Faculty Collaboration Database

Chemoradiation therapy for potentially resectable gastric cancer: clinical outcomes among patients who do not undergo planned surgery. Int J Radiat Oncol Biol Phys 2008 May 01;71(1):167-72

Date

04/15/2008

Pubmed ID

18406886

DOI

10.1016/j.ijrobp.2007.09.019

Scopus ID

2-s2.0-41849144160 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

PURPOSE: We retrospectively analyzed treatment outcomes among resectable gastric cancer patients treated preoperatively with chemoradiation therapy (CRT) but rendered ineligible for planned surgery because of clinical deterioration or development of overt metastatic disease.

METHODS AND MATERIALS: Between 1996 and 2004, 39 patients with potentially resectable gastric cancer received preoperative CRT but failed to undergo surgery. At baseline clinical staging, 33 (85%) patients had T3-T4 disease, and 27 (69%) patients had nodal involvement. Most patients received 45 Gy of radiotherapy with concurrent 5-fluorouracil-based chemotherapy. Twenty-one patients underwent induction chemotherapy before CRT. Actuarial times to local control (LC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method.

RESULTS: The cause for surgical ineligibility was development of metastatic disease (28 patients, 72%; predominantly peritoneal, 18 patients), poor performance status (5 patients, 13%), patient/physician preference (4 patients, 10%), and treatment-related death (2 patients, 5%). With a median follow-up of 8 months (range, 1-95 months), actuarial 1-year LC, DC, and OS were 46%, 12%, and 36%, respectively. Median LC and OS were 11.0 and 10.1 months, respectively.

CONCLUSIONS: Patients with potentially resectable gastric cancer treated with preoperative CRT are found to be ineligible for surgery principally because of peritoneal progression. Patients who are unable to undergo planned surgery have outcomes comparable to that of patients with advanced gastric cancer treated with chemotherapy alone. CRT provides durable LC for the majority of the remaining life of these patients.

Author List

Kim MM, Mansfield PF, Das P, Janjan NA, Badgwell BD, Phan AT, Delclos ME, Maru D, Ajani JA, Crane CH, Krishnan S

Author

Alexandria T. Phan MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Disease Progression
Female
Fluorouracil
Humans
Male
Middle Aged
Peritoneal Neoplasms
Radiotherapy Dosage
Remission Induction
Retrospective Studies
Stomach Neoplasms
Treatment Failure