title: Adjuvant chemoradiation in gastric cancer: long-term outcomes and prognostic factors from a single institution.
abstract: BACKGROUND
  Adjuvant chemoradiotherapy (CRT) improves relapse-free (RFS) and overall survival (OS) in patients with resected gastric cancer. However, difficulties in standardizing an optimal surgical approach and a perceived higher toxicity compared with the perioperative approach have limited its widespread application in Europe. The aim of our study was to assess toxicity and long-term outcomes of adjuvant CRT at our institution.
  
  
  METHODS
  A retrospective review (September 2001-January 2012) was completed of patients with resected gastric cancer who received adjuvant CRT (Macdonald regimen). Adverse events and completion rates, RFS and OS were estimated. Univariate and multivariate analyses of prognostic factors for OS were performed.
  
  
  RESULTS
  Eighty-seven patients were included. Most had diffuse (52%) and locally advanced tumors (stage III-IV; 66.7%). D2 lymphadenectomy was performed in 80.5%. The most frequent grade 3-4 toxicities were gastrointestinal (28%) and stomatitis (20%), with 78.2% completing treatment. With a median follow-up of 115 months, 58.5% had relapsed, most of them distantly. Median RFS and OS were 9 and 24 months, respectively. Univariate analysis showed that performance status, stage and lymph node burden were significant factors for OS. In the multivariate study, only stage and lymph node burden remained as independent OS predictors.
  
  
  CONCLUSIONS
  Our implementation of the Macdonald regimen achieved worse outcomes than those reported in the INT-0116 trial. The rate of distant relapse remains unacceptably high. Higher rate of positive lymph nodes and of diffuse tumors could explain some differences. The use of perioperative chemotherapy, especially in patients with a poorer prognosis, might improve these results.
authors.affiliation: Department of Medical Oncology, La Fe University and Polytechnic Hospital, Valencia - Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Bruixola
authors.forename: Ángel
authors.initials: Á
authors.lastname: Segura
authors.forename: Robert
authors.initials: R
authors.lastname: Díaz-Beveridge
authors.forename: Javier
authors.initials: J
authors.lastname: Caballero
authors.forename: Mohamed Hassan
authors.initials: MH
authors.lastname: Bennis
authors.forename: Laura
authors.initials: L
authors.lastname: Palomar
authors.forename: Alejandra
authors.initials: A
authors.lastname: Giménez
authors.forename: Fernando
authors.initials: F
authors.lastname: Mingol
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Mora
authors.forename: Jorge
authors.initials: J
authors.lastname: Aparicio
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D004334:Drug Administration Schedule; D005060:Europe; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002955:Leucovorin; D005472:Fluorouracil