Adjuvant chemoradiation (CRT) for high-risk gastric cancer (GC): Single-center experience using infusional 5-fluorouracil (5FU) and radiotherapy (RT).

Abstract

e14571 Background: Postoperative CRT is a standard treatment option for fully resected high risk GC. Adjuvant CRT using bolus 5FU significantly improved overall (OS) and disease free survival (DFS) versus surgery alone. However, this regimen is associated with significant toxicity and poor tolerability. Methods: Sixty eight patients (pts) with high risk GC were referred following surgery for adjuvant CRT. The treatment comprised six cycles of the “modified de Gramont”regimen [leucovorin: 350 mg iv (d1) and 5-FU: 400 mg/m2 iv-bolus (d1), 2,800mg/m2 over 46 hours]; the third and fourth cycle of chemotherapy given concurrently with RT as follows: total dose of RT 4,500 cGy in 25 fractions of 180 cGy. Pts were evaluated retrospectively for toxicity, DFS and OS. Results: With a median follow-up period of 32 months (mo; range: 5–90), 68 patients (36 men, 32 women), median age 59 years (range: 30-76) were treated; stage IB: 4,4% (3/68 pts), IIA:7,35% (5/68 pts), IIB:13% (9/68 pts), IIIA: 11,7% (8/68 pts), IIIB: 30,8% (21/68 pts), IIIC: 32,3% (22/68 pts). The median DFS and OS were 25,2 and 32 mo, respectively. Three year DFS and OS were 24% and 29%. Grade III or higher myelotoxicity was: neutropenia 16% (11 pts); two pts grade IV neutropenia, thrombocytopenia 3% (2 pts). Grade III or higher non hematologic toxicity were: diarrhea 19% (13pts), vomiting 3% (2 pts), stomatitis/esophagitis 8% (6 pts) and constipation 3% (2 pts). There was no grade IV non hematologic toxicity. Fifty-three pts (78%) completed the treatment. Discontinuation was necessary in 5 pts due to diarrheas, 3 due to neutropenia, 3 due to performance status deterioration, 1 patient due to infection, 1 due to arythmia and 2 pts after informed consent withdrawal. Two pts died during treatment: one from possible/unconfirmed cardiovascular event and the other one due to sepsis. Conclusions: Despite a relatively short median follow-up and small sample size, our findings suggest that this regimen could be an alternative option, with favorable toxicity and tolerability in patients with fully resected high risk GC.