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Background <p>Perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard treatment for resectable gastric cancer. However, adherence to postoperative cycles is frequently poor, and in the Brazilian public health system, FLOT is reimbursed only in the neoadjuvant setting. This has led to the adoption of an alternative approach delivering all eight cycles preoperatively. We evaluated the feasibility, safety, and outcomes of this exclusive neoadjuvant strategy.</p> Methods <p>We retrospectively analyzed 32 patients with resectable gastric cancer treated between 2019 and 2024. Patients were grouped according to the number of neoadjuvant cycles received (≤ 4 vs. &gt; 4). Clinical outcomes included treatment adherence, R0 resection rate, overall survival (OS), disease-free survival (DFS), pathological complete response (ypT0N0) rate, and toxicity. Kaplan-Meier curves, log-rank test, and hazard ratio were used in the analysis.</p> Results <p>Twenty-one patients (65.6%) completed all eight preoperative cycles. Five patients (15.7%) received ≤ 4 cycles, while 27 (84.3%) received &gt; 4 cycles. The R0 rate was 75%. Median OS was 45.3 months for patients receiving &gt; 4 cycles versus 18.6 months for those with ≤ 4 cycles (<i>p</i> = 0.0096). Median DFS was 41.1 months vs. 18.6 months, respectively (<i>p</i> = 0.028). Pathological complete response was achieved in 9.4% of patients. Toxicity was manageable, although 50% required dose adjustments.</p> Conclusion <p>Delivering all eight cycles of FLOT exclusively in the neoadjuvant setting was feasible and safe in this Brazilian cohort, with high adherence and favorable survival outcomes. This approach may represent a viable alternative in contexts with low adherence to adjuvant treatment or limited access to postoperative chemotherapy.</p>

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Exclusive Neoadjuvant Chemotherapy with the FLOT Regimen Protocol in Resectable Gastric Cancer: A Retrospective Cohort Study in a Brazilian Reference Center

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Kelre Wannlen Campos Silva Araújo,
  • Fernanda Carneiro Ronchi,
  • Carlos Eduardo Stecca,
  • Carlos Roberto Naufel Júnior,
  • Paulo Henrique Nocete,
  • Rayssa Helena de Sena,
  • Renata Medeiros Ferreira,
  • Emily Karoline Araujo Nonato

摘要

Background

Perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard treatment for resectable gastric cancer. However, adherence to postoperative cycles is frequently poor, and in the Brazilian public health system, FLOT is reimbursed only in the neoadjuvant setting. This has led to the adoption of an alternative approach delivering all eight cycles preoperatively. We evaluated the feasibility, safety, and outcomes of this exclusive neoadjuvant strategy.

Methods

We retrospectively analyzed 32 patients with resectable gastric cancer treated between 2019 and 2024. Patients were grouped according to the number of neoadjuvant cycles received (≤ 4 vs. > 4). Clinical outcomes included treatment adherence, R0 resection rate, overall survival (OS), disease-free survival (DFS), pathological complete response (ypT0N0) rate, and toxicity. Kaplan-Meier curves, log-rank test, and hazard ratio were used in the analysis.

Results

Twenty-one patients (65.6%) completed all eight preoperative cycles. Five patients (15.7%) received ≤ 4 cycles, while 27 (84.3%) received > 4 cycles. The R0 rate was 75%. Median OS was 45.3 months for patients receiving > 4 cycles versus 18.6 months for those with ≤ 4 cycles (p = 0.0096). Median DFS was 41.1 months vs. 18.6 months, respectively (p = 0.028). Pathological complete response was achieved in 9.4% of patients. Toxicity was manageable, although 50% required dose adjustments.

Conclusion

Delivering all eight cycles of FLOT exclusively in the neoadjuvant setting was feasible and safe in this Brazilian cohort, with high adherence and favorable survival outcomes. This approach may represent a viable alternative in contexts with low adherence to adjuvant treatment or limited access to postoperative chemotherapy.