21Z
dc.date.issued2024
dc.description.abstractBackground: The FLOT 4-AIO trial established the docetaxel-based regimen's superiority over epirubicin-based triplet therapy in terms of survival rates and acceptable toxicity for locally advanced resectable gastric (LARGC). Yet, fewer than half of the patients achieved completion of eight prescribed FLOT cycles. We proposed that administering all FLOT cycles in the form of total neoadjuvant therapy may improve completion rates and downstaging. This study contrasted total neoadjuvant therapy (FLOT x8) with standard neoadjuvant therapy (FLOT 4+4) for patients LARGC adenocarcinoma who underwent curative resection with routine D2 lymphadenectomy, focusing on histopathological outcomes, toxicity, and survival outcomes. Methods: We reviewed patients with histologically confirmed advanced clinical stage cT2 or higher, nodal positive stage (cN+), or both, with resectable gastric tumors and no distant metastases (January 2017 to July 2023). We divided patients into two groups, FLOT 4+4 and FLOT x8;FLOT 4+4 patients underwent four preoperative and four postoperative bi-weekly cycles of docetaxel, oxaliplatin, leucovorin, and fluorouracil, while FLOT x8 patients received all eight cycles preoperatively after a gradual practice change starting from January 2020. Propensity score matching adjusted for age, clinical stage, tumor location, and histology. Results: Of the 77 patients in the FLOT x8 group, 37 were propensity-matched to an equal number in the FLOT 4+4 group. Demographics, duration of surgery, and hospital stay showed no significant differences between the groups. The FLOT x8 group exhibited a significantly higher all-cycle completion rate at 89.1% compared to FLOT 4+4's 67.6% (p < 0.01). Both groups demonstrated comparable hematological and non-hematological toxicity rates, Clavien-Dindo >= 3 complications, and CAP tumor regression grades. The mean number of harvested lymph nodes was 42.5 and 41.2 in the FLOT 4+4 and FLOT x8 groups, respectively. Similar rates of disease-free survival and overall survival were noted in both groups, despite a trend toward a higher pathological complete response rate, albeit not statistically significant (8.1% vs. 18.9%, p = 0.29), in the FLOT x8 group at a median follow-up of 36 months. Conclusion: Total neoadjuvant therapy with the FLOT x8 protocol corresponds to higher treatment completion rates, a safety profile similar to standard perioperative therapy, and a twofold increase in complete pathological response. Further research on long-term oncological outcomes is needed to confirm the effectiveness of total neoadjuvant therapy.
dc.description.indexedbyWOS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.identifier.doi10.1002/jso.27934
dc.identifier.eissn1096-9098
dc.identifier.issn0022-4790
dc.identifier.quartileQ2
dc.identifier.scopus2-s2.0-85206137211
dc.identifier.urihttps://doi.org/10.1002/jso.27934
dc.identifier.urihttps://hdl.handle.net/20.500.14288/27671
dc.identifier.wos1336655400001
dc.keywordsFLOT therapy
dc.keywordsGastric cancer
dc.keywordsPerioperative therapy
dc.keywordsTotal neoadjuvant therapy
dc.language.isoeng
dc.publisherWiley
dc.relation.ispartofJournal of Surgical Oncology
dc.subjectOncology
dc.subjectSurgery
dc.titleThe new era of total neoadjuvant FLOT therapy for locally advanced, resectable gastric cancer: a propensity-matched comparison with standard perioperative therapy
dc.typeJournal Article
dc.type.otherEarly access
dspace.entity.typePublication
local.contributor.kuauthorRencüzoğulları, Ahmet
local.contributor.kuauthorKarahan, Salih Nafiz
local.contributor.kuauthorSelçukbiricik, Fatih
local.contributor.kuauthorLaçin, Şahin
local.contributor.kuauthorTaşkın, Orhun Çığ
local.contributor.kuauthorSaka, Burcu
local.contributor.kuauthorKarahacıoğlu, Duygu
local.contributor.kuauthorGürses, Bengi
local.contributor.kuauthorÖzoran, Emre
local.contributor.kuauthorUymaz, Derya Salim
local.contributor.kuauthorÖzata, İbrahim Halil
local.contributor.kuauthorBalık, Emre
local.contributor.kuauthorDursun, Buğra
local.publication.orgunit1SCHOOL OF MEDICINE
local.publication.orgunit2School of Medicine
relation.isOrgUnitOfPublicationd02929e1-2a70-44f0-ae17-7819f587bedd
relation.isOrgUnitOfPublication.latestForDiscoveryd02929e1-2a70-44f0-ae17-7819f587bedd
relation.isParentOrgUnitOfPublication17f2dc8e-6e54-4fa8-b5e0-d6415123a93e
relation.isParentOrgUnitOfPublication.latestForDiscovery17f2dc8e-6e54-4fa8-b5e0-d6415123a93e

Files