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Perioperative chemotherapy
Source: Gastric Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: February 21, 2025 · Captured 2026-09-09.
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Context: Treatment of Stage I Gastric Cancer / Treatment Options for Stage I Gastric Cancer
Investigators in Europe evaluated the role of perioperative chemotherapy without radiation therapy.[9]
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Evidence (perioperative chemotherapy):
In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT); or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[3][Level of evidence A1]
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In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT); or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[3][Level of evidence A1]
Median overall survival was 50 months with FLOT and 35 months with ECF/ECX (hazard ratio, 0.77; 95% confidence interval, 0.63–0.94; P = .012).
In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT); or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[3][Level of evidence A1]
Margin-free resection in the FLOT group was 85% versus 78% in the ECF/ECX group (P = .0162).
In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT); or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[3][Level of evidence A1]
Toxicity rates were similar between groups (26% required hospitalizations in the ECF/ECX group and 25% in the FLOT group). However, types of side effects differed, with increased nausea, thromboembolic events, and anemia in the ECF/ECX group versus higher rates of grade 3/4 infections, neutropenia, diarrhea, and neuropathy in the FLOT group.
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Preserved source evidence · Not medical advice