A randomized, controlled, multicenter study comparing intensity-modulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection

Zhu, Weiguo; Xua, Da-fu; Pu, Jun; Zong, Cheng-dong; Li, Tao; Tao, Guangzhou; Fan, Jinxia; Zhou, Xianghui; Han, Jing; Wang, Cheng-shi; Yu, Chunhao; Yi, Jiang-guo; Su, Xi-long; Ding, Jinxia

doi:10.1016/j.radonc.2012.08.024

Cited by 125 publications

(141 citation statements)

References 31 publications

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“…Patient intolerance arises since the radiation dose to normal organs is high. 30,31 Recently, low-dose radiotherapy has been reported to safely control gastric cancer-related symptoms, demonstrating significant clinical utility. 29 Previous studies have demonstrated that local low-dose irradiation (LDI) alone resulted in an increase in intratumoral CD8+ T cells, 32 which was shown to be correlated with the upregulated expression of adhesion molecules on tumor vasculature and the increased expression of chemoattractants.…”

Section: Introductionmentioning

confidence: 99%

Human cytotoxic T-lymphocyte membrane-camouflaged nanoparticles combined with low-dose irradiation: a new approach to enhance drug targeting in gastric cancer

Zhang

Chen

et al. 2017

IJN

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Section: Introductionmentioning

confidence: 99%

Human cytotoxic T-lymphocyte membrane-camouflaged nanoparticles combined with low-dose irradiation: a new approach to enhance drug targeting in gastric cancer

Zhang

Chen

et al. 2017

IJN

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“…No differences in OS were observed between the two groups, which might be due to the high risk of peritoneal and distant metastasis as well as an inadequate follow-up period. According to current studies, the local recurrence rate after D2 dissection varies from 13% to 24.2% 7,8,16,17 for patients receiving CT only and from 7% to 15.6% 8,16 in those treated by CRT. In our study, we observed an increased risk of local regional recurrence in the CT group compared with that in the CRT group (16.7% vs 8.7%, p 5 0.04) and this difference in the recurrence patterns highlighted the importance of CRT even after D2 dissection.…”

Section: Discussionmentioning

confidence: 96%

Identification of patients with lymph node metastasis from gastric cancer who may benefit from adjuvant chemoradiotherapy after D2 dissection—do N3 patients benefit from additional radiation?

Fan¹,

Li²,

Shen³

et al. 2016

BJR

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Identification of patients with lymph node metastasis from gastric cancer who may benefit from adjuvant chemoradiotherapy after D2 dissection-do N3 patients benefit from additional radiation? Br J Radiol 2016; 89: 20150758. FULL PAPERIdentification of patients with lymph node metastasis from gastric cancer who may benefit from adjuvant chemoradiotherapy after D2 dissection-do N3 patients benefit from additional radiation? Objective: The role of adjuvant chemoradiotherapy (CRT) in locally advanced gastric cancer (LAGC) after D2 dissection is controversial. Subgroup analysis of the ARTIST trial indicated that patients with lymph node metastasis might benefit from additional radiation. The present study compared adjuvant CRT with adjuvant chemotherapy (CT) for the treatment of lymph node metastasis and suggested patient-selection guidelines. Methods: Patients with LAGC and positive lymph nodes who underwent D2, R0 gastrectomy in our hospital were retrospectively investigated. Patients were divided into two balanced groups by the use of propensity-score matching: CRT group (n 5 138) received adjuvant CRT with fluorouracil-based regimens and radiation (45-50.4 Gy), and the CT group (n 5 138) received adjuvant CT alone. Results: Of the 276 patients, 147 patients died (69 patients in the CRT group and 78 patients in the CT group), and 151 patients experienced recurrence (65 patients in the CRT group and 86 patients in the CT group). The estimated 3-year disease-free survival (DFS) and overall survival in the CRT and CT groups were 51.5% vs 41.3% (p 5 0.05) and 52.0% vs 50.1% (p 5 0.35), respectively. The risk of local regional recurrence was increased in the CT group compared with the CRT group (16.7% vs 8.7%, p 5 0.04, respectively). In the subgroup analysis, patients with N1-2 stage were associated with better survival from CRT (hazard ratio 5 0.44, p 5 0.01). Conclusion: Adjuvant CRT may improve the 3-year DFS and local control in patients with LAGC after D2 dissection. Investigation of stratification factors for patient selection is warranted. Advances in knowledge: Patients with N1-2 stage rather than those with N3 stage benefit most from additional radiation after D2 dissection.

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“…Furthermore, in the subgroup analysis of the ARTIST trial, improved DFS (P < 0.05) was observed in stage Ⅲ and Ⅳ patients in the CRT group. The proportion of stage Ⅲ/Ⅳ (M0) patients enrolled in the study by Zhu et al [57] was 71%, which demonstrated a Subgroup analysis of 5-year OS in the ACTS-GC trial from Japan showed an insufficient survival benefit of S1 for N3a and N3b stages (HR = 0.77, 95%CI: 0.53-1.13 and HR = 0.92, 95%CI: 0.47-1.79, respectively). The results indicated the necessity of adjuvant RT in these patients who were at high risk for locoregional relapse.…”

Section: Stagementioning

confidence: 97%

“…According to the recent studies, IMRT for gastric cancer is dosimetrically superior to conventional therapy, because IMRT is able to decrease the radiation dose to organs at risk, especially the spinal cord and kidney, while providing the intended radiation dose to the target areas [55,56] . The most recent phase Ⅲ trial comparing concomitant CT with IMRT and chemotherapy alone investigated the role of IMRT among gastric cancer patients with D2 LND [57] . The IMRT plus CT arm was tolerable with a significant improvement in DFS (5-year DFS, 45% vs 36%); however, the results of this trial could not point at an OS benefit like the previous comparative studies (5-year OS, 24% vs 27%, P > 0.05).…”

Section: Radiotherapy Techniquementioning

confidence: 99%

“…Macdonald et al [6] Bolus 5-FU + LV/bolus 5-FU + LV 556 10% 54%/33% 64% 2D Lee et al [43] FP/capecitabine 31 100% 50.2%/12.8% 74.20% 2D Zhu et al [57] Bolus 5-FU + LV/bolus 5-FU + LV 380 100% 5.9%/7.5% NA IMRT Leong et al [44] ECF/inf 5-FU 54 NA 66%/28% NA 3D Schwartz et al [49] PC (PCF arm closed)/PC 78 NA 24%/33% (for PC arm) NA 3D Lee et al [4] XP/capecitabine 458 100% 48.4%/19% 81.7% 3D Table 2 to increase in some patients [59,60] . Whether 3D conformal RT or IMRT provides better protection of organs at risk remains controversial.…”

Section: D2 Rates G3-g4 Toxicity (Hem/gi) Completeness Of Treatment Rmentioning

confidence: 99%

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Current adjuvant treatment modalities for gastric cancer: From history to the future

Kılıç

Ordu

Yıldız

et al. 2016

WJGO

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The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients. Core tip: Despite extensive surgery, gastric cancer will likely recur for most patients. Fortunately, additional treatment modalities either in the perioperative or postoperative setting provide varying degrees of survival

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A randomized, controlled, multicenter study comparing intensity-modulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection

Cited by 125 publications

References 31 publications

Human cytotoxic T-lymphocyte membrane-camouflaged nanoparticles combined with low-dose irradiation: a new approach to enhance drug targeting in gastric cancer

Human cytotoxic T-lymphocyte membrane-camouflaged nanoparticles combined with low-dose irradiation: a new approach to enhance drug targeting in gastric cancer

Identification of patients with lymph node metastasis from gastric cancer who may benefit from adjuvant chemoradiotherapy after D2 dissection—do N3 patients benefit from additional radiation?

Current adjuvant treatment modalities for gastric cancer: From history to the future

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