title: Postoperative chemotherapy followed by conformal concomitant chemoradiotherapy in high-risk gastric cancer.
abstract: OBJECTIVE
  To analyze the efficacy, toxicity, and pattern of relapse after adjuvant cisplatin-based chemotherapy followed by three-dimensional irradiation and concomitant LV5FU2 chemotherapy (high-dose leucovorin and 5-fluorouracil bolus plus continuous infusion) in the treatment of completely resected high-risk gastric cancer.
  
  
  METHODS
  This was a retrospective analysis of 52 patients with high-risk gastric cancer initially treated by total/partial gastrectomy and lymphadenectomy between January 2002 and June 2007. Median age was 54 years (range, 36-75 years). Postoperative treatment consisted of 5-fluorouracil and cisplatin chemotherapy. Adjuvant chemotherapy was followed by three-dimensional conformal radiotherapy in the tumor bed and regional lymph nodes at 4500 cGy/25 fractions in association with concomitant chemotherapy. Concomitant chemotherapy consisted of a 2-h infusion of leucovorin (200 mg/m²) followed by a bolus of 5-fluorouracil (400 mg/m²) and then a 44-h continuous infusion of 5-fluorouracil (2400-3600 mg/m²) given every 14 days, for three cycles (LV5FU2 protocol).
  
  
  RESULTS
  Five-year overall and disease-free survival were 50% and 48%, respectively. Distant metastases and peritoneal spread were the most frequent sites of relapse (37% each). After multivariate analysis, only pathologic nodal status was significantly associated with disease-free and overall survival. Acute toxicities were essentially gastrointestinal and hematologic. One myocardial infarction and one pulmonary embolism were also reported. Eighteen patients had a radiotherapy program interruption because of acute toxicity. All patients but 2 have completed radiotherapy.
  
  
  CONCLUSIONS
  Postoperative cisplatin-based chemotherapy followed by conformal radiotherapy in association with concurrent 5-fluorouracil seemed to be feasible and resulted in successful locoregional control.
authors.affiliation: Department of Radiation Oncology, Saint-Louis Hospital, Paris, France. laurent.quero@sls.aphp.fr
authors.forename: Laurent
authors.initials: L
authors.lastname: Quero
authors.forename: Zineb
authors.initials: Z
authors.lastname: Bouchbika
authors.forename: Honorine
authors.initials: H
authors.lastname: Kouto
authors.forename: Valerie
authors.initials: V
authors.lastname: Baruch-Hennequin
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cojean-Zelek
authors.forename: Remi
authors.initials: R
authors.lastname: Houdart
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.forename: Thomas
authors.initials: T
authors.lastname: Aparicio
authors.forename: Claude
authors.initials: C
authors.lastname: Maylin
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D005743:Gastrectomy; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil