Postoperative adjuvant chemoradiation in completely resected locally advanced gastric cancer.
BACKGROUND
The 5-year survival of patients with completely resected node-positive gastric cancer ranges from 15% to 25%. We explored the feasibility of a chemoradiation regime consisting of concomitant hyperfractionated radiotherapy and 5-fluorouracil protracted venous infusion (5-FU PVI).


METHODS
Forty patients received a total or partial gastrectomy operation and D2 nodal resection for Stage III gastric cancer; they were then irradiated by linac with 6-15-MV photons. The target included the gastric bed, the anastomosis, stumps, and regional nodes. A total dose of 55 Gy was given in 50 fractions using 1.1 Gy b.i.d. All patients received a concomitant 200 mg/m2/day 5-FU PVI. Patients were examined during the follow-up period as programmed. Toxicity was recorded according to RTOG criteria.


RESULTS
After a median follow-up of 75.6 months (range: 22-136 months), 24 (60%) patients had died, and 16 (40%) were alive and free of disease. The 5-year actuarial incidence of relapse was 39%, 22%, and 2% for distant metastases, out-field peritoneal seeding, and in-field local regional recurrences, respectively. The 5-year actuarial cause-specific survival was 43%. Three patients survived more than 11 years. Acute > or = Grade 3 toxicity consisted of hematologic (22.5%) and gastrointestinal toxicity (nausea and vomiting 22.5%, diarrhea 2.8%, and abdominal pain 2.6%). No late toxicity was observed.


CONCLUSIONS
This regime of concomitant 5-FU PVI and hyperfractionated radiotherapy was well tolerated and resulted in successful locoregional control and satisfactory survival.
Arcangeli
Giorgio
G
Division of Radiation Oncology, Regina Elena National Cancer Institute, Via E. Chianesi 53, 00144 Rome, Italy. arcangeli@ifo.it
Saracino
Biancamaria
B
Arcangeli
Giancarlo
G
Angelini
Francesco
F
Marchetti
Paolo
P
Tirindelli Danesi
Donatella
D
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011878:Radiotherapy / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D000970:Antineoplastic Agents