BACKGROUND: The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. METHODS: Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. RESULTS: We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity ≥ grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. CONCLUSIONS: Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.
BACKGROUND: The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. METHODS:Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. RESULTS: We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity ≥ grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. CONCLUSIONS: Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.
Authors: Vincenzo Valentini; Francesco Cellini; Bruce D Minsky; Gian Carlo Mattiucci; Mario Balducci; Giuseppe D'Agostino; Elisa D'Angelo; Nicola Dinapoli; Nicola Nicolotti; Chiara Valentini; Giuseppe La Torre Journal: Radiother Oncol Date: 2009-07-06 Impact factor: 6.280
Authors: E Mari; I Floriani; A Tinazzi; A Buda; M Belfiglio; M Valentini; S Cascinu; S Barni; R Labianca; V Torri Journal: Ann Oncol Date: 2000-07 Impact factor: 32.976
Authors: J Ringash; S J Khaksart; A Oza; J Couture; B Japp; M Moore; L L Siu; D Hedley; C Swallow; S Wong; B Cummings; J Kim; R Wong; J Brierley Journal: Clin Oncol (R Coll Radiol) Date: 2005-04 Impact factor: 4.126
Authors: Stephen R Smalley; Leonard Gunderson; Joel Tepper; James A Martenson; Bruce Minsky; Christopher Willett; Tyvin Rich Journal: Int J Radiat Oncol Biol Phys Date: 2002-02-01 Impact factor: 7.038
Authors: M Degiuli; M Sasako; M Calgaro; M Garino; F Rebecchi; M Mineccia; D Scaglione; D Andreone; A Ponti; F Calvo Journal: Eur J Surg Oncol Date: 2004-04 Impact factor: 4.424
Authors: Francesco Fiorica; Francesco Cartei; Marco Enea; Anna Licata; Giuseppe Cabibbo; Barbara Carau; Alberto Liboni; Stefano Ursino; Calogero Cammà Journal: Cancer Treat Rev Date: 2007-11-01 Impact factor: 12.111