الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Background and Objectives The prognosis of locally advanced gastric carcinoma remains dismal even after radical surgery. To date, most therapeutic efforts are directed toward tailoring the extent of surgery and integrating it with the administration of pre- and/or postoperative treatment. Accordingly, our objective in this study is to determine whether chemotherapy before surgery improves the rate of curative resection and the outcomes of gastric cancer. Patients and Methods Twenty three patients with treatment naïve locally advanced gastric carcinoma, with no evidence of distant metastases, received 3 cycles of pre-operative chemotherapy protocol (cisplatin and flurouracil); clinical response to treatment was assessed. Surgery was scheduled to take place 3-4 weeks after completion of preoperative chemotherapy. Curability of resection was determined. The responding patients received another 3 cycles postoperatively. Paired t-test was used to test for significance of change in tumor diameter after chemotherapy. Survival was calculated by Kaplan-Meier method and differences were assessed by the Log-rank test. Results All patients received preoperative chemotherapy as scheduled; there was significant tumor shrinkage (from 8±1.86 cm to 5±2.4 cm, p < 0.001). Response to chemotherapy was assessed for all patients, 12 patients (52.2%) had partial response, nine patients (39.1%) had stationary disease and 2 patients (8.7%) showed disease progression. No patient reached clinical complete response. Curative resection (R0) rate was 83.3%. At the end of follow up, 11 out of 23 patients are alive with no evidence of disease. The 2-year actuarial overall survival (OS) and PFS after curative resection were 86% and 78%, respectively. At univariate analysis, curative resection (R0) found to be the only prognostic factor affecting survival (Log-rank test; p=0.015). Conclusion Preoperative chemotherapy resulted in significant tumor shrinkage with improving patients’ survival after actual curative resection. Accordingly, preoperative chemotherapy is a promising modality for gastric carcinoma patients who could benefit from a curative surgery.