title: Is chemoradiation effective or harmful for stage VI gastric cancer patients?
abstract: We aim to clarify beneficial effect of pre-operative radiation with chemotherapy in highly advanced gastric cancer patients, evaluating histological response, toxicity and patients' quality of life (QOL). We used pre-operative radiation with S-1 and low-dose cisplatin to treat 8 patients with highly advanced gastric cancer (clinical stage IV) in a pilot study. Clinical staging after therapy showed 5 PRs (partial response), 2 NCs (no change), and 1 PD (partial disease) following evaluation of the primary tumor and suspicious metastatic lesions in the lymph nodes, esophagus, liver, and peritoneum, for a response rate of 62.5% (5/8 cases). Of 8 patients, 6 underwent surgery, and 2 of these 6 patients had a histologically complete response (grade 3 effect) and 3 patients had a partial response (grade 2 effect), suggesting that a high histological response (5/6 cases; 83.3%) is expected by the chemoradiation. The survival analysis showed that 5 out of the 8 patients died within 10 months after initiating therapy, while 3 patients are alive without recurrence at 15, 18, and 30 months after therapy, suggesting a relatively good outcome for clinical stage IV gastric cancer. All cases showed grade 2-4 bone marrow suppression toxicity and/or grade 0-2 gastro-intestinal toxicity, while 5 out of 8 patients (62.5%) showed improvement in appetite loss at the end of the therapy, indicating that the patients' quality of life (QOL) was preserved. Chemoradiation may be a powerful regimen for obtaining histological response with tolerable toxicity and improved QOL in highly advanced gastric cancer patients.
authors.affiliation: Department of Surgery, School of Medicine, Keio University, 35 Sinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. saiky@sc.itc.keio.ac.jp
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Saikawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yukako
authors.initials: Y
authors.lastname: Akatsu
authors.forename: Rieko
authors.initials: R
authors.lastname: Nakamura
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Shigematsu
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Otani
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin