Adjuvant Chemoradiotherapy for Gastric Tumors with D2 Dissection: A Controversial Problem

Abstract

Objectives: What would be the optimal adjuvant therapy in operated gastric and gastro-esophageal junction (GEJ) adenocarcinoma patients who underwent D2 lymph node dissection remains to be a controversial issue in oncology. The objective of this study is to determine disease-free survival (DFS) and overall survival (OS) data in patients with gastric and GEJ adenocarcinoma with D2 dissected who receive adjuvant chemotherapy (CT) and adjuvant chemoradiotherapy (CRT), to examine the adverse effect profiles developed during treatment, to determine whether adding CRT to the treatment impacts the completion of adjuvant chemotherapy. Methods: Fifty-seven patients older than 18 years of age with D2 dissection, pathologically stage I-IIIC who received adjuvant CT and CRT treatment were included. Patients who were metastatic at the time of diagnosis, received neoadjuvant chemotherapy or CRT, did not have adequate follow-up and whose data could not be reached were excluded from the study. Results: In the study, while 3-year DFS was 60%, 3-year OS was 62.5%. 3-year OS was 53.3% for those with a performance score of 0-1 after CRT, while 3-year OS was 16% for those with a score of 2-3 (p=0.003). The 3-year DFS was 45% for those with 0-1 eastern cooperative oncology group (ECOG) performance score after CRT, while 3-year DFS was 16% for those with 2-3 (p=0.006). The estimated median OS and DFS were significantly shorter in 15 patients who could not complete adjuvant chemotherapy after CRT (75 months vs. 22 months for OS; p=0.00), (87 vs. 17 months for DFS; p<0.001). The most common adverse effect was fatigue (91%), and the most common hematological adverse effect was anemia (89.5%). Conclusion: Adding CRT to adjuvant chemotherapy in operated gastric and GEJ cancer patients who underwent D2 lymph node dissection might decrease the overall adjuvant treatment completion rate and the overall performance score of the patients and cause the risk of decreasing the success of adjuvant therapy by impacting the profile of adverse effects. Keywords: Adjuvant chemoradiotherapy, D2 dissection, gastric cancer