Abstract
BackgroundPrevious studies have reported that neoadjuvant chemoradiotherapy can downstage the advanced gastric cancer. However, no studies are available on the application of hypo-radiotherapy to neoadjuvant radiotherapy. This study sought to assess the maximum tolerated dose (MTD) and dose-limited toxicity (DLT) of hypo-fractionated chemoradiotherapy for local advanced gastric cancer.MethodPatients with cT3–4 and/or lymph node-positive locally advanced gastric cancer or Siewert II/III esophagogastric junction adenocarcinoma were enrolled. Preoperative chemoradiation was followed by 3 cycles of oxaliplatin + S-1 neoadjuvant chemotherapy with an interval duration of 3–4 weeks. D2 resection was performed 2–4 weeks after neoadjuvant therapy. Three cycles of adjuvant chemotherapy were planned after surgery. Intensity-modulated radiotherapy (IMRT) was used. The radiotherapy dose level was defined using three levels, namely, 40.0 Gy/2.5 Gy, 41.6 Gy/2.6 Gy, 43.2 Gy/2.7 Gy delivered concurrently with S-1 at 80 mg/m2.ResultsFrom May 2016 to Dec 2016, nine patients with a median age of 63 years were enrolled in this study. The most common grade I-III adverse events were leukopenia (88.9%), nausea (88.9%), vomiting (77.8%) and weight loss (66.7%). Grade III adverse events consisted of vomiting and weight loss.ConclusionThe MTD of hypo-fractionated radiotherapy for locally advanced gastric cancer was 40.0 Gy/2.5 Gy, and the DLTs were vomiting and weight loss.Trial registrationClinicaltrials.gov ID: NCT03427684 (Retrospectively registered on February 9, 2018).
Highlights
Previous studies have reported that neoadjuvant chemoradiotherapy can downstage the advanced gastric cancer
Previous studies have reported that neoadjuvant chemoradiotherapy can downstage the primary tumor to increase the radical resection rate for improved long-term prognosis of advanced gastric cancer
In the first 3 cases at the 41.6 Gy/2.6 Gy dose level, dose-limited toxicity (DLT) occurred in 1 patient, and 1 DLT occurred in an additional 3 cases (Table 3)
Summary
Previous studies have reported that neoadjuvant chemoradiotherapy can downstage the advanced gastric cancer. No studies are available on the application of hypo-radiotherapy to neoadjuvant radiotherapy. This study sought to assess the maximum tolerated dose (MTD) and dose-limited toxicity (DLT) of hypo-fractionated chemoradiotherapy for local advanced gastric cancer. Previous studies have reported that neoadjuvant chemoradiotherapy can downstage the primary tumor to increase the radical resection rate for improved long-term prognosis of advanced gastric cancer [2,3,4,5]. No studies are available on the application of hypo-radiotherapy to neoadjuvant radiotherapy in gastric cancer. The aim of this study was to observe the maximum tolerated dose (MTD) and dose-limited toxicity (DLT) of hypo-fractionated radiotherapy for locally advanced gastric cancer
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