title: Adjuvant Therapy Completion Rates in Patients with Gastric Cancer Undergoing Perioperative Chemotherapy Versus a Surgery-First Approach.
abstract: Delayed recovery after gastrectomy may preclude the administration of adjuvant therapy in a significant percentage of patients who undergo elective gastrectomy as the initial therapy for gastric cancer. Clinicopathologic and treatment variables of 155 patients undergoing potentially curative gastrectomy for stages Ib-IIIc gastric adenocarcinoma from 2001 to 2014 were analyzed, and rates of receipt of chemotherapy and radiotherapy in patients treated with either a surgery-first approach (SURG) or neoadjuvant therapy followed by surgery followed by postoperative therapy (PERIOP) were compared. SURG patients (n = 93) were older and more likely to have distal tumors and to undergo distal gastrectomy and D1 lymphadenectomy than PERIOP patients (n = 62). The distribution of ASA scores was similar between groups. SURG patients were less likely than PERIOP patients to complete at least one cycle of chemotherapy (56 vs 100%, P = 0.001) and all recommended chemotherapy and radiation therapy (44 vs 66%, P = 0.013). These findings were consistent for SURG patients treated during different time periods throughout the study and for patients of poorer performance status. A significantly higher percentage of gastric cancer patients treated with perioperative chemotherapy receive some or all of the recommended components of multimodality therapy than patients treated with a surgery-first approach.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Fuentes
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Theodore S
authors.initials: TS
authors.lastname: Hong
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Clark
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Eunice L
authors.initials: EL
authors.lastname: Kwak
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.affiliation: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA. jmullen@partners.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery / Q000628:therapy*
keywords: Adjuvant therapy completion; Gastric cancer; Perioperative chemotherapy; Surgery first