Adjuvant chemoradiotherapy with carboplatin and a fluoropyrimidine for resectable gastric and gastroesophageal junction cancer: A retrospective review of the Stanford experience

Abstract

e15674 Background: The standard of care for the adjuvant treatment of resected gastric or gastroesophageal junction (GEJ) adenocarcinoma in the U.S. is post-operative 5FU and radiotherapy per the MacDonald regimen. At Stanford Cancer Center (SCC) we have adopted a modified regimen of chemoradiotherapy using carboplatin and a fluoropyrimidine. Methods: A retrospective review was performed of patients at SCC with T2-T4 or node positive gastric or GEJ cancer who underwent surgery with curative intent, and then received the following treatment. Carboplatin (AUC 6) was administered on days 1 and 22. Patients also received either 5FU at 200 mg/m2/day (via continuous infusion) plus leucovorin for six weeks, or capecitabine at 1,000 mg/po BID for 14 days, repeated every 21 days for 2 cycles. At week 8, infusional 5FU or capecitabine was combined with external beam radiotherapy to the gastric bed for five weeks (total 4,500 cGy). At week 14, patients repeated an additional 2 cycles of carboplatin and fluoropyrimidine as tolerated. Results: Forty-nine patients were identified. The majority (76%) were male. Median age at diagnosis was 57 years. Thirty-nine had gastric and 10 had GEJ cancers. With a mean follow up of 35 months, twenty-one patients (43%) have died; median disease free and overall survival have not been reached. Eighteen patients (37%) have recurred. The percentage of patients alive by stage was 100% (4/4) for stage IB, 62% (8/13) for stage 2, 53% (9/17) for stage IIIA, 33% (2/6) for stage IIIB and 22% (2/9) for stage IV. Grade 3 or 4 toxicities occurred in 27 patients (55%); most common were neutropenia (16), thrombocytopenia (11) and gastrointestinal toxicity in (8). Conclusions: Adjuvant chemoradiotherapy with carboplatin and a fluoropyrimidine after curative resection of gastric and GEJ cancer was well tolerated and yielded survival results similar to historical data. No significant financial relationships to disclose.