Jul 2026· Journal of Health Science and Medical Research· pp. 20261385· 0 citations
TL;DR
Nosoenteric enteral nutrition is a feasible and effective method to enable the safe delivery of neoadjuvant therapy in patients with pyloric obstruction resulting from gastric cancer and optimizes nutrition, enhances treatment tolerance, and contributes to favorable oncologic outcomes.
Abstract
Objective: To evaluate whether neoadjuvant therapy can be carried out in pyloric obstruction secondary to gastric cancer through nasojejunal enteral nutrition and assess tumor regression and improvement in surgical outcomes.Material and Methods: A retrospective cohort analysis of patients diagnosed with locally advanced gastric cancer (LAGC) with pyloric obstruction who received preoperative nutritional support via nasojejunal tube feeding. Once nutritional adequacy was achieved, patients proceeded to neoadjuvant therapy consisting of S-1 plus oxaliplatin (SOX chemotherapy), targeted therapy with apatinib, and immunotherapy with sintilimab. Tumor and lymph node responses were assessed radiologically and confirmed by postoperative pathological analysis.Results: Enteral feeding was well tolerated without major complications, and all patients were able to complete the neoadjuvant regimen. Imaging showed dramatic shrinkage of the tumor mass and regression of regional lymph node enlargement. After surgery, certain cases yielded a result of complete tumor regression (Tumor Regression Grade 0) in the pathology, including resolution of lymph node metastases. Clinical results established that nutritional optimization helped in the effective downstaging of tumors and thus improved the chances of R0 resection.Conclusion: Nasoenteric enteral nutrition is a feasible and effective method to enable the safe delivery of neoadjuvant therapy in patients with pyloric obstruction resulting from gastric cancer. It optimizes nutrition, enhances treatment tolerance, and contributes to favorable oncologic outcomes.
Introduction. Gastric cancer is a leading cause of cancer mortality worldwide, and outcomes for patients with locally advanced gastric and gastroesophageal junction (GEJ) adenocarcinoma remain poor. Perioperative chemotherapy became the standard of care after the MAGIC and FNCLCC/FFCD trials demonstrated improved survival compared with surgery alone. The FLOT regimen (fluorouracil, leucovorin, oxaliplatin, and docetaxel) subsequently demonstrated superior efficacy and has become the current standard of care. However, many patients do not complete the planned adjuvant chemotherapy because of postoperative complications or disease progression, prompting interest in delivering the entire chemotherapy course preoperatively as total neoadjuvant therapy (TNT) using the FLOT regimen.Aim. To evaluate the efficacy and safety of total neoadjuvant chemotherapy using the FLOT regimen in patients with locally advanced gastric adenocarcinoma and gastroesophageal junction adenocarcinoma.Materials and methods. A narrative literature review was performed. Relevant studies were identified through searches of Scopus, Web of Science, MEDLINE, Cochrane Library, EMBASE, and Global Health. Key clinical trials (MAGIC, FNCLCC/FFCD, FLOT4, NeoFLOT, ESOPEC, etc.) and retrospective analyses of perioperative and neoadjuvant therapy were analyzed.Results. The MAGIC (UK) and FNCLCC/FFCD (France) trials confirmed that adding chemotherapy to surgery improves patient survival. The FLOT4 trial demonstrated that the FLOT regimen provides superior outcomes compared with ECF, including improved survival and a threefold increase in the pathological complete response (pCR) rate. Moreover, the phase II NeoFLOT trial and an analysis from Memorial Sloan Kettering Cancer Center (MSKCC, 2023) demonstrated the feasibility of total neoadjuvant chemotherapy: NeoFLOT achieved an R0 resection rate of 86% and a pCR rate of 20%, while the MSKCC experience showed that most patients completed all preoperative FLOT cycles without an increase in postoperative complications. In addition, the ESOPEC trial (2024) demonstrated that perioperative FLOT chemotherapy resulted in superior survival outcomes compared with standard neoadjuvant chemoradiotherapy (CROSS) in patients with esophageal and GEJ adenocarcinoma.Conclusions. The introduction of the FLOT regimen has significantly improved the treatment outcomes of locally advanced gastric and GEJ adenocarcinoma by increasing R0 resection rates as well as overall and disease-free survival. Delivering the entire FLOT regimen preoperatively is a promising strategy to ensure completion of systemic therapy and increase pCR rates without compromising surgical outcomes. However, there is currently no definitive evidence that total neoadjuvant FLOT improves long-term survival compared with standard perioperative chemotherapy. Further prospective studies are required, while perioperative chemotherapy remains the current standard of care.
M. Pepenin, Arthur M. Khudyntsev, Y. Kondratskyi et al.· Clinical and Preventive Medi...· 0 citations
Introduction: Standard of care of locally advanced gastric and Type III GE junction tumors is perioperative chemotherapy followed by radical surgery. There is clear evidence of FLOT outperforming other regimens in current literature. However, there is scarce data on dose modifications of various regimens and its effect on pathological tumor regression grade.
Material and Methods: This is retrospective study from a single institution between 2022 and 2024. Patients diagnosed with locally advanced gastric and Type III GE junction tumors, who underwent perioperative chemotherapy followed by radical surgery were included. Data including histopathological report, tumor regression grade following perioperative chemotherapy, chemotherapy regimen, chemotherapy dose intensity, and completion of chemotherapy, were collected from the medical records.
Results: Forty-one patients diagnosed as locally advanced gastric or GE junction cancers. Twenty patients (61%) received 3 cycles of perioperative EOX and 16 patients (39%) received 4 cycles of FLOT. Pathological complete response was higher in the EOX group than FLOT (75% vs 25%). Among patients receiving <80% of planned chemotherapy dose, none of the FLOT patients achieved TRG 0, whereas 36.4% of EOX patients did. Among patients receiving ≥80% of planned dose, the rate of TRG 0 was similar between regimens: EOX: 35.7%, FLOT: 30%. On logistic regression analysis, dose intensity ≥80% demonstrated higher odds of achieving major tumor regression. Distal tumors and dose intensity >80% increased the odds of improved tumor regression.
Conclusion: EOX regimen numerically showed more pCR rates than FLOT regimen. Dose density of >80% and distal tumors were predictors of better TRG scores.
Jithin T. Chand, A. Reddy, C. M. Giridhar et al.· Journal of Analytical Oncolo...· 0 citations
Background It is unclear which patients will benefit most from adjuvant chemotherapy for locally advanced esophago-gastric adenocarcinoma after systemic neoadjuvant treatment and resection. This study aims to systematically evaluate the efficacy of adjuvant chemotherapy in patients with resected esophago-gastric adenocarcinoma, based on pathologically documented response (pathological response) to the same neoadjuvant regimen. Materials and methods A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant articles were acquired from PubMed, Embase, Web of Science, and Scopus from 2000 to 2025. Patients were trichotomized into minimal, partial, and complete pathological responders to neoadjuvant chemotherapy based on resection histology. A meta-analysis of overall survival (OS) and recurrence-free survival (RFS) comparing patients who did and did not receive adjuvant chemotherapy was carried out. Results Eleven studies were included in this systematic review, and five were meta-analyzed, totaling 6600 and 4688 patients, respectively. For partial responders, adjuvant chemotherapy conferred a significant RFS [pooled hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.57-0.87] and OS (pooled HR 0.64, 95% CI 0.53-0.77) benefit. Conversely, for complete responders, adjuvant chemotherapy did not confer an RFS (pooled HR 0.57, 95% CI 0.19-1.73) or OS (pooled HR 1.00, 95% CI 0.32-3.08) benefit. In minimal responders, adjuvant chemotherapy was not associated with an RFS [pooled HR 0.64, 95% CI 0.28-1.48] or OS (pooled HR 0.72, 95% CI 0.49-1.05) benefit. Studies that were not eligible for meta-analysis were described qualitatively. Conclusion Pathological response to neoadjuvant chemotherapy may help stratify oncological benefit from subsequent adjuvant chemotherapy, potentially supporting more personalized adjuvant treatment decisions in esophago-gastric cancer.
S. M. Jinnaah, L. Owens, C. Cabalag et al.· ESMO gastrointestinal oncolo...· 0 citations
Simple Summary Advanced-stage endometrial cancer is difficult to treat because many patients have disease that cannot be safely removed with surgery at the time of diagnosis. In these situations, chemotherapy may be given first to shrink the cancer before surgery, an approach called neoadjuvant chemotherapy. However, it is still unclear which patients benefit most from this strategy and which factors influence their outcomes. In this study, we reviewed the medical records of 42 patients with advanced-stage endometrial cancer who received neoadjuvant chemotherapy followed by interval debulking surgery. Most patients experienced tumor shrinkage after chemotherapy, and more than 80% had no visible tumor remaining after surgery. Although no individual clinical or molecular factor independently predicted survival after statistical adjustment, tumor response to chemotherapy and the complete surgical removal of the tumor showed potential associations with progression-free survival. These findings add to the growing evidence supporting neoadjuvant chemotherapy as a treatment option for selected patients with advanced endometrial cancer and highlight the need for larger studies to better identify which patients are most likely to benefit from this approach.
Mira Kheil, Tariq Mekkaoui, Emily Andresan et al.· Current Oncology· 0 citations
Esophageal Cancer: Other
Esophageal cancer commonly presents with dysphagia and malnutrition. Esophagectomy following neoadjuvant chemoradiation is the standard treatment for locally advanced disease but is associated with significant postoperative morbidity. Immunonutrition may improve immune response and reduce postoperative complications.
This prospective comparative study included 36 patients with squamous cell carcinoma of the esophagus who underwent neoadjuvant chemoradiation followed by esophagectomy with conduit formation. Eighteen patients received preoperative immunonutrition supplementation for seven days in addition to standard diet, while outcomes were compared with 18 previously operated patients who received standard nutrition alone under similar perioperative conditions. Postoperative nutritional parameters, inflammatory markers, infective and non-infective complications, length of hospital stay, and mortality were analyzedto assess the impact of immunonutrition.
Patients receiving immunonutrition demonstrated a faster postoperative rise in serum albumin levels, though the overall trend was not statistically significant. A significant reduction in postoperative C-reactive protein levels was observed in the immunonutrition group. Pneumonia occurred in 22.2% of patients receiving immunonutrition compared to 61.1% in the standard nutrition group (p = 0.018). The incidence of anastomotic leak, conduit necrosis, and duration of hospital stay were lower in the immunonutrition group but did not reach statistical significance. No significant difference was observed in other complications or mortality.
Preoperative immunonutrition supplementation in patients undergoing esophagectomy for squamous cell carcinoma significantly reduced postoperative infective complications, particularly pneumonia, and improved early nutritional recovery. These findings support the routine use of immunonutrition in the perioperative management of esophageal cancer patients to enhance short-term outcomes.
Shivangi Sharma, C. Tandup, L. Reddy et al.· Diseases of the esophagus· 0 citations
Background: Despite these theoretical advantages, there is still a lack of evidence to answer whether NeoAdjuvant Chemotherapy (NAC) can further improve the survival of Locally Advanced Gastric Cancer (LAGC) patients on the basis of Adjuvant Chemotherapy (AC) following curative gastrectomy. The present research assessed the 36-month survival of gastric cancer patients treated in our center with and without NAC and over-all 36-month survival. Methods: The present research assessed the 36-month survival of gastric cancer patients treated in our center with and without NAC and over-all 36-month survival. 79 patients entered this study, of whom 64 received NAC and 15 underwent direct surgery. Results: Generally, the three-year survival rate in the groups was statistically different based on the Wilcoxon test (P 0.004). NAC was effective in increasing survival in the groups with lymph o vascular invasion, higher stage and all pathologic groups. However, age, type of surgery (TG vs DG), number of positive lymph nodes, and positive margin after surgery were not effective in interfering with survival in both groups. Neoadjuvant chemotherapy can positively increase OS and DFS in locally advanced gastric cancer. NAC was effective in increasing survival in the groups with lymph o vascular invasion, higher stage and all pathologic groups. Conclusion: Considering the similar results in previous studies, larger prospective studies with accurate information can effectively achieve definitive results. However, age, type of surgery (TG vs DG), number of positive lymph nodes, positive margin after surgery were not effective interfering with survival in both groups.
V. Zangouri, Masoumeh Molanorouzi, S. Ebrahimian· Caspian Journal of Internal...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
