Real-world perioperative FLOT delivery in gastric and gastro-oesophageal junction adenocarcinoma: a single-centre service evaluation in a District General Hospital in the UK
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Although perioperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) is the standard neoadjuvant regimen for resectable gastric and gastro-oesophageal junction adenocarcinoma, evidence describing treatment delivery in routine clinical practice remains limited, particularly regarding relative dose intensity (RDI) and treatment completion. Objectives To evaluate real-world delivery of preoperative FLOT chemotherapy, including treatment completion, progression to surgery, RDI, toxicity and exploratory changes in estimated lean body mass (LBM). Methods A retrospective single-centre service evaluation included consecutive patients receiving neoadjuvant FLOT during 2024. Outcomes included treatment completion, surgery, RDI, toxicity, pathological response and estimated LBM. Descriptive statistics were used. Results Twelve patients were included (median age 68.6 years; 91.7% male). Eleven (91.6%) completed all four preoperative cycles and proceeded to surgery. Mean RDI was 76.7%. Pre-emptive dose capping was the predominant dose modification strategy, with only one reactive dose reduction. Two grade 3 adverse events occurred. Major pathological response (Mandard grade 1–2) was observed in 2/12 patients (16.7%). Mean estimated LBM declined from 54.3 to 53.4 kg. Greater LBM loss appeared to coincide with poorer clinical outcomes. Conclusions High treatment completion and progression to surgery were achieved despite reduced RDI. These findings support prospective evaluation of strategies to optimise chemotherapy delivery while maintaining tolerability in routine clinical practice. Key Messages What is already known on this topic? Perioperative FLOT is standard treatment for resectable gastric and gastro-oesophageal junction adenocarcinoma, but toxicity frequently necessitates dose modification. Real-world data on relative dose intensity and treatment completion remain limited. What this study adds? In this single-centre cohort, 91.6% of patients completed all four planned preoperative FLOT cycles and proceeded to surgery despite a mean relative dose intensity of 76.7%. Pre-emptive dose capping was the predominant dose-modification strategy. How this study might affect research, practice or policy? Routine monitoring of relative dose intensity alongside treatment completion may provide a useful measure of chemotherapy delivery. Larger studies should evaluate whether individualised dose optimisation can maintain treatment continuity while balancing toxicity and dose intensity.
Source: medRxiv
Authors: Riya Sabharwal, Divyalakshmi Bhaskaran
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223125698