title: Chemoradiation therapy for potentially resectable gastric cancer: clinical outcomes among patients who do not undergo planned surgery.
abstract: OBJECTIVE
  We retrospectively analyzed treatment outcomes among resectable gastric cancer patients treated preoperatively with chemoradiation therapy (CRT) but rendered ineligible for planned surgery because of clinical deterioration or development of overt metastatic disease.
  
  
  METHODS
  Between 1996 and 2004, 39 patients with potentially resectable gastric cancer received preoperative CRT but failed to undergo surgery. At baseline clinical staging, 33 (85%) patients had T3-T4 disease, and 27 (69%) patients had nodal involvement. Most patients received 45 Gy of radiotherapy with concurrent 5-fluorouracil-based chemotherapy. Twenty-one patients underwent induction chemotherapy before CRT. Actuarial times to local control (LC), distant control (DC), and overall survival (OS) were calculated by the Kaplan-Meier method.
  
  
  RESULTS
  The cause for surgical ineligibility was development of metastatic disease (28 patients, 72%; predominantly peritoneal, 18 patients), poor performance status (5 patients, 13%), patient/physician preference (4 patients, 10%), and treatment-related death (2 patients, 5%). With a median follow-up of 8 months (range, 1-95 months), actuarial 1-year LC, DC, and OS were 46%, 12%, and 36%, respectively. Median LC and OS were 11.0 and 10.1 months, respectively.
  
  
  CONCLUSIONS
  Patients with potentially resectable gastric cancer treated with preoperative CRT are found to be ineligible for surgery principally because of peritoneal progression. Patients who are unable to undergo planned surgery have outcomes comparable to that of patients with advanced gastric cancer treated with chemotherapy alone. CRT provides durable LC for the majority of the remaining life of these patients.
authors.affiliation: Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kim
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Nora A
authors.initials: NA
authors.lastname: Janjan
authors.forename: Brian D
authors.initials: BD
authors.lastname: Badgwell
authors.forename: Alexandria T
authors.initials: AT
authors.lastname: Phan
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: Dipen
authors.initials: D
authors.lastname: Maru
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D018450:Disease Progression; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017211:Treatment Failure
chemical_list: D005472:Fluorouracil