DCF and FLOT: — Your Stomach Cancer Chemotherapy Explained
Two acronyms on a chemotherapy chart — FLOT and DCF — each stand for a different combination of drugs used to treat stomach and gastroesophageal cancer. This page expands every letter and explains how these regimens fit around surgery.
- Four drugs, one acronym — FLOT expands to fluorouracil, leucovorin, oxaliplatin, and docetaxel — one letter stands for each drug.
- FLOT wraps around surgery — In operable stomach cancer, FLOT is given before the operation and again after recovery — this is called perioperative chemotherapy.
- DCF is a different combination — DCF contains docetaxel, cisplatin, and fluorouracil, and is used in a different clinical setting to FLOT.
- Both need specialist supervision — These are intravenous regimens given in a hospital or day-care oncology unit — not medicines taken at home.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026
FLOT contains fluorouracil, leucovorin, oxaliplatin, and docetaxel. DCF contains docetaxel, cisplatin, and fluorouracil. ESMO and NCCN guidelines list FLOT as the preferred perioperative regimen for operable stomach cancer. DCF is used in a different clinical context. Both are given by intravenous infusion under specialist supervision.
How does FLOT fit around surgery?
Staging and planning
Your oncologist confirms the stage of the cancer with scans and endoscopy and assesses whether you are fit for surgery and perioperative chemotherapy.
Chemotherapy before surgery
FLOT is given as several intravenous cycles before the operation. This is called neoadjuvant or preoperative chemotherapy.
Reassessment
After the preoperative cycles, your oncologist reviews the response with imaging before confirming the plan for surgery.
Surgery
The surgeon removes the tumour from the stomach or gastroesophageal junction. The extent of the operation depends on the tumour's location and what staging showed.
Chemotherapy after surgery
Once you have recovered from the operation, FLOT is given again in further cycles. Your fitness at that point guides whether and when this phase starts.
What does each letter in DCF and FLOT stand for?
Each letter in both acronyms is a different drug given as part of the same combination.
FLOT: F is fluorouracil (also written 5-FU), which interferes with how cancer cells copy their DNA. L is leucovorin, also called folinic acid — it is not itself a chemotherapy drug, but it makes fluorouracil work more effectively inside the cell. O is oxaliplatin, a platinum-based drug. T is docetaxel, a taxane drug.
DCF: D is docetaxel, C is cisplatin (another platinum-based drug), and F is fluorouracil.
Both regimens share two drugs — docetaxel and fluorouracil. The key difference is that FLOT uses oxaliplatin and adds leucovorin, where DCF uses cisplatin instead.
What should I tell my team before each cycle?
- Any new numbness, tingling, or burning in your hands or feet
- Any fever — report it on the day, not at your next scheduled appointment
- Changes in how much you can eat, or any unplanned weight loss
- Mouth sores, difficulty swallowing, or a persistent sore throat
- Any change in your bowel habit — diarrhoea or constipation
- All medicines, supplements, vitamins, and herbal preparations you are taking
- Any new or worsening pain anywhere in your body
Who is DCF or FLOT not suitable for?
These regimens are not suitable for all patients with stomach or gastroesophageal cancer. Eligibility is decided by an oncologist on the individual case, based on staging, organ function, and fitness for surgery and chemotherapy.
DCF and FLOT are generally not given to patients who:
- Have significantly reduced kidney function — cisplatin in DCF is cleared through the kidneys and can cause further harm; oxaliplatin in FLOT is also renally excreted
- Have pre-existing significant peripheral neuropathy, as docetaxel and oxaliplatin can worsen nerve damage in the hands and feet
- Are not fit enough for major surgery, since perioperative FLOT is planned around an operation
- Have cancer that has already spread beyond the point where surgery would be considered
- Have serious active infections or other uncontrolled medical conditions
DCF is generally considered to carry a higher burden of side effects, which influences when an oncologist considers it appropriate. Your oncologist will assess organ function, performance status, and cancer biology before making a recommendation.
What side effects do FLOT and DCF cause?
Fatigue, nausea, and changes in bowel habit are among the most common effects of both FLOT and DCF.
Both regimens affect cells that divide quickly — including the lining of the gut, hair follicles, and blood-forming cells in the bone marrow. Hair thinning or loss occurs in a proportion of patients, mainly because of docetaxel.
Oxaliplatin in FLOT frequently causes cold sensitivity — tingling or discomfort when touching cold objects or drinking cold liquids. This usually starts early and should be reported to your team.
Low blood counts can occur in any cycle and may raise the risk of infection. A fever during chemotherapy is a same-day call, not something to wait out.
Cisplatin in DCF can affect kidney function. Your team will check kidney blood tests before each cycle.
When is FLOT recommended and when is DCF used?
ESMO and NCCN guidelines list FLOT as the preferred perioperative regimen for resectable gastric and gastroesophageal junction cancer.
DCF is used in some centres for locally advanced or metastatic gastric cancer where a cisplatin-based combination is appropriate.
Which applies to you depends on the stage of the cancer, whether surgery is part of the plan, your kidney function, and your overall fitness. That decision belongs to your oncologist.
Your questions about FLOT and DCF
Does FLOT always involve surgery?
FLOT is specifically designed as a perioperative regimen — it is given around surgery, not instead of it. The assumption when FLOT is chosen is that the cancer is potentially removable. If imaging later shows that surgery is not feasible, your oncologist will review the plan. FLOT is not typically used in a palliative setting; there are other regimens for that situation.
How long does the whole treatment take from start to finish?
The perioperative sequence spans several months in total: cycles of FLOT before surgery, then recovery from the operation, then further cycles after. The exact number of cycles your oncologist plans will depend on how well you tolerate treatment and how the cancer responds. Your team will give you a timeline at the start and review it as you go.
What happens if I am too unwell after surgery to have more chemotherapy?
Recovery from major stomach surgery can take longer than expected, and some patients are not well enough to start the postoperative phase on time, or at all. If that happens, your oncologist will weigh your current fitness against the likely benefit and may reduce the number of cycles, delay the start, or decide the postoperative phase is not appropriate for you. This is a clinical judgment based on your individual situation.
Is there a difference in side effects between FLOT and DCF?
Yes. Cold sensitivity — tingling or discomfort when touching cold objects or drinking cold liquids — is specific to oxaliplatin, which is in FLOT but not DCF. Careful monitoring of kidney function is particularly important with cisplatin in DCF. Both regimens can cause fatigue, low blood counts, gut side effects, and hair loss because docetaxel and fluorouracil appear in both. Ask your oncologist which effects are most likely given your specific plan.
Do I need to stay in hospital for these infusions?
Both regimens are given as intravenous infusions over several hours. Many centres run these as day-care sessions without an overnight stay, though the setup depends on the specific drugs being given on a particular day and your individual situation. Your team will tell you how long each session typically runs, whether you can eat beforehand, and whether to arrange transport home.
What scans will happen during FLOT treatment?
Imaging is done after the preoperative cycles to assess the tumour before surgery is planned. Further imaging may be used to guide the surgical plan and to monitor your recovery and response after the operation. The exact scan schedule depends on your centre's protocol and your individual situation. Ask your team at the start which imaging is planned and at what points.
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Frequently asked questions
What is the difference between FLOT and DCF?
FLOT contains four drugs — fluorouracil, leucovorin, oxaliplatin, and docetaxel. DCF contains three — docetaxel, cisplatin, and fluorouracil. Both share docetaxel and fluorouracil. ESMO and NCCN guidelines list FLOT as the preferred perioperative regimen for resectable gastric cancer. DCF is used in some centres for locally advanced or metastatic disease. The choice depends on the stage of the cancer, whether surgery is planned, and your kidney function and overall fitness.
Can these regimens be given if the stomach cancer has spread?
FLOT as a perioperative regimen is designed for cancers that are potentially removable by surgery. If the cancer has spread to other organs, a different treatment approach is usually made. DCF has been used in locally advanced or metastatic disease, though the regimen and treatment goals differ from the perioperative setting. Your oncologist will explain what the appropriate plan is for your specific stage and situation.
Will I lose my hair?
Hair thinning or loss is common with both FLOT and DCF, mainly because of the docetaxel component. For most people it is temporary — hair usually regrows after treatment ends, though the timing and extent vary from person to person. Tell your team early if this is a concern; they can offer practical advice about what to expect with your specific regimen.
Can I eat normally during chemotherapy?
Eating well during treatment matters, and your team will want to know if your appetite or ability to swallow changes. Nausea is common, especially in the days after each cycle, and anti-nausea medicines are usually prescribed alongside the chemotherapy. Mouth soreness can make eating uncomfortable during some cycles. Ask your team whether a dietitian referral has been arranged — this is standard in most gastric cancer programmes.
What should I do if I get a fever during treatment?
A fever during chemotherapy is a same-day call to your treatment centre — not something to wait out until your next appointment. Low blood counts after each cycle can reduce your body's ability to fight infection, and a fever may be the first sign of a serious problem. Your oncologist will give you a specific protocol for this at the start of treatment. Follow it, and when in doubt, call on the same day.
How will we know if the treatment is working before surgery?
After the preoperative cycles, your oncologist will arrange imaging to assess the tumour. The scan compares its appearance against the original staging images. Even when the tumour appears smaller on imaging, the pathology report after surgery often gives the most detailed picture of how the cancer responded. Your team will explain what the scan shows and what it means for the surgical plan.
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