Adjuvant postoperative chemoradiotherapy in gastric carcinoma

Escudero, M. P.; Alonso, Vicente; Valencia, Javier; Lastra, Rodrigo Pimienta; Grandez, R.; Polo, Susana Hernando; Lobera, A. Ruiz de; Polo, E.; Antón, A.; Trés, A.

doi:10.1200/jco.2004.22.90140.4168

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“…However, elderly patients tolerated the cisplatin-containing regimen poorly, and it is our impression that, for the schedule we tested, the mtd for patients over 70 years of age may be cohort 1 (12 weeks of infusional 5fu with radiotherapy). One strategy to optimize the balance of acute toxicities and survival outcomes in gastric cancer is an assessment of alternative chemoradiation regimens in the adjuvant setting [17][18][19][20][21][22][23] . The use of infusional 5fu may itself improve survival and toxicity outcomes.…”

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confidence: 99%

Adjuvant Chemoradiation for Gastric Cancer with Infusional 5-Fluorouracil and Cisplatin: A Phase I Study

et al. 2010

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ObjectiveThis phase i study aimed to determine the maximal tolerated dose of cisplatin administered every 2 weeks with infusional 5-fluorouracil (5fu) and concurrent radiation therapy (rt) in patients after complete resection of gastric adenocarcinoma. MethodsPatients with resected stage ib to iv (M0) gastric adenocarcinoma were treated with 12 weeks of infusional 5fu (200 mg/m 2 daily) and with rt (45 Gy in 25 fractions starting on day 16). Cisplatin was administered in escalating doses (0,20, 30, and 40 mg/m 2 ) in weeks 1, 3, 5, and 7. In the final cohort, patients received an additional dose of cisplatin (40 mg/m 2 ) in week 9. ResultsAmong the 34 patients [median age: 56 years (range: 31-77 years)] who were assessable for toxicity, 5 experienced dose-limiting toxicities: 1 sepsis (cohort 1), 1 fatigue (cohort 2), 3 upper gastrointestinal toxicity (1 in cohort 2, 2 in cohort 5). Cohort 5 exceeded the maximal tolerated dose. Median follow-up was 2.5 years (range: 0.3-5 years). The 3-year overall and relapse-free survival rates were 86% and 71% respectively; median survival was not reached. ConclusionsCisplatin was well tolerated in combination with infusional 5fu and rt, showing promising activity in the adjuvant treatment of gastric cancer. Infusional 5fu 200 mg/m 2 daily for 12 weeks with cisplatin 40 mg/m 2 in weeks 1, 3, 5, and 7 and with concurrent rt 45 Gy in 25 fractions, starting at day 16, is being explored in a phase ii study at our institution.

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