PURPOSE: To assess the long-term results of radiation therapy (RT) when added preoperatively to systemic chemotherapy in patients with locally advanced gastric cancer. METHODS AND MATERIALS: Patients presenting with T3-4 or N+ gastric cancer received two cycles of cisplatin 100 mg/m2 d1, 5FU 800 mg/m2 d1-4, and Leucovorin 60 mg twice daily d1-4; one cycle before and one concomitantly with hyperfractionated RT (median dose, 38.4; range, 31.2-45.6 Gy). All patients underwent a total or subtotal gastrectomy with D2 lymph node resection. RESULTS: Nineteen patients were accrued and 18 completed the neoadjuvant therapeutic program. All patients were subsequently operated and no fatality occurred. At a mean follow-up of 8 years for the surviving patients, no severe late toxicity was observed. The 5-year locoregional control, disease-free, and overall survival were of 85%, 41%, and 35%, respectively. The peritoneum was the most frequent site of relapse. Among long terms survivors, no severe (Radiation Therapy Oncology Group Grade 3-4) late complication was reported. CONCLUSIONS: The present neoadjuvant treatment does not seem to increase the operative risk, nor the late side effects. The encouraging locoregional control rate suggests that the neoadjuvant approach should be considered for future trials in locally advanced gastric cancer. Also, the frequency of peritoneal recurrence stresses the need for a more efficient systemic or intraperitoneal treatment.
PURPOSE: To assess the long-term results of radiation therapy (RT) when added preoperatively to systemic chemotherapy in patients with locally advanced gastric cancer. METHODS AND MATERIALS: Patients presenting with T3-4 or N+ gastric cancer received two cycles of cisplatin 100 mg/m2 d1, 5FU 800 mg/m2 d1-4, and Leucovorin 60 mg twice daily d1-4; one cycle before and one concomitantly with hyperfractionated RT (median dose, 38.4; range, 31.2-45.6 Gy). All patients underwent a total or subtotal gastrectomy with D2 lymph node resection. RESULTS: Nineteen patients were accrued and 18 completed the neoadjuvant therapeutic program. All patients were subsequently operated and no fatality occurred. At a mean follow-up of 8 years for the surviving patients, no severe late toxicity was observed. The 5-year locoregional control, disease-free, and overall survival were of 85%, 41%, and 35%, respectively. The peritoneum was the most frequent site of relapse. Among long terms survivors, no severe (Radiation Therapy Oncology Group Grade 3-4) late complication was reported. CONCLUSIONS: The present neoadjuvant treatment does not seem to increase the operative risk, nor the late side effects. The encouraging locoregional control rate suggests that the neoadjuvant approach should be considered for future trials in locally advanced gastric cancer. Also, the frequency of peritoneal recurrence stresses the need for a more efficient systemic or intraperitoneal treatment.
Authors: Johan L Dikken; Cornelis J H van de Velde; Daniel G Coit; Manish A Shah; Marcel Verheij; Annemieke Cats Journal: Therap Adv Gastroenterol Date: 2012-01 Impact factor: 4.409
Authors: Mi Sun Kim; Joon Seok Lim; Woo Jin Hyung; Yong Chan Lee; Sun Young Rha; Ki Chang Keum; Woong Sub Koom Journal: World J Gastroenterol Date: 2015-03-07 Impact factor: 5.742
Authors: Alberto Biondi; Maria C Lirosi; Domenico D'Ugo; Valeria Fico; Riccardo Ricci; Francesco Santullo; Antonia Rizzuto; Ferdinando Cm Cananzi; Roberto Persiani Journal: World J Gastrointest Oncol Date: 2015-12-15
Authors: Gennaro Galizia; Eva Lieto; Michele Orditura; Paolo Castellano; Anna La Mura; Vincenzo Imperatore; Margherita Pinto; Anna Zamboli; Ferdinando De Vita; Francesca Ferraraccio Journal: World J Surg Date: 2007-07 Impact factor: 3.352
Authors: Stephen R Smalley; Jacqueline K Benedetti; Daniel G Haller; Scott A Hundahl; Norman C Estes; Jaffer A Ajani; Leonard L Gunderson; Bryan Goldman; James A Martenson; J Milburn Jessup; Grant N Stemmermann; Charles D Blanke; John S Macdonald Journal: J Clin Oncol Date: 2012-05-14 Impact factor: 44.544