A 58-year-old man is found to have a 4 cm gastric cancer on CT staging (cT3N2M0, Lauren diffuse type). He undergoes FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) perioperative chemotherapy per FLOT4 trial protocol. How many cycles are given preoperatively and postoperatively?
- A 3 cycles pre-op and 3 cycles post-op (ECF protocol)
- B 4 cycles pre-op and 4 cycles post-op (FLOT protocol) ✓
- C 6 cycles pre-op only (FLOT modified)
- D 2 cycles pre-op and 6 cycles post-op (MAGIC protocol)
Correct answer: B. 4 cycles pre-op and 4 cycles post-op (FLOT protocol)
Explanation
The FLOT4 trial (Al-Batran et al., NEJM 2019) replaced the ECF-based MAGIC protocol as the standard for resectable gastric/gastroesophageal junction adenocarcinoma. FLOT is given as 4 cycles (8 weeks) preoperatively and 4 cycles (8 weeks) postoperatively. FLOT showed superior median OS (50 months vs 35 months) and higher pathological complete response compared to ECF. The MAGIC protocol used 3 pre-op and 3 post-op cycles of ECF.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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