V K Y Ho1, E P M Jansen2, B P L Wijnhoven3, K J Neelis4, J W van Sandick5, R H A Verhoeven6, V E P Lemmens6,7, H W M van Laarhoven8. 1. Departments of Registry and Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands. v.ho@iknl.nl. 2. Department of Radiotherapy, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. 4. Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Surgery, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Departments of Registry and Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands. 7. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. 8. Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
BACKGROUND: While the curative approach to gastric cancer includes perioperative regimens in several countries, a substantial proportion of patients may not receive treatment prior to surgery. This study examines the adjuvant provision of chemoradiotherapy (CRT) for non-pretreated patients with cancer of the stomach including the gastric cardia. METHODS: All surgically treated patients with primary adenocarcinoma of the stomach and gastric cardia diagnosed between January 2004-December 2013 were selected from the Netherlands Cancer Registry. Patients who did not receive neoadjuvant treatment were included. Early gastric cancers (cT1), postoperative deaths within 90 days, patients with metastatic disease (M1), patients who received adjuvant chemotherapy and patients with macroscopic tumor after surgery (R2) were excluded. RESULTS: Some 3277 patients underwent surgery, and 99 patients (3%) received adjuvant CRT. Treatment was more often administered in patients with a younger age (<65 years) and a high socioeconomic status (SES), in case of non-cardia cancer, positive lymph nodes, and positive resection margins (R1). Median survival time was 28 months (95% CI 17-39), compared to 35 months (95% CI 33-38) in CRT-naïve patients. After adjustment for confounders, a small net benefit for adjuvant CRT was found (hazard ratio, HR: 0.75, 95% CI 0.58-0.96). In subgroup analyses, benefit was most pronounced for patients with seven or more lymph metastases. CONCLUSIONS: Marginal survival benefit was observed for adjuvant CRT in gastric cancer patients who did not receive neoadjuvant treatment. Treatment could be considered for patients with disease involving nodal invasion and those left with microscopic residual disease after surgery.
BACKGROUND: While the curative approach to gastric cancer includes perioperative regimens in several countries, a substantial proportion of patients may not receive treatment prior to surgery. This study examines the adjuvant provision of chemoradiotherapy (CRT) for non-pretreated patients with cancer of the stomach including the gastric cardia. METHODS: All surgically treated patients with primary adenocarcinoma of the stomach and gastric cardia diagnosed between January 2004-December 2013 were selected from the Netherlands Cancer Registry. Patients who did not receive neoadjuvant treatment were included. Early gastric cancers (cT1), postoperative deaths within 90 days, patients with metastatic disease (M1), patients who received adjuvant chemotherapy and patients with macroscopic tumor after surgery (R2) were excluded. RESULTS: Some 3277 patients underwent surgery, and 99 patients (3%) received adjuvant CRT. Treatment was more often administered in patients with a younger age (<65 years) and a high socioeconomic status (SES), in case of non-cardia cancer, positive lymph nodes, and positive resection margins (R1). Median survival time was 28 months (95% CI 17-39), compared to 35 months (95% CI 33-38) in CRT-naïve patients. After adjustment for confounders, a small net benefit for adjuvant CRT was found (hazard ratio, HR: 0.75, 95% CI 0.58-0.96). In subgroup analyses, benefit was most pronounced for patients with seven or more lymph metastases. CONCLUSIONS: Marginal survival benefit was observed for adjuvant CRT in gastric cancerpatients who did not receive neoadjuvant treatment. Treatment could be considered for patients with disease involving nodal invasion and those left with microscopic residual disease after surgery.
Authors: Leonie R van der Werf; Charlotte Cords; Ivo Arntz; Eric J T Belt; Ivan M Cherepanin; Peter-Paul L O Coene; Erwin van der Harst; Joos Heisterkamp; Barbara S Langenhoff; Bas Lamme; Mark I van Berge Henegouwen; Sjoerd M Lagarde; Bas P L Wijnhoven Journal: Ann Surg Oncol Date: 2019-04-22 Impact factor: 5.344