Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

Mansouri, Houyem; Zemni, Inès; Achouri, Leila; Mahjoub, Najet; Ayedi, Mohamed Ali; Safta, Inès Ben; Dhiab, Tarek Ben; Chargui, Riadh; Rahal, Khaled

doi:10.5603/rpor.a2021.0040

Cited by 8 publications

(5 citation statements)

References 38 publications

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“…The postoperative 5-year survival rate is as high as 90% in patients with early gastric cancer, but in patients with advanced-stage disease, radical resection only is associated with a high risk of recurrence [ 6 ]. Further, it was reported that 40%-65% of radically resected patients could have local recurrences on the initial tumor bed, anastomotic region, or locoregional lymph nodes [ 7 ]. Metastasis is the predominant cause of poor treatment outcomes and mortality in gastric cancer, for which surgery and radiotherapy remain the only local treatments.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Adjuvant Chemoradiotherapy on the Survival of Stage III Gastric Cancer

Shao

Sun

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. Although adjuvant therapy has been shown to be beneficial in gastric cancer, the use of adjuvant chemoradiotherapy remains controversial. This paper investigated the effects of postoperative adjuvant chemoradiotherapy on the survival of patients with stage III gastric cancer. Methods. In total, the data of 72 stage III gastric cancer patients treated at our hospital from January 2014 to December 2019 were retrieved and assessed. They were categorized into a chemotherapy group (CT group) and a radiochemotherapy group (RCT group) according to their given treatment regimens. A 3-year follow-up was conducted to record their incidence of disease-free survival (DFS), overall survival (OS), and adverse events. Results. For the CT and RCT groups, DFS was 86.4% and 92.6% in the first year, decreasing to 55.1% and 73.7% in the second year, and 41.3% and 69.1% in the third year. There was no significant difference in DFS between the two groups during the three-year follow-up. Additionally, for the CT and RCT groups, their respective 1-year, 2-year, and 3-year OS were 95.6% and 96.3%, 75.1% and 87.9%, and 50.3% and 74.2%, indicating that the OS of patients in the RCT group was significantly higher than that in the CT group during 3 years of follow-up. Further, no significant difference in the incidence of adverse events was found between the two treatment groups. Conclusions. Collectively, adjuvant radiochemotherapy after radical gastrectomy for stage III gastric cancer was associated with better survival outcomes than chemotherapy, without increase in adverse events.

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Section: Introductionmentioning

confidence: 99%

Postoperative Adjuvant Chemoradiotherapy on the Survival of Stage III Gastric Cancer

Shao

Sun

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Although intensive protocols are promising, selecting the optimal adjuvant chemotherapy remains a difficult task that requires a balance between the therapeutic benefits and toxicity. The most common adverse events were asthenia/anorexia (33.3%), hematologic malignancies (29.6%), and infection (14.8%) (25). Thus, a biomarker study is urgently necessary for selecting the GC subgroups for which adjuvant treatment provides an oncological benefit postoperation.…”

Section: Discussionmentioning

confidence: 99%

Integrative Radiogenomics Approach for Risk Assessment of Postoperative and Adjuvant Chemotherapy Benefits for Gastric Cancer Patients

Yin

et al. 2021

Front. Oncol.

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Gastric cancer (GC) is a typical heterogeneous malignant tumor, whose insensitivity to chemotherapy is a common cause of tumor recurrence and metastasis. There is no doubt regarding the effectiveness of adjuvant chemotherapy (ACT) for GC, but the population for whom it is indicated and the selection of specific options remain the focus of present research. The conventional pathological TNM prediction focuses on cancer cells to predict prognosis, while they do not provide sufficient prediction. Enhanced computed tomography (CT) scanning is a validated tool that assesses the involvement of careful identification of the tumor, lymph node involvement, and metastatic spread. Using the radiomics approach, we selected the least absolute shrinkage and selection operator (LASSO) Cox regression model to build a radiomics signature for predicting the overall survival (OS) and disease-free survival (DFS) of patients with complete postoperative gastric cancer and further identifying candidate benefits from ACT. The radiomics trait-associated genes captured clinically relevant molecular pathways and potential chemotherapeutic drug metabolism mechanisms. Our results of precise surrogates using radiogenomics can lead to additional benefit from adjuvant chemotherapy and then survival prediction in postoperative GC patients.

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“…A retrospective pooled analysis by Dikken et al [ 40 ] evaluated the effectiveness of adjuvant chemoradiotherapy in comparison to surgical excision alone in 91 patients with GC from two phase I/II studies and 694 patients from the Dutch Gastric Cancer Group Trial (DGCT). Patients in the DGCT group underwent only surgery and were randomly assigned to D1 or D2 Lymph-node dissection.…”

Section: Treatmentmentioning

confidence: 99%

“…Subgroup analysis according to the extent of lymph node dissection showed a statistically significantly lower recurrence rate in the chemoradiation arm in the D1 subgroup (2% vs 8%); however, no difference was observed in patients that had D2 surgery. Chemoradiation also improved outcomes of patients that underwent surgical excision with microscopically positive margins (R1 resection)[ 40 ].…”

Section: Treatmentmentioning

confidence: 99%

Trimodality treatment in gastric and gastroesophageal junction cancers: Current approach and future perspectives

Charalampakis¹,

Tsakatikas²,

Schizas³

et al. 2022

WJGO

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Gastric and gastroesophageal junction (GEJ) cancers represent an aggressive group of malignancies with poor prognosis even when diagnosed in relatively early stage, with an increasing incidence both in Asia and in Western countries. These cancers are characterized by heterogeneity as a result of different pathogenetic mechanisms as shown in recent molecular analyses. Accordingly, the understanding of phenotypic and genotypic correlations/classifications has been improved. Current therapeutic strategies have also advanced and moved beyond surgical extirpation alone, with the incorporation of other treatment modalities, such as radiation and chemotherapy (including biologics). Chemoradiotherapy has been used as postoperative treatment after suboptimal gastrectomy to ensure local disease control but also improvement in survival. Preoperative chemoradiotherapy/chemotherapy has been employed to increase the chance of a successful R0 resection and pathologic complete response rate, which is associated with improved long-term outcomes. Several studies have defined various chemotherapy regimens to accompany radiation (before and after surgery). Recently, addition of immunotherapy after trimodality of gastroesophageal cancer has produced an advantage in disease-free interval. Targeted agents used in the metastatic setting are being investigated in the early setting with mixed results. The aim of this review is to summarize the existing data on trimodality approaches for gastric and GEJ cancers, highlight the remaining questions and present the current research effort addressing them.

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Chemoradiotherapy or chemotherapy as adjuvant treatment for resected gastric cancer: should we use selection criteria?

Cited by 8 publications

References 38 publications

Postoperative Adjuvant Chemoradiotherapy on the Survival of Stage III Gastric Cancer

Postoperative Adjuvant Chemoradiotherapy on the Survival of Stage III Gastric Cancer

Integrative Radiogenomics Approach for Risk Assessment of Postoperative and Adjuvant Chemotherapy Benefits for Gastric Cancer Patients

Trimodality treatment in gastric and gastroesophageal junction cancers: Current approach and future perspectives

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