Abstract
4168 Background: To evaluate the impact of postoperative external radiation therapy combined with 5-Fluorouracil (5FU)-based chemotherapy on the disease-free and overall survival of patients with resected gastric adenocarcinoma. Methods: Patients with pathological T3/T4 or N+ gastric adenocarcinoma were treated with postgastrectomy chemoradiotherapy. External radiotherapy was administered to the tumor bed and regional nodes, and 2 cm beyond the proximal and distal margins of resection (45 Gy/25 fractions). Radiation was delivered with 18-MV photons, and CT-images were used by defining the PTV. Chemotherapy: Group A: 5-FU 425 mg/m2/d + LV 20 mg/m2 on days 1–5 every four weeks for two cycles before and after radiation therapy. During radiation therapy with 5-FU protracted continuous infusion (225 mg/m2/d) was administered. Group B: Mitomicin C 20 mg/m2 on day 1 (single dose) followed by Tegafur 500 mg/m2/d for six months, even during radiation therapy Results: 40 patients have been included (20 group A, 20 group B). 26 male/14 female. Median age 65 years (range 34–77). Pathologic stage: II 12p, IIIA 14p, IIIB 7p, IV-M0 7p. R0 28p/R1 12p. Median nodes analyzed 14 (range 3–41). With a median follow-up of 20 months, 21 patients are still alive, 17 free of disease. Relapse: local and regional relapse (in-field recurrence) 6 patients, distant metastases (out-field recurrence) 12 patients and both 5 patients. The median progression-free survival was 20.1 months and the median overall survival was 27.9 months. We did not find any difference in relapse or survival between the two groups. Conclusions: This scheme is feasible and well tolerated. The locoregional relapse rate was low probably due to the radiation therapy addition. However the distant metastases rate and the median overall survival seem to be hardly modified by the treatment. We need to find a better scheme of chemotherapy for further studies in order to improve these results. No significant financial relationships to disclose.
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