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Turkish Journal of Medical Sciences

Abstract

Background/aim: Perioperative FLOT is considered the gold standard treatment for locally advanced gastric cancer. However, in the adjuvant setting, chemotherapy intolerance has brought de-escalation strategies to the forefront as an important area of research. This study aimed to compare the efficacy of adjuvant FLOT and FOLFOX regimens in enhancing survival outcomes in patients with locally advanced gastric cancer who underwent surgical resection following neoadjuvant FLOT treatment.

Materials and methods: Patients with locally advanced gastric cancer (cT2-4, N0-3) who received four cycles of neoadjuvant FLOT and subsequently underwent surgery at Ankara Bilkent City Hospital between January 2018 and September 2024 were retrospectively evaluated. Disease-free survival (DFS) and overall survival (OS) outcomes were compared to patients receiving adjuvant FOLFOX or FLOT. Clinical variables such as disease stage and response to neoadjuvant therapy were also analyzed to determine their impact on DFS and OS.

Results: The analysis included 171 patients, with a median age of 59 years and a median follow-up duration of 16.1 months. At 16 months, the DFS and OS rates were 66% and 82%, respectively. Of the 171 patients, 105 received adjuvant FLOT, 37 received FOLFOX, and 29 received no adjuvant therapy. Statistical analysis revealed no significant differences in DFS (HR: 0.63, 95% CI: 0.30–1.33, p = 0.229) or OS (HR: 0.76, 95% CI: 0.24–2.37, p = 0.635) between the FLOT and FOLFOX groups. However, the advanced disease stage and lack of pathological response to neoadjuvant FLOT were associated with decreased DFS and OS, highlighting these factors as potential prognostic indicators.

Conclusion: Among patients undergoing surgery after neoadjuvant FLOT, adjuvant FOLFOX showed comparable efficacy to FLOT, suggesting its potential as an alternative option, particularly for patients with deteriorated ECOG PS or those who developed chemotherapy intolerance postoperatively. These findings inform treatment strategies and optimize adjuvant therapy selection based on individual patient profiles.

Author ORCID Identifier

FURKAN CEYLAN: 0000-0002-1944-0861

DİDEM ŞENER DEDE: 0000-0002-9756-5942

SAFA CAN EFİL: 0000-0001-9586-2858

ATEŞ TENEKECİ: 0009-0007-6224-945X

EREN CEYLAN: 0009-0003-1244-4530

SERHAT SEKMEK: 0000-0003-4650-248X

MEHMET ÇAKMAK: 0000-0002-5362-6109

BURAK BİLGİN: 0000-0003-1717-8246

ŞEBNEM YÜCEL: 0000-0001-6235-7927

HAYRİYE TATLI DOĞAN: 0000-0003-4318-2775

MEHMET ALİ ŞENDUR: 0000-0001-7021-6139

MUHAMMED AKINCI: 0000-0001-7575-9925

DOĞAN UNCU: 0000-0002-0929-3271

BÜLENT YALÇIN: 0000-0002-4431-8948

DOI

10.55730/1300-0144.6002

Keywords

FLOT, FOLFOX, Gastric cancer, response, Survival

First Page

547

Last Page

558

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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