Neoadjuvant chemoradiotherapy in non-cardia gastric cancer patients--does it improve survival?
BACKGROUND
Survival rates after resection of advanced gastric cancer are extremely poor. An increasing number of patients with gastric carcinomas (GC) are therefore being treated with preoperative chemotherapy. We evaluated 36 month survival rate of GC patients that were treated by adding a neoadjuvant chemoradiotherapy before gastrostomy.


METHODS
Patients with stage II or III gastric adenocarcinomas were enrolled. The patients divided into two groups: (A) Neoadjuvant group that received concurrent chemoradiation before surgery (4,500 cGy of radiation at 180 cGy per day plus chemotherapy with cisplatin and 5-fluorouracil, in the first and the end four days of radiotherapy). Resection was attempted 5 to 6 weeks after end of chemoradiotherapy. (B) Adjuvant group that received concurrent chemo-radiation after surgical resection.


RESULTS
Two (16.7%) patients out of 12 patients treated with neoadjuvant chemo-radiotherapy and 5 (38.5%) out of 13 in the surgery group survived after 36 months. These rates were not significantly different with per protocol and intention-to-treat analysis. The median survival time of patients in group A and B were 13.4 and 21.6 months , respectively, again not significantly different. Survival was significantly greater in patients with well differentiated adenocarcinoma in group B than in group A (p<0.004).


CONCLUSIONS
According to this study we suggest surgery then chemoradiotherapy for patients with well differentiated gastric adenocarcinoma rather than other approaches. Additional studies with greater sample size and accurate matching relying on cancer molecular behavior are recommended.
Radiation Oncology, Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences Rasht, Iran E-mail : ghanaie@yahoo.com.
Hamid Saeidi
HS
Saedi
Fariborz
F
Mansour-Ghanaei
Farahnaz
F
Joukar
Afshin
A
Shafaghi
Soodabeh
S
Shahidsales
Zahra
Z
Atrkar-Roushan
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D002299:Cardia / Q000473:pathology; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D007492:Iran; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome