Preoperative chemoradiotherapy for locally advanced gastric cancer

Joseph M. Pepek, Junzo P. Chino, Christopher G. Willett, Manisha Palta, Dan G. Blazer, Douglas Tyler, Hope E. Uronis, Brian G. Czito

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer.Methods: Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0.Results: Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively.Conclusions: Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

Original languageEnglish (US)
Article number6
JournalRadiation Oncology
Volume8
Issue number1
DOIs
StatePublished - Jan 4 2013
Externally publishedYes

Fingerprint

Chemoradiotherapy
Stomach Neoplasms
Disease-Free Survival
Esophagogastric Junction
Survival
Cardia
Mortality
Stomach
Adenocarcinoma
Radiotherapy
Survival Rate
Morbidity
Drug Therapy

Keywords

  • Chemoradiotherapy
  • Gastric cancer
  • Neoadjuvant

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Pepek, J. M., Chino, J. P., Willett, C. G., Palta, M., Blazer, D. G., Tyler, D., ... Czito, B. G. (2013). Preoperative chemoradiotherapy for locally advanced gastric cancer. Radiation Oncology, 8(1), [6]. https://doi.org/10.1186/1748-717X-8-6

Preoperative chemoradiotherapy for locally advanced gastric cancer. / Pepek, Joseph M.; Chino, Junzo P.; Willett, Christopher G.; Palta, Manisha; Blazer, Dan G.; Tyler, Douglas; Uronis, Hope E.; Czito, Brian G.

In: Radiation Oncology, Vol. 8, No. 1, 6, 04.01.2013.

Research output: Contribution to journalArticle

Pepek, JM, Chino, JP, Willett, CG, Palta, M, Blazer, DG, Tyler, D, Uronis, HE & Czito, BG 2013, 'Preoperative chemoradiotherapy for locally advanced gastric cancer', Radiation Oncology, vol. 8, no. 1, 6. https://doi.org/10.1186/1748-717X-8-6
Pepek, Joseph M. ; Chino, Junzo P. ; Willett, Christopher G. ; Palta, Manisha ; Blazer, Dan G. ; Tyler, Douglas ; Uronis, Hope E. ; Czito, Brian G. / Preoperative chemoradiotherapy for locally advanced gastric cancer. In: Radiation Oncology. 2013 ; Vol. 8, No. 1.
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AB - Background: To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer.Methods: Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0.Results: Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively.Conclusions: Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

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