Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

Abstract

Purpose-To retrospectively determine the incidence and patterns (in-field, marginal, or out-offield) of locoregional recurrence of gastric cancer in patients who received preoperative chemoradiotherapy and to determine the outcome in these patients. 1994 and 2004, 149 patients with gastric carcinoma were treated on institutional protocols with preoperative chemoradiation. Ultimately, 105 patients had an R0 resection. Sixty-five of these patients received preoperative chemotherapy followed by chemoradiotherapy and 40 patients received preoperative chemoradiotherapy. Most (96%) of these patients received 5-fluorouracil-based chemotherapy during radiation, and the median dose of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods and Materials-Between HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript radiation administered was 45 Gy. We retrospectively identified and classified the patterns of locoregional recurrences.Results-The 3-year actuarial incidence of locoregional recurrence was 13%, with locoregional disease recurring as any part of the failure pattern in 14 patients. The majority (64%) of evaluable locoregional recurrences were in-field. Two of the four patients with marginal recurrence had inadequate coverage of regional nodal volumes on their oblique fields. The pathologic complete response rate was 23%. A pathologic complete response was the only statistically significant predictor of locoregional control.Conclusions-Patients with gastric cancer who received preoperative chemoradiotherapy had low rates of locoregional recurrence. This strategy merits prospective multi-institutional and randomized evaluation.

Perioperative Chemotherapy for Gastroesophageal Cancer in British Columbia: A Multicentre Experience

“…However, the prognostic value of a pathologic complete response after neoadjuvant treatment for gastric cancer is still a matter of debate 39 and deserves further analyses. Unfortunately, the magic trial has not reported a rate of complete pathologic response.…”

Preoperative chemoradiotherapy for locally advanced gastric cancer

“…Several small prospective studies have examined the use of induction ChT prior to preoperative CRT for potentially resectable gastric cancer [12-14]. Single institution experiences using either preoperative ChT and/or CRT have also been described [15-17], although the data examining a neoadjuvant approach in gastric cancer remains limited. Our institution has favored an approach of neoadjuvant CRT without induction ChT for patients primarily with locally advanced disease, prompting the present analysis of treatment-related toxicities and outcomes for this group of patients.…”

“…Several series have demonstrated that pathologic response to CRT is predictive of patient outcomes [12,13,15-17]. Three phase II trials from Ajani et al showed pCR rates ranging from 20% to 30% with the use of induction CT followed by concurrent CRT, [12-14] with associated improvements in OS and DFS in these patients.…”

“…Additionally, several small phase II trials examining the role of induction ChT followed by preoperative CRT for gastric cancer showed encouraging rates of pathologic complete response (pCR) and R0 resections, with acceptable rates of acute and late toxicity [12-14]. Single institution experiences examining a neoadjuvant approach for gastric cancer have also been published [15-17], but data looking at preoperative CRT without induction ChT are limited. The intent of this study is to examine our institutional experience with neoadjuvant CRT for potentially resectable gastric adenocarcinoma, evaluating treatment-related toxicity, R0 resection rates, pCR rates, and disease-related endpoints.…”

Retrospective assessment of patterns of recurrence relative to radiotherapy volumes for adjuvant conformal chemoradiotherapy in gastric cancer

“…There have been few articles evaluating patterns of failure in gastric cancer, particularly in patients who have received adjuvant chemoradiotherapy [7][8][9][10]. Dikken et al [9] reported their experience in 2010 and demonstrated a change in recurrence pattern, with distant failures outnumbering locoregional ones.…”