Total neoadjuvant chemotherapy: a silver lining during the COVID pandemic for a patient with locally advanced diffuse distal gastric adenocarcinoma

Perioperative oncological therapies resulting in pathological complete response (pCR) in diffuse-type distal gastric adenocarcinoma are extremely rare. We report a case of locally advanced (cT3 N2 M0) diffuse-type distal gastric adenocarcinoma treated with 'total neoadjuvant' FLOT (eight c...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2022-07, Vol.104 (7), p.e197-e201
Main Authors: Patil, P, Clements, H A, Ramkumar, P G, Walsh, S, Petty, R
Format: Article
Language:English
Subjects:
Adenocarcinoma - diagnostic imaging
Adenocarcinoma - drug therapy
Adenocarcinoma - surgery
Algorithms
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biomarkers
Cancer therapies
Chemotherapy
Coronaviruses
COVID-19
Fluorodeoxyglucose F18 - therapeutic use
Gastrectomy - methods
Gastric cancer
Gastrointestinal surgery
Growth factors
Humans
Immunotherapy
Laparoscopy
Lymphatic system
Neoadjuvant Therapy
Online Case Report
Pandemics
Patients
Physiology
Positron Emission Tomography Computed Tomography
Quality of life
Stomach Neoplasms - drug therapy
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgical outcomes
Tomography
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Summary:Perioperative oncological therapies resulting in pathological complete response (pCR) in diffuse-type distal gastric adenocarcinoma are extremely rare. We report a case of locally advanced (cT3 N2 M0) diffuse-type distal gastric adenocarcinoma treated with 'total neoadjuvant' FLOT (eight cycles), due to the COVID-19 pandemic, and laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy. The patient demonstrated a progressive radiological response on positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-d-glucose integrated with computed tomography ( F-FDG PET-CT) and pCR in the resected specimen (ypT0 N0). As far as we are aware, this is the first case of pCR in locally advanced T3 N2 diffuse distal gastric cancer to be reported in the literature. It introduces a novel approach of total neoadjuvant chemotherapy with F-FDG PET-CT to assess response, combined with radical minimally invasive surgical management to provide optimal care for patients with gastric cancer.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2021.0235