Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Abstract

Background The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. Methods Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. Results We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity C grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. Conclusions Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.

Proposal for a Multifactorial Prognostic Score That Accurately Classifies 3 Groups of Gastric Carcinoma Patients With Different Outcomes After Neoadjuvant Chemotherapy and Surgery

“…Alternative conventional chemotherapeutic substances or additional radiotherapy, however, may be identified, especially for tumors of the gastroesophageal junction. [38][39][40][41][42] Moreover, since the introduction of novel molecular therapeutic concepts (eg, Her2 targeting 43 ), these potentially beneficial therapies may offer novel perspectives beyond the best supportive care, especially in those tumors that show resistance to conventional chemotherapy. With regard to the proposed PRSC, however, its prognostic significance must be validated for tumors that have been treated with newly developed targeted drugs.…”

Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study

“…All patients were treated in the clinical ward of the radiation oncology department, with strict clinical control and observation, and there were no interruptions to therapy, except in three cases with an IMRT delay of 2-3 days. Thus, therapy was more continuous than is usually achieved with con RT [7][8][9][10].…”

Evaluation of N-Ratio in Selecting Patients for Adjuvant Chemoradiotherapy After D2-Gastrectomy

“…In these settings, the N-Ratio system (i.e., the ratio between metastatic and examined lymph nodes) could be a better option to compensate for this effect and may predict survival more accurately, especially for patients undergoing a limited lymph node dissection (12,20,21) . Based on the superiority of N-Ratio for gastric cancer staging (21,22) and the potential benefit from chemoradiotherapy for patients with positive pathologic lymph nodes after an extended lymphadenectomy (3,10,13,23) , we explore the clinical utility of N-Ratio in selecting candidates for adjuvant chemoradiotherapy using our sample of patients who underwent a D2-gastrectomy.…”