Observational Study Comparing Efficacy and Safety between Neoadjuvant Concurrent Chemoradiotherapy and Chemotherapy for Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer.

Yung-Sung Yeh,Ming-Yii Huang,Ching-Wen Huang,Jaw-Yuan Wang,Hsiang-Lin Tsai,Hsiang-Yao Shih,Cheng-Jen Ma,Fang-Jung Yu,Yen-Cheng Chen,Ching-Chun Li

doi:10.1155/2020/6931317

Yung-Sung Yeh, Ming-Yii Huang + Show 8 more

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https://doi.org/10.1155/2020/6931317

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Abstract

Objective Dismal outcomes in patients with locally advanced or metastatic gastric cancer (GC) highlight the need for effective systemic neoadjuvant treatment strategies to improve clinical results. Neoadjuvant multimodality strategies vary widely. This study compared the efficacy, safety, and clinical outcomes of neoadjuvant CCRT and chemotherapy for such patients. Materials and Methods Sixty-five patients with histologically confirmed locally advanced or metastatic GC following neoadjuvant CCRT or computed tomography (CT) were retrospectively enrolled between January 2010 and April 2019. Clinical outcomes included response, progression-free survival (PFS), and overall survival (OS), and toxicity was compared between the two groups. Results Of the 65 patients, 18 (27.7%) were in the response group (2 patients with a complete response and 16 with a partial response) and 47 (72.3%) in the nonresponse group (29 patients with a stable disease and 18 with a progressive disease). Multivariate analysis revealed no independent response predictor between CCRT and chemotherapy groups (all P > 0.05). Furthermore, results revealed no statistical differences in toxicity between the two groups (all P > 0.05). With a follow-up median of 12 months (ranging 6–48 months), 12-month OS and PFS were 39.7% and 20.4% in the CCRT group and 30.3% and 13.2% in the chemotherapy group, respectively. The median OS and PFS were 14.0 months (95% CI 9.661–18.339) and 9.0 months (95% CI 6.805–11.195) in the CCRT group and 10.0 months (95% CI 6.523–13.477) and 8.0 months (95% CI 6.927–9.073) in the chemotherapy group, respectively. Both OS (P=0.011) and PFS (P=0.008) in patients with CCRT were significantly better than those in patients with chemotherapy alone. Conclusion Neoadjuvant CCRT achieved more favorable OS and PFS than did neoadjuvant chemotherapy alone, without significant increases of toxicity in patients. However, prospective randomized trials comparing treatment modalities are necessary to confirm the potential advantages of neoadjuvant CCRT.

Highlights

Gastric cancer (GC) is one of the most common malignancies and, despite a steady decline, GC remains the leading cause of death with widely varying incidence worldwide [1]
We presented our experience with neoadjuvant concurrent chemoradiotherapy (CCRT) versus chemotherapy alone in patients with unresectable locally advanced or metastatic GC and compared baseline characteristics, efficacy, and safety between the two groups
Data Source and Study Design. is study was conducted at Kaohsiung Medical University Hospital with approval from the hospital’s institutional review board (KMUHIRB20130022), and informed consent was obtained from all patients. e study started in January 2010, and as of April 2019, 65 patients with histologically confirmed locally advanced T4 or metastatic GC have been included

Summary

Introduction

Gastric cancer (GC) is one of the most common malignancies and, despite a steady decline, GC remains the leading cause of death with widely varying incidence worldwide [1]. In patients with unresectable locally advanced or metastatic GC, the median survival time without chemotherapy is approximately 3-4 months. Us, dismal outcomes in patients with locally advanced or metastatic GC highlight the need for effective systemic neoadjuvant treatment to improve clinical results. Several clinical trials have shown that neoadjuvant CCRT can benefit patient survival after surgery for GC [4, 5]. Ese strategies improve disease-related outcomes more than surgery alone but are associated with higher rates of treatment-related morbidity. Illustrating this fact, only 64% of patients in the Intergroup-0116 trial and 42% in the Medical Research Council Adjuvant Gastric Infusional Chemotherapy trial could complete their prescribed treatment courses [7, 8]. The establishment of a more precise treatment protocol that appropriately selects patients and provides specific therapy is ongoing

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