Postoperative chemoradiation in patients with localized gastric adenocarcinoma: single center experience.
BACKGROUND
5-Fluorouracil (FU)-based chemotherapy (CT) and concurrent 45 Gy radiotherapy (RT) is one of the standard postoperative approaches currently used in gastric carcinoma. The high toxicity rates of this treatment leads to interruption of treatment in the majority of patients. In our study, we investigated the rates of toxicity and treatment discontinuation observed during postoperative FU-based chemoradiotherapy (CRT); retrospectively evaluated the effect of CRT and the other prognostic factors on local and distant control and survival.


METHODS
A total of 160 patients consisting of 97 total and 63 subtotal gastrectomy receiving postoperative CRT, have been studied retrospectively.


RESULTS
Patients who had to discontinue the treatment for a median of 6 (range, 3-13) days experienced toxicity during treatment at a rate of 43%. During the 21 (range, 4-68) months of follow-up local recurrences were observed in 8 (5%) patients and distant recurrences were observed in 41 (25.6%) patients. While the 1-3 year overall survival (OS) rates were 75% and 42%, 13-year disease-free survival (DFS) rates were 63% and 42%, respectively. In the univariate analysis for OS and DFS demonstrated statistical significance for below those 60 years of age, D1-D2 dissection type, negative surgical margin, early treatment beginning, the absence of invasion, and early stage disease. D1D2 dissection type, early treatment beginning, age below 60 years and early stage disease significantly improve OS and DFS in multivariate analysis.


CONCLUSIONS
Survival is worse in patients older than 60 years, had late treatment beginning, advanced stage and D0 dissection.
Department of Radiation Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey. adnan@yoney.net
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Yoney
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Y
Bati
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Isikli
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Unsal
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil