Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Abstract

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among highrisk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5-and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.

Adjuvant Chemoradiation in Gastric Cancer: Long-term Outcomes and Prognostic Factors from a Single Institution

“…Noteworthy is the fact that almost a third of patients had linitis plastica, a well-known poor prognostic factor. Our data are consistent with those of a single-institution experience published recently by Misirlioglu et al (19), which has reported similar 1-, 3-and 5-year OS rates; it supports the suggestion that outside the framework of clinical trials, it could be difficult to reach these results.…”

“…Although it did not reach statistical significance, the high proportion of patients with diffuse histology could have played a key role in our poor survival outcomes; it is known from the Macdonald study that this subgroup of patients benefit less from adjuvant therapy, for reasons that remain unclear. Nevertheless, diffuse histology is underrepresented in the study of Misirlioglu et al (19), and yet despite that, their published survival data are comparable to ours. In this sense, the impact of histology on survival is still unclear, but we think it warrants further studies.…”

“…However, in a real-life setting, the selection of patient candidates for this treatment as well as the management of toxicity may differ from that seen in clinical trials. Table IV outlines the main baseline characteristics and treatment outcomes between the INT-0116 trial, the present study and other recent series using the Macdonald protocol (16)(17)(18)(19), although, as we freely admit, our study had limitations (single-arm and retrospective analysis with a small number of patients, prone to biases) that prevent a formal comparison between them.…”