Evaluation of Surgery Versus Primary Chemotherapy in Resectable Signet Ring Cell Gastric Adenocarcinoma

Inclusion Criteria

• •adenocarcinoma of the stomach or the oesogastric junction of type III of Siewert classification,histologically proven with the presence of signet ring cells (according to WHO 2000 classification) or diffuse form (according to Lauren classification) on pre-therapeutic biopsies
• •tumoural stage IB, II or III (according to UICC-AJCC 2009)
• •patient judged resectable in a curative intent on inclusion
• •absence of distant metastasis
• •absence of peritoneal carcinomatosis during pre-treatment explorative laparoscopy
• •WHO performance status 2 or less
• •age over 18 or under 80 years
• •weight loss at the time of inclusion \< 15%
• •neutrophilic polynuclears more than 1500/mm3
• •platelets more than 100000/mm3
• •creatinine clearance more than 50 ml/min
• •serum-albumin more than 30 gram/l
• •bilirubin less than 1,5 normal
• •prothrombin rate over 80%
• •absence of prior treatment with chemotherapy or radiotherapy for gastric cancer
• •absence of kniwn child B or C cirrhosis
• •left ventricular ejection fraction more than 50% before epirubicin treatment
• •extension check-up performed within 4 weeks of inclusion
• •signed written informed consent given by the patient
• •another malignant tumour treated for curative purposes during the past 5 years excepted basocellular skin carcinoma or in situ uterine cervix cancer
• •allergy to the active substance or one of the excipients in the study drugs
• •pregnancy or breast-feeding
• •any other concommitant treatment, immunotherapy or hormonal therapy
• •history of abdominal or chest radiotherapy
• •any evolving disorder which is not under control (liver failure, kidney failure, respiratory failure, evolving heart failure or myocardial necrosis during the past 6 months)
• •patients who cannot be regularly monitored