No survival benefit for Neoadjuvant Chemotherapy Compared With Surgery Alone for Locally Advanced Cancer of the Stomach and Cardia, results from EORTC trial 40954

Patients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy, although fewer than 50% could receive postoperative chemotherapy. A Randomized EORTC trial (40954) examined the value of purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines. Authors found a significantly increased R0 (radical, no tumor left) resection rate in the preoperative chemotherapy group, but failed to demonstrate a survival benefit. Possible explanations are low statistical power, a high rate of proximal gastric cancer including esophagogastric junction (AEG) and/or a better outcome than expected after radical surgery alone due to the high quality of surgery with resections of regional lymph nodes outside the perigastic area (celiac trunc, hepatic ligament, lymph node at a. lienalis; D2).