Consequences of modifying an adjuvant treatment protocol for resected gastric carcinoma: A retrospective study at a single institution in western Canada

Abstract

15176 Background: Gastric adenocarcinoma has a poor outcome: surgical resection alone in stage IA-IVA is curative in < 30%. Adjuvant chemo-radiotherapy (INT-0116 protocol) increases median overall survival from 27 to 36 months but is associated with high morbidity with many patients requiring protocol modifications to complete treatment. The benefit of modified protocols in this setting has not been well studied. We set out to compare the morbidity and mortality of the INT-0116 protocol with that of modified protocols in a single institution in Western Canada. Methods: We conducted a retrospective review of stage IA-IVA gastric adenocarcinoma patients treated with adjuvant chemo-radiation at our institution after curative-intent surgical resection. Patients were identified from Tom Baker Cancer Centre records. End points were: survival, completion of therapy, local, regional and distant failure. The modified protocol was defined as: combined modality component postponed from the second to the third or fourth chemotherapy cycle or radiation given alone after two or three cycles of chemotherapy. Results: Twenty three consecutive patients were identified; 11 received standard protocol, twelve a modified protocol. Demographic characteristics / staging at resection of those two groups did not significantly differ. Outcomes are summarized in Table 1 . Conclusions: Many patients were unable to complete the INT-0116 protocol as described, while patients placed on a modified protocol had a greater chance of completing treatment. Survival at 12 and 36 months in patients treated with the modified protocol was at least as good as those who underwent the standard protocol. This limited study at a single institution suggests that modifying the INT 0116 protocol can make this treatment more palatable to patients while not compromising outcome. Further research is warranted. Data on a further nine patients more recently treated is being analyzed and will be presented. [Table: see text] No significant financial relationships to disclose.