title: Radiotherapy patterns of care in gastric adenocarcinoma: a single institution experience.
abstract: BACKGROUND
  Gastric adenocarcinoma (GAC) is one of the most commonly diagnosed cancers worldwide. Two standard approaches for treatment of resectable GAC include adjuvant 5-fluorouracil-based chemoradiotherapy [per Intergroup 0116 (INT-0116) trial and perioperative epirubicin, cisplatin, fluorouracil (ECF) chemotherapy per Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial]. Controversy remains regarding the most appropriate treatment strategy to decrease recurrence rates and improve survival following surgery. The purpose of this study was to analyze how patterns of care for patients with GAC treated at Emory University Hospital changed following publication of the MAGIC trial in 2006.
  
  
  METHODS
  We analyzed a prospectively maintained database of 150 patients who underwent resection for GAC between December 2000 and June 2013. Patients were divided into two cohorts, Early [2000-2006] and late [2007-2013]. The primary objective was to compare the number of patients assigned to adjuvant chemoradiotherapy (aCRT) vs. perioperative chemotherapy (PC) throughout the study period and secondarily assess for recurrence patterns and survival outcomes for patients assigned to those two strategies.
  
  
  RESULTS
  Between 2000 and 2013, 124 patients received adjuvant therapy for GAC. Fifty-four patients were treated with PC and 70 patients with aCRT. The early cohort included 56 patients, and the late cohort included 94 patients. There was no statistical difference in the number of patients receiving aCRT between the Early and Late cohorts [n=23 (50%) vs. 35 (38%) respectively, P=0.21]. PC increased from 2 patients (3.6%) in the Early cohort to 32 patients (34%) in the Late cohort (P<0.001). Four-year overall survival (OS) was 32.6% for the Early cohort and 68.8% for the Late cohort (P=0.010). Overall recurrence rate was 25.3% with no significant difference in rates of recurrence seen between the Early and Late cohorts.
  
  
  CONCLUSIONS
  PC has become more prevalent in patients treated at Emory following publication of the MAGIC trial in 2006. OS, but not recurrence rates, has also improved since publication. Although improved survival is suggestive of improved care, the question of optimal treatment regimen remains open. Further prospective comparisons of PC and aCRT are needed to identify patient and disease parameters that may guide therapy selection.
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Cheng
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Mikell
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Fisher
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: El-Rayes
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Hall
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Colbert
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Shelton
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Landry
authors.affiliation: 1 Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA ; 2 Division of Surgical Oncology, Department of Surgery, 3 Department of Radiation Oncology, 4 Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, NE Atlanta, GA 30322, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Yu
keywords: D2 lymphadenectomy; Gastric adenocarcinoma (GAC); Intergroup 0116 trial (INT-0116 trial); Medical Research Council Adjuvant Gastric Infusional Chemotherapy trial (MAGIC trial); patterns of care; radiation therapy