title: Combined adjuvant radiochemotherapy with IMRT/XELOX improves outcome with low renal toxicity in gastric cancer.
abstract: OBJECTIVE
  Adjuvant radiochemotherapy improves survival of patients with advanced gastric cancer. We assessed in two sequential cohorts whether improved radiotherapy technique (IMRT) together with intensified chemotherapy improves outcome vs. conventional three-dimensional conformal radiotherapy (3D-CRT) and standard chemotherapy in these patients while maintaining or reducing renal toxicity.
  
  
  METHODS
  Sixty consecutive patients treated for gastric cancer either with 3D-CRT (n = 27) and IMRT (n = 33) were evaluated. More than 70% had undergone D2 resection. Although there was a slight imbalance in R0 status between cohorts, N+ status was balanced. Chemotherapy consisted predominantly of 5-fluorouracil/folinic acid (n = 36) in the earlier cohort and mostly of oxaliplatin/capecitabine (XELOX, n = 24) in the later cohort. Primary end points were overall survival (OS), disease-free survival (DFS), and renal toxicity based on creatinine levels.
  
  
  RESULTS
  Median follow-up (FU) of all patients in the 3D-CRT group was 18 months and in the IMRT group 22 months (median FU of surviving patients 67 months in the 3D-CRT group and 25 months in the IMRT group). Overall median survival (and DFS) were 18 (13) months in the 3D-CRT group and both not reached in the IMRT group (p = 0.0492 and 0.0216). Actuarial 2-year survival was 37% and 67% in the 3D-CRT and IMRT groups, respectively. No late renal toxicity >Grade 2 (LENT-SOMA scale) was observed in either cohort.
  
  
  CONCLUSIONS
  When comparing sequentially treated patient cohorts with similar characteristics, OS and DFS improved with the use of IMRT and intensified chemotherapy without signs of increased renal toxicity.
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany.
authors.forename: Judit
authors.initials: J
authors.lastname: Boda-Heggemann
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hofheinz
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Philipp
authors.initials: P
authors.lastname: Mennemeyer
authors.forename: Sabine K
authors.initials: SK
authors.lastname: Mai
authors.forename: Petra
authors.initials: P
authors.lastname: Hermes
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Wertz
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Bernd
authors.initials: B
authors.lastname: Massner
authors.forename: Udo
authors.initials: U
authors.lastname: Hieber
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochhaus
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: Frank
authors.initials: F
authors.lastname: Lohr
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011832:Radiation Injuries / Q000097:blood / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*
chemical_list: D015415:Biomarkers; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000069287:Capecitabine; D003404:Creatinine; D002955:Leucovorin; D005472:Fluorouracil