Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation

Smalley, Stephen R.; Gunderson, Leonard L.; Tepper, Joel E.; Martenson, James A.; Minsky, Bruce D.; Willett, Christopher G.; Rich, Tyvin A.

doi:10.1016/s0360-3016(01)02646-3

Cited by 155 publications

(105 citation statements)

References 35 publications

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“…Up to 35% of treatment plans were found to contain major or minor deviations from the protocol. Subsequently, consensus guidelines were published to review important anatomic issues to be considered to ensure that radiation oncologists understood the location of the intended targets [45,46]. Current studies are exploring the benefits of transcending the two-dimensional techniques used in the INT-0116 study in favor of three-dimensional conformal and intensity-modulated radiation therapy [47,48].…”

Section: Discussion: Is Radiation Really Necessary?mentioning

confidence: 99%

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

2013

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Section: Discussion: Is Radiation Really Necessary?mentioning

confidence: 99%

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

2013

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“…The field borders were adopted from a consensus report by Smalley et al [12]. Typically the field covered the upper border of T10 down to the lower border of L3.…”

Section: Methods Patients and Materialsmentioning

confidence: 99%

“…Since the Intergroup study, guidelines on radiotherapy for resected gastric cancer have been published, which mainly consist of conventional two-dimensional planning [12]. In the era of using conformal and even intensity modulated radiotherapy (IMRT) with respiratory-gated procedures in gastric cancer, more advanced techniques may have an impact on treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Chang

Law

et al. 2011

Gastric Cancer

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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.

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“…Radiotherapy fields were designed using conventional simulation with minimal use of CT planning to define the clinical target volume, and all patients were treated with simple parallel-opposed anterior and posterior field arrangements (Smalley et al, 2002). However, many radiation oncologists are reluctant to treat such large abdominal volumes with anterior and posterior fields due to concerns about normal tissue toxicity, particularly in relation to the kidneys and spinal cord.…”

mentioning

confidence: 99%

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

et al. 2003

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Chemoradiation is now used more commonly for gastric cancer following publication of the US Intergroup trial results that demonstrate an advantage to adjuvant postoperative chemoradiotherapy. However, there remain concerns regarding the toxicity of this treatment, the optimal chemotherapy regimen and the optimal method of radiotherapy delivery. In this prospective study, we evaluated the toxicity and feasibility of an alternative chemoradiation regimen to that used in the Intergroup trial. A total of 26 patients with adenocarcinoma of the stomach were treated with 3D-conformal radiation therapy to a dose of 45 Gy in 25 fractions with concurrent continuous infusional 5-fluorouracil (5-FU). The majority of patients received epirubicin, cisplatin and 5-FU (ECF) as the systemic component given before and after concurrent chemoradiation. The overall rates of observed grade 3 and 4 toxicities were 38 and 15%, respectively. GIT grade 3 toxicity was observed in 19% of patients, while haematologic grade 3 and 4 toxicities were observed in 23%. Our results suggest that this adjuvant regimen can be delivered safely and with acceptable toxicity. This regimen forms the basis of several new studies being developed for postoperative adjuvant therapy of gastric cancer.

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Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation

Cited by 155 publications

References 35 publications

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

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

Adjuvant and neoadjuvant therapy for gastric cancer using epirubicin/cisplatin/5-fluorouracil (ECF) and alternative regimens before and after chemoradiation

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