title: Adjuvant IMRT/XELOX radiochemotherapy improves long-term overall- and disease-free survival in advanced gastric cancer.
abstract: OBJECTIVE
  In a retrospective analysis, adjuvant intensity-modulated radiation therapy (IMRT) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination of three-dimensional conformal radiation therapy (3D-CRT) and conventional chemotherapy. We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy, or 3D-CRT and conventional chemotherapy.
  
  
  METHODS
  Between 2001 and 2008, 65 consecutive gastric cancer patients received either 3D-CRT (n = 27) or IMRT (n = 38) following tumor resection. Chemotherapy comprised predominantly 5-fluorouracil/folinic acid (5-FU/FA) in the earlier cohort and capecitabine plus oxaliplatin (XELOX) in the latter. The primary endpoints were overall survival (OS) and disease-free survival (DFS).
  
  
  RESULTS
  Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups, respectively (p = 0.0602). Actuarial 5-year OS rates were 26 and 47  %, respectively. Within the IMRT group, XELOX gave better results than 5-FU/FA in terms of OS, but this difference was not statistically significant. The primary cause of death in both groups was distant metastasis. Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups, respectively (p = 0.0693). Actuarial 5-year DFS rates were 22 and 44  %, respectively. Among patients receiving 5-FU/FA, DFS tended to be better in the IMRT group, but this was not statistically significant. A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients. No late toxicity exceeding grade 3 or secondary tumors were observed.
  
  
  CONCLUSIONS
  After a median follow-up period of over 5 years, OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group. Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity.
authors.affiliation: Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. judit.boda-heggemann@umm.de
authors.forename: J
authors.initials: J
authors.lastname: Boda-Heggemann
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.forename: V
authors.initials: V
authors.lastname: Schneider
authors.forename: R-D
authors.initials: RD
authors.lastname: Hofheinz
authors.forename: S
authors.initials: S
authors.lastname: Haneder
authors.forename: H
authors.initials: H
authors.lastname: Michaely
authors.forename: H
authors.initials: H
authors.lastname: Wertz
authors.forename: U
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: A
authors.initials: A
authors.lastname: Hochhaus
authors.forename: F
authors.initials: F
authors.lastname: Wenz
authors.forename: F
authors.initials: F
authors.lastname: Lohr
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D059248:Chemoradiotherapy / Q000401:mortality* / Q000706:statistics & numerical data; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D010071:Oxaloacetates; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000401:mortality* / Q000706:statistics & numerical data; D013274:Stomach Neoplasms / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil
references.citation: Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):781-5
references.pmid: 17157445
references.citation: Strahlenther Onkol. 2011 Apr;187(4):231-7
references.pmid: 21437768
references.citation: Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1279-85
references.pmid: 16099596
references.citation: J Clin Oncol. 2011 May 1;29(13):1715-21
references.pmid: 21444866
references.citation: J Clin Oncol. 2012 Jan 20;30(3):268-73
references.pmid: 22184384
references.citation: Eur J Surg Oncol. 1989 Dec;15(6):535-43
references.pmid: 2689236
references.citation: Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):1187-95
references.pmid: 19409725
references.citation: Cancer. 2001 Mar 1;91(5):918-27
references.pmid: 11251943
references.citation: Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):1-11
references.pmid: 7061243
references.citation: Int J Radiat Oncol Biol Phys. 2002 Feb 1;52(2):283-93
references.pmid: 11872272
references.citation: Lancet. 2012 Jan 28;379(9813):315-21
references.pmid: 22226517
references.citation: N Engl J Med. 2012 May 31;366(22):2074-84
references.pmid: 22646630
references.citation: N Engl J Med. 2007 Nov 1;357(18):1810-20
references.pmid: 17978289
references.citation: Radiat Oncol. 2012 Nov 16;7:192
references.pmid: 23157945
references.citation: Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1236-44
references.pmid: 15234061
references.citation: J Clin Oncol. 2012 Jul 1;30(19):2327-33
references.pmid: 22585691
references.citation: Strahlenther Onkol. 2003 Aug;179(8):557-63
references.pmid: 14509955
references.citation: N Engl J Med. 2001 Sep 6;345(10):725-30
references.pmid: 11547741
references.citation: Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1429-35
references.pmid: 17692474
references.citation: N Engl J Med. 2006 Jul 6;355(1):11-20
references.pmid: 16822992
references.citation: J Clin Oncol. 2009 Feb 20;27(6):851-6
references.pmid: 19139439
references.citation: Strahlenther Onkol. 2012 Nov;188(11):1052-3
references.pmid: 23053155
references.citation: Strahlenther Onkol. 2012 Oct;188(10):949-50
references.pmid: 22903396
references.citation: Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):142-7
references.pmid: 18539404
references.citation: Strahlenther Onkol. 2012 Jul;188(7):636-7
references.pmid: 22638935
references.citation: Strahlenther Onkol. 2012 Dec;188(12):1146-54
references.pmid: 23111472