Multi-Institutional Trial of Preoperative Chemoradiotherapy in Patients With Potentially Resectable Gastric Carcinoma

Ajani, Jaffer A.; Mansfield, Paul F.; Janjan, Nora A.; Morris, Jeffrey S.; Pisters, Peter W.T.; Lynch, Patrick M.; Feig, Barry W.; Myerson, Robert J.; Nivers, R.; Cohen, Deborah S.; Gunderson, Leonard L.

doi:10.1200/jco.2004.01.015

Cited by 302 publications

(218 citation statements)

References 22 publications

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“…In the preoperative treatment of other gastrointestinal cancers, like gastric cancer or oesophageal cancer, the rate of pCR is an independent factor for survival (Forastiere et al, 1997;De Vita et al, 2002;Terrosu et al, 2003;Ajani et al, 2004). Also, in our study, the progression-free survival for patients with complete responses or only MRD is higher than for patients with only partial response (4-year OS: 8878 vs 58712%; P ¼ 0.06; see Figure 2).…”

Section: Discussionsupporting

confidence: 46%

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Klautke¹,

Feyerherd

Ludwig

et al. 2005

Br J Cancer

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This study aimed to evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy intensified with irinotecan in patients with locally advanced rectal cancer. Eligible patients had nonmetastatic disease at a locally advanced stage that made R0 resection and sphincter preservation uncertain. They received preoperative radiation over 6 weeks to 45 Gy and boost of 5.4 Gy and concurrent continuous infusion 5-fluorouracil 250 mg m À2 day À1 and weekly irinotecan 40 mg m À2 . In all, 37 patients entered the study. T stage at baseline as determined by ultrasound was T2/T3/T4 in 2/19/16 patients; 31 patients had lymph node involvement. The predominant toxicity was diarrhoea (grade 3/4 in 10/2 patients). Haematologic toxicity and surgical complications were moderate. Among 36 patients undergoing surgery, 32 (89%) had R0 resection and 23 (64%) sphincter preservation. Pathologic complete response (pCR) was achieved in eight (22%) of 36 patients, and 10 patients (28%) had only microscopic residual disease. At 4 years, overall survival was 66%, disease-free survival 73%, local relapse rate 7%, and distant failure rate 24%. Extent of resection and postoperative nodal status were significant predictors of overall and disease-free survival. Intensified neoadjuvant chemoradiotherapy with irinotecan can be safely administered and results in a high pCR rate.

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Section: Discussionsupporting

confidence: 46%

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Klautke¹,

Feyerherd

Ludwig

et al. 2005

Br J Cancer

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“…Becker et al [14,15] proposed the following system: tumors with no viable cells are assigned grade Ia; tumors with 1-10 % viable cells, grade Ib; tumors with 10-50 % viable cells, grade II; and tumors with more than 50 % viable cells, grade III. Ajani et al [16,17] proposed a grading scheme: cases showing either an absence of tumor cells or necrosis in more than 90 % of the resected tumor were classified as responders. In this study, we used the JCGC grading system, whereby cases showing viable tumor cells remain in less than two thirds are classified as responders, but for our sensitivity analysis we changed the cutoff point from two thirds to one third.…”

Section: Discussionmentioning

confidence: 99%

Validity of response assessment criteria in neoadjuvant chemotherapy for gastric cancer (JCOG0507-A)

et al. 2013

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Background Neoadjuvant chemotherapy may improve outcomes in gastric cancer. Tumor responses can be evaluated with RECIST, Japanese Classification of Gastric Carcinoma (JCGC), and histological criteria. These approaches have not yet been compared. Methods We analyzed two phase II trials of neoadjuvant chemotherapy using S-1 plus cisplatin. JCOG0210 included patients with linitis plastica and large ulcero-invasive tumors, whereas JCOG0405 comprised those with paraaortic or bulky lymph node metastases. Radiologic evaluations were conducted using RECIST in JCOG0405 and JCGC criteria in JCOG0210, because the latter included many patients without measurable lesions. A histological responder was defined as a patient in whom one third or more of the tumor was affected. The hazard ratios (HR) for death between responders and non-responders and response rate differences between short-and long-term survivors were estimated. Results In JCOG0210 (n = 49), HR was 0.54 in JCGC responders (P = 0.059) and 0.40 in histological responders (P = 0.005). The difference in response rates between short-and long-term survivors using histological criteria (34 %, P = 0.023) was greater than that using JCGC criteria (24 %, P = 0.15). In JCOG0405 (n = 51), HR was 0.67 in RECIST responders (P = 0.35) and 0.39 in histological responders (P = 0.030). In short-and long-term survivors, respectively, RECIST response rates were 62 and 67 % (P = 0.77), whereas histological response rates were 33 and 63 % (P = 0.048). Conclusions Histological criteria showed higher response assessment validity than RECIST or JCGC criteria and yielded the best surrogate endpoint for overall survival.

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“…The schedule and doses for these regimens have been published elsewhere. 8,9,10 Typical radiation fields encompassed the stomach and regional lymph nodes employing a multiportal technique with customized blocking that included oblique or lateral fields. Thirty-five percent of patients were treated with use of three-dimensional conformal radiation planning.…”

Section: Treatmentmentioning

confidence: 99%

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

Reed

Krishnan

Mansfield

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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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.

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Multi-Institutional Trial of Preoperative Chemoradiotherapy in Patients With Potentially Resectable Gastric Carcinoma

Cited by 302 publications

References 22 publications

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer

Validity of response assessment criteria in neoadjuvant chemotherapy for gastric cancer (JCOG0507-A)

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

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