• Correlation of fluorodeoxyglucose positron emission tomography imaging with histologic response, overall survival, and progression-free survival [ Designated as safety issue: No ]
  

• Efficacy and safety [ Designated as safety issue: Yes ]
  
• Response to chemotherapy as assessed by DNA microarray and histopathology [ Designated as safety issue: No ]
  
• Biodistribution, dosimetry, and potential clinical usefulness of F18-fluorothymidine PET [ Designated as safety issue: No ]
  

OBJECTIVES:

• Correlate the early-treatment F18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) response with histologic response and patient outcome, in terms of overall and progression-free survival, in patients with locally advanced adenocarcinoma of the stomach or gastroesophageal junction treated with neoadjuvant irinotecan and cisplatin followed by surgical resection.
• Determine the efficacy and safety of this regimen in these patients.
• Evaluate the biology of locally advanced gastric cancer and response to chemotherapy by DNA microarray and histopathology in these patients.
• Determine, preliminarily, biodistribution, dosimetry, and potential clinical usefulness of F18-fluorothymidine PET (FLT-PET/CT) in patients treated with these regimens.

OUTLINE: This is an open-label, nonrandomized, multicenter study.

• Neoadjuvant chemotherapy: Patients receive cisplatin IV over 30 minutes followed by irinotecan IV over 30 minutes on days 1, 8, 22, and 29. Treatment repeats every 6 weeks for 2 courses in the absence of disease progression or unacceptable toxicity.
• Surgery: Within 4 weeks after completion of neoadjuvant chemotherapy, patients undergo radical subtotal or total gastrectomy with lymph node dissection.

Patients undergo fluorodeoxyglucose FDG-PET/CT at baseline. Some patients undergo additional FDG-PET/CT scans in weeks 3 and 6. Approximately 5 patients undergo fluorothymidine FLT-PET/CT at baseline, during week 3, and/or before surgical resection.

Patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 40 patients will be accrued for this study within 10 months.

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the stomach or gastroesophageal (GE) junction

  • Tumors involving the GE junction must have the bulk of disease in the stomach
  • Siewert's type II and III tumors involving the GE junction are eligible
  • Tumors of the distal esophagus that extend less than 2 cm into the stomach are ineligible

• Locally advanced disease that is potentially curable by surgery

  • Any T, N+, M0 or T3-T4, any N, M0 by staging CT scan and laparoscopy or endoscopic ultrasound
  • No T1-T2, N0, M0 tumors

• No metastatic disease

  • Any suspected sites of M1 disease must be proven to be M0

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Karnofsky 60-100% OR
• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic

• Bilirubin no greater than 1.5 mg/dL

Renal

• Creatinine no greater than 1.5 mg/dL

Cardiovascular

• No history of active angina
• No New York Heart Association class III or IV heart disease
• No myocardial infarction within the past 6 months
• No history of significant ventricular arrhythmia requiring antiarrhythmic medication
• No history of clinically significant conduction system abnormality

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No concurrent serious infection
• No other uncontrolled medical illness that would preclude study participation
• No psychiatric illness that would preclude study compliance
• No clinically significant auditory impairment
• No pre-existing peripheral neuropathy grade 2 or greater
• No other active malignancy within the past 5 years except nonmelanoma skin cancer, nonmetastatic prostate cancer, or carcinoma in situ of the cervix
• Able to tolerate the proposed study surgical procedure and chemotherapy regimen

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No prior biologic therapy for this disease

Chemotherapy

• No prior chemotherapy for this disease
• No other concurrent chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy for this disease

Surgery

• See Disease Characteristics

Other

• No concurrent vitamins, antioxidants, or herbal preparations or supplements

  • A single daily multivitamin tablet is allowed