Introducing national guidelines on perioperative chemotherapy for gastric cancer in Norway: a retrospective audit.

BACKGROUND: In 2006, perioperative chemotherapy with epirubicin, cisplatin/oxaliplatin, and capecitabine was recommended in the National Guidelines for patients with resectable gastric cancer in Norway. We conducted a national audit related to clinical aspects, local organisation and the implementation of this multimodal treatment. PATIENTS AND METHODS: All Norwegian departments of oncology were asked to submit aggregated data on gastric cancer patients who had started perioperative chemotherapy for cure; departments of surgery were asked to report on patients undergoing resection after preoperative chemotherapy. Data were retrospectively collected.
RESULTS: All 20 departments of oncology and 20 of 21 departments of surgery responded. Of 336 patients operated on for gastric cancer and reported by surgeons, 144 (43%) received preoperative chemotherapy. 169 patients were reported by departments of oncology. 152 (90%) completed the preoperative cycles; 92 (54%) started the postoperative cycles; and 68 (40%) completed all cycles. Toxicity grade >or= 3, overall and haematological, increased during postoperative compared to preoperative cycles, 50 vs. 34% (P = 0.012) and 35 vs. 20% (P = 0.012), respectively. Surgical morbidity and mortality were 26 and <2%, respectively. R0 resection was achieved in 86% of surgically treated patients. Five per cent had a complete pathological response (ypT0) and 48% were node negative (ypN0). Within the first year, the National Guidelines were implemented in 19 of 25 hospitals (76%).
CONCLUSIONS: In this population-based series, the tolerability of perioperative chemotherapy reported in the MAGIC trial was reproduced. Toxicity grade >or= 3 was considerable and significantly increased related to postoperative cycles. The National Guidelines were rapidly adopted.