Abstract
BackgroundTo examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer.MethodsPatients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0.ResultsForty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively.ConclusionsPreoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.
Highlights
Postoperative chemoradiotherapy (CRT), perioperative chemotherapy (ChT) or postoperative ChT are the current standards of care for resectable gastric cancer based on the outcomes of phase III randomized trials [1,2,3,4]
The intent of this study is to examine our institutional experience with neoadjuvant CRT for potentially resectable gastric adenocarcinoma, evaluating treatment-related toxicity, R0 resection rates, pathologic complete response (pCR) rates, and disease-related endpoints
Staging positron emission tomography (PET) scan was used for 19 patients (40%) and computed tomography (CT) scan was used for 28 (59%)
Summary
Postoperative chemoradiotherapy (CRT), perioperative chemotherapy (ChT) or postoperative ChT are the current standards of care for resectable gastric cancer based on the outcomes of phase III randomized trials [1,2,3,4]. While these strategies have been shown to improve diseaserelated outcomes compared to surgery alone, they are associated with higher rates of treatment-related morbidity. The presence of intact tumor vasculature and oxygenation may enhance responsiveness to radiotherapy (RT) and systemic therapy This treatment approach may sterilize the surgical field, potentially reducing the risk of local tumor dissemination at resection. To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer
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