title: Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma.
abstract: OBJECTIVE
  In the West, curative (R0) resection is achieved in approximately 50% of patients with localized gastric carcinoma, and more than 60% die of cancer following an R0 resection. A multi-institutional study of preoperative chemoradiotherapy was done to assess the R0 resection rate, pathologic complete response (pathCR) rate, safety, and survival in patients with resectable gastric carcinoma.
  
  
  METHODS
  Operable patients with localized gastric adenocarcinoma were eligible. Staging also included a laparoscopy and endoscopic ultrasonography (EUS). Patients received up to two 28-day cycles of induction chemotherapy of fluorouracil, leucovorin, and cisplatin, followed by 45 Gy of radiation plus concurrent fluorouracil. Patients were then staged and surgery was attempted.
  
  
  RESULTS
  Thirty-four patients were registered at three institutions. One ineligible patient was excluded. Most patients had a promixal cancer and EUST3N1 designation. Twenty-eight (85%) of 33 patients underwent surgery. The R0 resection rate was 70% and pathCR rate was 30%. A pathologic partial response (< 10% residual carcinoma in the primary) occurred in eight patients (24%). EUS T plus N and postsurgery T plus N correlation showed significant downstaging (P = <.01). The median survival time for 33 patients was 33.7 months. Patients achieving a pathCR or pathPR had a significantly longer median survival time (63.9 months) than those achieving less than pathPR (12.6 months; P =.03). There were two treatment-related deaths.
  
  
  CONCLUSIONS
  Our data suggest that the three-step strategy of preoperative induction chemotherapy followed by chemoradiotherapy resulted in substantial pathologic response that resulted in durable survival time. This strategy is worthy of a direct comparison with postoperative adjuvant chemoradiotherapy.
authors.affiliation: Department of Gastrointestinal Medical Oncology, Stop 426, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. jajani@mdanderson.org
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
authors.forename: P F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: N
authors.initials: N
authors.lastname: Janjan
authors.forename: J
authors.initials: J
authors.lastname: Morris
authors.forename: P W
authors.initials: PW
authors.lastname: Pisters
authors.forename: P M
authors.initials: PM
authors.lastname: Lynch
authors.forename: B
authors.initials: B
authors.lastname: Feig
authors.forename: R
authors.initials: R
authors.lastname: Myerson
authors.forename: R
authors.initials: R
authors.lastname: Nivers
authors.forename: D S
authors.initials: DS
authors.lastname: Cohen
authors.forename: L L
authors.initials: LL
authors.lastname: Gunderson
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005492:Folic Acid / Q000008:administration & dosage; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005492:Folic Acid; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil