title: Preoperative chemoradiotherapy for locally advanced gastric cancer.
abstract: BACKGROUND
  To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer.
  
  
  METHODS
  Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0.
  
  
  RESULTS
  Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively.
  
  
  CONCLUSIONS
  Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Box 3085, Durham, NC 27710, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pepek
authors.forename: Junzo P
authors.initials: JP
authors.lastname: Chino
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Willett
authors.forename: Manisha
authors.initials: M
authors.lastname: Palta
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer Iii
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Hope E
authors.initials: HE
authors.lastname: Uronis
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D059248:Chemoradiotherapy / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D020360:Neoadjuvant Therapy / Q000379:methods; D017785:Photons; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome