A 62-year-old man undergoes total gastrectomy with D2 lymphadenectomy for gastric carcinoma (pT3N2M0, 7 of 22 nodes involved). Post-operative adjuvant treatment per the FLOT4-AIO trial paradigm (European approach) involves which perioperative regimen?
- A Postoperative capecitabine + oxaliplatin (XELOX) alone for 8 cycles
- B Postoperative chemoradiation with 5-FU (Macdonald protocol)
- C Perioperative FLOT (5-FU, leucovorin, oxaliplatin, docetaxel): 4 cycles preop + 4 cycles postop ✓
- D Trastuzumab monotherapy for HER2-positive disease only
Explanation
The FLOT4-AIO trial (NEJM 2019) compared perioperative FLOT (4 cycles pre-op + 4 cycles post-op) versus the older ECF/ECX protocol, demonstrating superior pathological complete response rates (16% vs 6%), R0 resection rates, and significantly improved overall survival (50 vs 35 months median). FLOT has become the European standard for resectable locally advanced gastric and GEJ adenocarcinoma. The Macdonald protocol (adjuvant chemoradiation) was the previous US standard but FLOT is superior. XELOX alone postoperatively is less effective. Trastuzumab is added to chemotherapy for HER2+ disease but does not replace perioperative chemotherapy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.