Anouk K Trip1, Boelo J Poppema2, Mark I van Berge Henegouwen3, Ester Siemerink4, Jannet C Beukema5, Marcel Verheij1, John T M Plukker6, Dick J Richel7, Maarten C C M Hulshof8, Johanna W van Sandick9, Annemieke Cats10, Edwin P M Jansen1, Geke A P Hospers11. 1. Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 2. Department of Medical Oncology, University Medical Centre Groningen, The Netherlands. 3. Department of Surgical Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands. 4. Department of Internal Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands. 5. Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands. 6. Department of Surgical Oncology, University Medical Centre Groningen, The Netherlands. 7. Department of Medical Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands. 8. Department of Radiation Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands. 9. Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 10. Department of Gastroenterology and Hepatology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 11. Department of Medical Oncology, University Medical Centre Groningen, The Netherlands. Electronic address: g.a.p.hospers@umcg.nl.
Abstract
OBJECTIVES: This study was initiated to investigate the feasibility and efficacy of preoperative radiotherapy with weekly paclitaxel and carboplatin in locally advanced gastric cancer. METHODS: In a prospective study, patients with locally advanced gastric cancer stage IB-IV(M0) were treated with chemoradiotherapy followed by surgery 4-6 weeks after the last irradiation. Chemoradiotherapy consisted of radiation to a total dose of 45 Gy given in 25 fractions of 1.8 Gy, combined with concurrent weekly carboplatin and paclitaxel. RESULTS: Between December 2007 and January 2012, 25 patients with cT3 (64%) or cT4 (36%) gastric cancer were included. One patient discontinued concurrent chemotherapy in the 4th week due to toxicity, but completed radiotherapy. Another patient discontinued chemoradiotherapy after the 3rd week due to progressive disease. Grade III adverse events of chemoradiotherapy were: gastrointestinal 12%, haematological 12% and other 8%. All patients, except one who developed progressive disease, were operated. Surgical complications were: general/infectious 48%, anastomotic leakage 12%, and bowel perforation 8%. Postoperative mortality was 4%. Microscopically radical resection rate was 72%. Pathological complete response rate was 16% and near complete response rate 24%. CONCLUSIONS: In this study, preoperative chemoradiotherapy for patients with locally advanced gastric cancer was associated with manageable toxicity and encouraging pathological response rates.
OBJECTIVES: This study was initiated to investigate the feasibility and efficacy of preoperative radiotherapy with weekly paclitaxel and carboplatin in locally advanced gastric cancer. METHODS: In a prospective study, patients with locally advanced gastric cancer stage IB-IV(M0) were treated with chemoradiotherapy followed by surgery 4-6 weeks after the last irradiation. Chemoradiotherapy consisted of radiation to a total dose of 45 Gy given in 25 fractions of 1.8 Gy, combined with concurrent weekly carboplatin and paclitaxel. RESULTS: Between December 2007 and January 2012, 25 patients with cT3 (64%) or cT4 (36%) gastric cancer were included. One patient discontinued concurrent chemotherapy in the 4th week due to toxicity, but completed radiotherapy. Another patient discontinued chemoradiotherapy after the 3rd week due to progressive disease. Grade III adverse events of chemoradiotherapy were: gastrointestinal 12%, haematological 12% and other 8%. All patients, except one who developed progressive disease, were operated. Surgical complications were: general/infectious 48%, anastomotic leakage 12%, and bowel perforation 8%. Postoperative mortality was 4%. Microscopically radical resection rate was 72%. Pathological complete response rate was 16% and near complete response rate 24%. CONCLUSIONS: In this study, preoperative chemoradiotherapy for patients with locally advanced gastric cancer was associated with manageable toxicity and encouraging pathological response rates.
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