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
- 1St James's University Hospitals, Leeds Teaching Hospitals, NHS Trust, Beckett Street, LS9 7TF
Abstract
BackgroundAlthough 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.
ObjectivesTo 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).
MethodsA 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.
ResultsTwelve 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.
ConclusionsHigh 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 MessagesO_ST_ABSWhat is already known on this topic?C_ST_ABSPerioperative 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.
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BibTeX
@misc{sabharwal2026realworld,
title = {{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}},
author = {R. Sabharwal and D. Bhaskaran},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365836},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365836v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - 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
AU - R. Sabharwal
AU - D. Bhaskaran
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365836
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365836v1
AB - BackgroundAlthough 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. ObjectivesTo 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). MethodsA 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. ResultsTwelve 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. ConclusionsHigh 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 MessagesO_ST_ABSWhat is already known on this topic?C_ST_ABSPerioperative 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.
ER -