Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma.

Abstract

103 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: The Table summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]