Pierre Michel1, Gilles Breysacher2, Françoise Mornex3, Jean François Seitz4, Denis Pere-Verge5, Isabelle Martel-Lafay6, Roger Faroux7, Sophie Chapet8, Iradj Sobhani9, Denis Pezet10, Thomas Aparicio11, Suzanne Nguyen12, Bertrand Dousset13, Jean-Louis Jouve14, Emilie Maillard15. 1. Department of Gastroenterology, Rouen University Hospital, University of Rouen, 1 rue de Germont, 76031 Rouen, France. Electronic address: Pierre.michel@chu-rouen.fr. 2. Centre Hospitalier Colmar, France. 3. Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite, France. 4. Assistance Publique-hopitaux de Marseille, hopital Timone, France. 5. Centre Hospitalo-Universitaire Lyon Croix Rousse, France. 6. Centre de Lutte Contre le Cancer de Lyon, Leon Berard, France. 7. Centre Hospitalier La Roche sur Yon, France. 8. Centre Hospitalo-Universitaire, Tours, France. 9. Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Creteil, France. 10. Centre Hospitalo-Universitaire, Clermont Ferrand, France. 11. Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Bichat, France. 12. Centre Hospitalier, Beauvais, France. 13. Assistance Publique-hopitaux de Paris, Centre Hospitalo-Universitaire, Cochin, France. 14. Centre Hospitalo-Universitaire, Dijon, France. 15. Fédération Francophone de Cancérologie Digestive, France.
Abstract
BACKGROUND: For resectable gastric cancer, both postoperative chemoradiotherapy and perioperative chemotherapy demonstrate high-level evidence for improved survival in Western populations. To evaluate the feasibility of pre- or postoperative chemoradiotherapy, we proposed two multicentre phase II studies. PATIENTS AND METHODS: Patients with localised, histologically confirmed gastric cancer and Eastern Cooperative Oncology Group (ECOG) performance status <2 judged suitable for curative resection were eligible. Eligible patients were assigned to either preoperative chemoradiotherapy followed by surgical resection or surgical resection followed by chemoradiotherapy depending on each centre. Chemoradiotherapy regimen included four courses of FOLFIRI (5 Fluorouracil, Leucovorin, Irinotecan) regimen then Concurrent fluorouracil at 200 mg/m2/d by continuous infusion 5 days each week. A dose of 50 Gy in 25 fractions in the preoperative study, or 45 Gy in 25 fractions in the postoperative study, was delivered. The primary end-point for both studies was the proportion of patients, who completed the therapeutic sequence. RESULTS: Between September 2007 and January 2010, 63 patients were included in both studies. The postoperative study was stopped for futility at the first step. In the preoperative study, 31 patients (73.8%, confidence interval (CI) 95%: 65.8-90.1%) received complete therapeutic sequence. Serum albumin and dietary restriction evaluated by QLQ-STO22 (Quality of Life-Stomach module) score were significantly linked with chemoradiotherapy feasibility in univariate analysis with respectively Odds-ratio (OR) 1.16 [CI 95%: 1.01-1.33] and 0.17 [0.03-0.89], p=0.04. Median overall survival time was 26.4 months in the preoperative study. CONCLUSION: Feasibility of chemoradiotherapy was not achieved for these studies: 73.8% (CI 95%: 65.8-90.1) and 42.9% (CI 95%: 21.8-66%) in preoperative and postoperative settings respectively.
BACKGROUND: For resectable gastric cancer, both postoperative chemoradiotherapy and perioperative chemotherapy demonstrate high-level evidence for improved survival in Western populations. To evaluate the feasibility of pre- or postoperative chemoradiotherapy, we proposed two multicentre phase II studies. PATIENTS AND METHODS: Patients with localised, histologically confirmed gastric cancer and Eastern Cooperative Oncology Group (ECOG) performance status <2 judged suitable for curative resection were eligible. Eligible patients were assigned to either preoperative chemoradiotherapy followed by surgical resection or surgical resection followed by chemoradiotherapy depending on each centre. Chemoradiotherapy regimen included four courses of FOLFIRI (5 Fluorouracil, Leucovorin, Irinotecan) regimen then Concurrent fluorouracil at 200 mg/m2/d by continuous infusion 5 days each week. A dose of 50 Gy in 25 fractions in the preoperative study, or 45 Gy in 25 fractions in the postoperative study, was delivered. The primary end-point for both studies was the proportion of patients, who completed the therapeutic sequence. RESULTS: Between September 2007 and January 2010, 63 patients were included in both studies. The postoperative study was stopped for futility at the first step. In the preoperative study, 31 patients (73.8%, confidence interval (CI) 95%: 65.8-90.1%) received complete therapeutic sequence. Serum albumin and dietary restriction evaluated by QLQ-STO22 (Quality of Life-Stomach module) score were significantly linked with chemoradiotherapy feasibility in univariate analysis with respectively Odds-ratio (OR) 1.16 [CI 95%: 1.01-1.33] and 0.17 [0.03-0.89], p=0.04. Median overall survival time was 26.4 months in the preoperative study. CONCLUSION: Feasibility of chemoradiotherapy was not achieved for these studies: 73.8% (CI 95%: 65.8-90.1) and 42.9% (CI 95%: 21.8-66%) in preoperative and postoperative settings respectively.