title: Incidence, natural history, and patterns of locoregional recurrence in gastric cancer patients treated with preoperative chemoradiotherapy.
abstract: OBJECTIVE
  To retrospectively determine the incidence and patterns (in-field, marginal, or out-of-field) of locoregional gastric cancer recurrence in patients who received preoperative chemoradiotherapy and to determine the outcome in these patients.
  
  
  METHODS
  Between 1994 and 2004, 149 patients with gastric carcinoma were treated according to institutional protocols with preoperative chemoradiotherapy. Ultimately, 105 patients had an R0 resection. Of these 105 patients, 65 received preoperative chemotherapy followed by chemoradiotherapy and 40 received preoperative chemoradiotherapy. Most (96%) of these patients received 5-fluorouracil-based chemotherapy during radiotherapy, and the median radiation dose was 45 Gy. We retrospectively identified and classified the patterns of locoregional recurrence.
  
  
  RESULTS
  The 3-year actuarial incidence of locoregional recurrence was 13%, with locoregional disease recurring as any part of the failure pattern in 14 patients. Most (64%) of the evaluable locoregional recurrences were in-field. Of the 4 patients with a marginal recurrence, 2 had had inadequate coverage of the regional nodal volumes on their oblique fields. The pathologic complete response rate was 23%. A pathologic complete response was the only statistically significant predictor of locoregional control.
  
  
  CONCLUSIONS
  Patients with gastric cancer who received preoperative chemoradiotherapy had low rates of locoregional recurrence. This strategy merits prospective multi-institutional and randomized evaluation.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Valerie K
authors.initials: VK
authors.lastname: Reed
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Priya R
authors.initials: PR
authors.lastname: Bhosale
authors.forename: Michelle
authors.initials: M
authors.lastname: Kim
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Nora A
authors.initials: NA
authors.lastname: Janjan
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowy
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents