A 62-year-old man undergoes staging for gastric adenocarcinoma and is found to have a T3 N2 M0 tumour of the gastric body with signet ring cell histology. ECOG performance status is 1. HER2 is negative. The standard of care treatment is:
- A Upfront total gastrectomy followed by adjuvant capecitabine + oxaliplatin (CAPOX)
- B Perioperative chemotherapy with FLOT (docetaxel, oxaliplatin, leucovorin, fluorouracil) followed by total gastrectomy with D2 lymphadenectomy, then completion FLOT ✓
- C Palliative chemotherapy only
- D Chemoradiotherapy with concurrent capecitabine followed by surgery
Correct answer: B. Perioperative chemotherapy with FLOT (docetaxel, oxaliplatin, leucovorin, fluorouracil) followed by total gastrectomy with D2 lymphadenectomy, then completion FLOT
Explanation
Based on the FLOT4 trial, perioperative FLOT chemotherapy (4 pre-operative + 4 post-operative cycles) significantly improved overall survival compared to ECF/ECX and is the current European standard for resectable locally advanced gastric cancer. Total gastrectomy with D2 lymphadenectomy is the surgical procedure for body/fundus lesions.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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