Preoperative chemoradiotherapy for locally advanced gastric cancer

Pepek, Joseph M.; Chino, Junzo; Willett, Christopher G.; Palta, Manisha; Blazer, Dan G.; Tyler, Douglas S.; Uronis, Hope E.; Czito, Brian G.

doi:10.1186/1748-717x-8-6

Cited by 19 publications

(19 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…GC remains a leading malignancy worldwide, and management of patients with locally advanced or metastatic GC has not substantially changed in the last few decades. A neoadjuvant strategy may increase the likelihood of completing multimodality therapy, particularly when surgical management is associated with significant morbidity and complications that may preclude timely adjuvant therapy [9][10][11][12][13][14][15]. Preoperative concurrent chemoradiotherapy (CCRT) is a well-established primary treatment modality in other gastrointestinal malignancies including esophageal [9,11] and rectal cancer [12,13].…”

Section: Discussionmentioning

confidence: 99%

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

Yeh

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Dismal outcomes in patients with locally advanced or metastatic gastric cancer (GC) highlights the need for effective systemic neoadjuvant treatment strategies to improve clinical results. Neoadjuvant multimodality strategies vary widely. This study compared the efficacy, safety, and clinical outcomes of preoperative neoadjuvant CCRT and chemotherapy for such patients. Methods Sixty-five patients with histologically confirmed locally advanced or metastatic GC following neoadjuvant CCRT or computed tomography (CT) were retrospectively enrolled between January 2010 and April 2019. Clinical outcomes included response, progression-free survival (PFS), and overall survival (OS), and toxicity was compared between the two groups. Results Of the 65 patients, 18 (27.7%) were in the response group (2 patients with complete response and 16 with partial response) and 47 (72.3%) in the nonresponse group (29 patients with stable disease and 18 with progressive disease). Multivariate analysis revealed no independent response predictor between CCRT and CT groups (all P > 0.05). Furthermore, results revealed no statistical differences in toxicity between the two groups (all P > 0.05). With a follow-up median of 12 months (ranging 6–48 months), 12-month OS and PFS were 39.7% and 20.4% in the CCRT group and 30.3% and 13.2% in the chemotherapy group, respectively. The median OS and PFS were 14.0 months (95% CI 9.661–18.339) and 9.0 months (95% CI 6.805–11.195) in the CCRT group and 10.0 months (95% CI 6.523–13.477) and 8.0 months (95% CI 6.927–9.073) in the CT group, respectively. Both OS (P = 0.011) and PFS (P = 0.008) in patients with CCRT were significantly better than those in patients with chemotherapy alone. Conclusions Neoadjuvant CCRT achieved more favorable OS and PFS than did neoadjuvant chemotherapy alone, without significant increases of toxicity in patients. However, prospective randomized trials comparing treatment modalities are necessary to confirm potential advantages of preoperative neoadjuvant CCRT.

show abstract

Section: Discussionmentioning

confidence: 99%

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

Yeh

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…17 Preoperative chemoradiotherapy for gastric cancer can be delivered safely and is well tolerated, with acceptable rates of perioperative morbidity and mortality. 24,25 A meta-analysis from 2013 demonstrated that neoadjuvant chemotherapy for gastric cancer does not increase treatment related morbidity or mortality. 26 The FTS pathway could therefore be applied cautiously in patients who have undergone preoperative chemoradiotherapy.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

Chen¹,

Zou²,

Chen³

et al. 2015

ann r coll surg engl

View full text Add to dashboard Cite

show abstract

“…Two years overall survival (OAS) for all 32 patients was 51.3% (Figure 1), none of the six patients with pCR died during the median follow up period, while 2 years OAS for patients who did without achieving CR (26 patients) was 37.9% (P = 0.0118) ( Figure 2). Microscopically negative margin (R0) is another significant factor for survival as 2 years OAS was 65% for patient achieved negative microscopic margin while none of the remaining 8patients [6] patients had peritoneal deposits and 2 patients had positive microscopic margin], which did not achieve R0 survived for 2 years (Figure 3).…”

Section: Survivalmentioning

confidence: 99%

“…In gastroesophageal junction (GEJ) tumours, CROSS trial [3] in which preoperative CRT used it showed survival benefit more than perioperative chemotherapy [5]. The rationale for using perioperative CRT that the radiation field is small and accurate [6] better chemotherapy deliver with intact tumour vasculature also sterilize surgical field and eradicate subclinical metastasis [7]. Two trials have studied the role of the perioperative CRT in potentially resectable gastric tumours; one was done by Eastern cooperative oncology group (E7296), the other was done by RTOG (9904).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Conformal Radiotherapy Concurrently with Paclitaxel/Carboplatin in Gastric Cancer

Ahmed¹,

Fawzy²,

Rezk³

et al. 2018

JCT

View full text Add to dashboard Cite

Background and objectives: Surgery is the primary therapy for localized gastric cancer, but even with the best results only 40% 5-year survival can be achieved with the use of postoperative adjuvant chemoradiotherapy. Preoperative therapy might help increase the R0 resection rate, which is an independent predictor of 5-year OS. Our study hypothesized that the concurrent combination of carboplatin-paclitaxel with radiation therapy would result in a pathological CR rate, which will be in turn associated with OAS and DFS benefits. Patients and methods: prospective phase II study included 32 patients with locally advanced gastric adenocarcinoma including gastroesophageal junction who received a combination of neoadjuvant conformal radiotherapy concurrently with carboplatin-paclitaxel followed by surgery. Results: Pathological CR and R0 resection rates were 18.8% and 75% respectively. With a median follow up of 24 months, 2 years disease-free survival was 28.1% and overall survival was 51.3%. The regimen was tolerated with neither grade 4 toxicities nor deaths. Conclusion: Neoadjuvant radiotherapy concomitant with carboplatin-paclitaxel chemotherapy is a well-tolerated approach for patients with locally advanced gastric adenocarcinoma resulting in significant pathological CR and R0 resection margins as reflected by the good DFS and OS.

show abstract

Preoperative chemoradiotherapy for locally advanced gastric cancer

Cited by 19 publications

References 38 publications

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

Observational Study Comparing Efficacy and Safety Between Preoperative Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

Preoperative Conformal Radiotherapy Concurrently with Paclitaxel/Carboplatin in Gastric Cancer

Contact Info

Product

Resources

About