title: Adjuvant chemoradiation for gastric cancer using epirubicin, cisplatin, and 5-fluorouracil before and after three-dimensional conformal radiotherapy with concurrent infusional 5-fluorouracil: a multicenter study of the Trans-Tasman Radiation Oncology Group.
abstract: OBJECTIVE
  The INT0116 study has established postoperative chemoradiotherapy as the standard of care for completely resected gastric adenocarcinoma. However, the optimal chemoradiation regimen remains to be defined. We conducted a prospective, multicenter study to evaluate an alternative chemoradiation regimen that combines more current systemic treatment with modern techniques of radiotherapy delivery.
  
  
  METHODS
  Patients with adenocarcinoma of the stomach who had undergone an R0 resection were eligible. Adjuvant therapy consisted of one cycle of epirubicin, cisplatin, and 5-FU (ECF), followed by radiotherapy with concurrent infusional 5-FU, and then two additional cycles of ECF. Radiotherapy was delivered using precisely defined, multiple-field, three-dimensional conformal techniques.
  
  
  RESULTS
  A total of 54 assessable patients were enrolled from 19 institutions. The proportion of patients commencing Cycles 1, 2, and 3 of ECF chemotherapy were 100%, 81%, and 67% respectively. In all, 94% of patients who received radiotherapy completed treatment as planned. Grade 3/4 neutropenia occurred in 66% of patients with 7.4% developing febrile neutropenia. Most neutropenic episodes (83%) occurred in the post-radiotherapy period during cycles 2 and 3 of ECF. Grade 3/4 gastrointestinal toxicity occurred in 28% of patients. In all, 35% of radiotherapy treatment plans contained protocol deviations that were satisfactorily amended before commencement of treatment. At median follow-up of 36 months, the 3-year overall survival rate was estimated at 61.6%.
  
  
  CONCLUSIONS
  This adjuvant regimen using ECF before and after three-dimensional conformal chemoradiation is feasible and can be safely delivered in a cooperative group setting. A regimen similar to this is currently being compared with the INT0116 regimen in a National Cancer Institute-sponsored, randomized Phase III trial.
authors.affiliation: Division of Radiation Oncology, Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. trevor.leong@petermac.org
authors.forename: Trevor
authors.initials: T
authors.lastname: Leong
authors.forename: Daryl Lim
authors.initials: DL
authors.lastname: Joon
authors.forename: David
authors.initials: D
authors.lastname: Willis
authors.forename: Jayasingham
authors.initials: J
authors.lastname: Jayamoham
authors.forename: Nigel
authors.initials: N
authors.lastname: Spry
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harvey
authors.forename: Juliana
authors.initials: J
authors.lastname: Di Iulio
authors.forename: Alvin
authors.initials: A
authors.lastname: Milner
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
authors.forename: Michael
authors.initials: M
authors.lastname: Michael
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery
chemical_list: D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil