Neoadjuvant radiochemotherapy in locally advanced gastric carcinoma.
OBJECTIVE
Gastric carcinoma is characterized by a high rate of local recurrences and distant metastases and is often not resectable due to locally advanced stage. The aim of this study was to examine feasibility and effectiveness of neoadjuvant radiochemotherapy (RCT) for locally advanced, primarily nonresectable gastric carcinoma and to achieve curative resection.


METHODS
21 patients with locally advanced gastric cancer located in cardia (n = 17) and corpus (n = 4; seven cT3; 14 cT4; 18 cN+; all cM0) with a median age of 61 years were scheduled to receive neoadjuvant RCT. Therapy consisted of a conventionally fractionated, conformal radiotherapy using the shrinking-field technique (1.8 Gy to 45 Gy + 5.4 Gy) and chemotherapy using cisplatin (20 mg/m(2), d1-5, 29-33), 5-fluorouracil (5-FU; 800 mg/m(2), d1-5, 29-33) or paclitaxel (135 mg/m(2), d1, 29). 4-6 weeks after completion of RCT, surgery was performed whenever feasible.


RESULTS
Hematologic toxicity was moderate with grade 3 leukopenia in 10/21 patients and grade 3 thrombopenia in 5/21 (CTC). Nonhematologic toxicities consisted of 5/21 cases of fever as well as one fungal sepsis. Following RCT, tumors were classified resectable in 16/21 patients (76%); 12/21 patients (58%) were operated on, 11/12 achieved clear margins (R0). Response was as follows: complete remission (CR) 3/21 (14%), partial remission 13/21 (62%), no change 3/21 (14%), systemic progressive disease (PD) 2/21 (10%). The median survival and the 2-year survival rates were 18 months and 42%, respectively, for the patients following R0 resections as compared to 10 months and 0% for the remaining patients (p = 0.035). Local control (4 years) for patients following R0 resection was 89%.


CONCLUSIONS
Neoadjuvant RCT is feasible and locally highly effective but must be further investigated involving a higher number of patients.
Klautke
Gunther
G
Department of Radiotherapy, University of Rostock, Rostock, Germany. gunther.klautke@med.uni-rostock.de
Foitzik
Thomas
T
Ludwig
Kaja
K
Ketterer
Peter
P
Klar
Ernst
E
Fietkau
Rainer
R
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis
D000970:Antineoplastic Agents