Postoperative chemoradiotherapy in patients with locally advanced gastric cancer with poor pathologic response to neoadjuvant chemotherapy.

Autor: Gal O; Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel., Lewin R; Chaim Sheba Medical Center, Tel Hashomer, Israel., Perl G; Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel., Ulitzky O; Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel., Brenner B; Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Kundel Y; Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jazyk: angličtina
Zdroj: Journal of cancer research and therapeutics [J Cancer Res Ther] 2024 Jan 01; Vol. 20 (1), pp. 281-284. Date of Electronic Publication: 2023 Apr 07.
DOI: 10.4103/jcrt.jcrt_1718_22
Abstrakt: Purpose: To evaluate the effect of postoperative chemoradiotherapy (CRT) in patients with locally advanced gastric cancer (LAGC) who respond poorly to neoadjuvant chemotherapy (ChT).
Materials and Methods: The database of a tertiary medical center (2009-2020) was retrospectively reviewed for patients with LAGC in whom the initial treatment strategy consisted of perioperative ChT and surgery. Those who were subsequently referred for postoperative CRT because of a poor pathologic primary-tumor response (ypT3-4, ypN2-3, R1 resection) were selected for the study. CRT consisted of 45 Gy in 25 fractions of 1.8 Gy combined with capecitabine 825 mg/m2 twice daily on radiotherapy days or continuous infusion of 5-fluorouracil 180 mg/m2/day.
Results: The cohort included 26 patients of median age 61 years with LAGC (clinical stage IIA-III) after surgery with D1-D2 lymphadenectomy. R0 resection was achieved in 15 (58%). The pathological stage was III in 69% (IIA-IVA). Treatment was well tolerated. During a median follow-up time of 39 months, recurrences were documented in 14 patients (54%): 11 distant and 3 locoregional. Median progression-free survival was 23 months, and median overall survival was 65 months. Estimated 5-year survival rates were 42 and 54%, respectively.
Conclusions: This small retrospective study suggests that in patients with LAGC who show a poor pathologic response to neoadjuvant ChT, a good outcome relative to reference arms in randomized trials can still be achieved with the addition of postoperative CRT. Further studies of the benefit of a tailored adaptive treatment approach to LAGC based on the response to neoadjuvant ChT are warranted.
(Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.)
Databáze: MEDLINE
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