Adjuvant Therapy Completion Rates in Patients with Gastric Cancer Undergoing Perioperative Chemotherapy Versus a Surgery-First Approach

Delayed recovery after gastrectomy may preclude the administration of adjuvant therapy in a significant percentage of patients who undergo elective gastrectomy as the initial therapy for gastric cancer. Clinicopathologic and treatment variables of 155 patients undergoing potentially curative gastrectomy for stages Ib–IIIc gastric adenocarcinoma from 2001 to 2014 were analyzed, and rates of receipt of chemotherapy and radiotherapy in patients treated with either a surgery-first approach (SURG) or neoadjuvant therapy followed by surgery followed by postoperative therapy (PERIOP) were compared. SURG patients (n = 93) were older and more likely to have distal tumors and to undergo distal gastrectomy and D1 lymphadenectomy than PERIOP patients (n = 62). The distribution of ASA scores was similar between groups. SURG patients were less likely than PERIOP patients to complete at least one cycle of chemotherapy (56 vs 100 %, P = 0.001) and all recommended chemotherapy and radiation therapy (44 vs 66 %, P = 0.013). These findings were consistent for SURG patients treated during different time periods throughout the study and for patients of poorer performance status. A significantly higher percentage of gastric cancer patients treated with perioperative chemotherapy receive some or all of the recommended components of multimodality therapy than patients treated with a surgery-first approach.