ABSTRACT
Background: Overall 5 years survival for surgically excised gastric cancer is 30 percent. Adjuvant treatment may improve the surgical results. Aim: To assess treatment results and toxicity in patients with surgically excised gastric cancer, treated with adjuvant radiotherapy and concomitant continuous 5-Fluorouracil (5-FU). Material and Methods: Forty one patients aged 32 to 73 years (29 males) with stage II-IVA gastric cancer, subjected to a total or subtotal gastrectomy and D2 nodal dissection between 1997 to 2006, were studied. They received adjuvant radiotherapy to the gastric bed and draining lymphatic nodes in a total dose of 50.4 Gy in 28 fractions and chemotherapy with continuous infusión 5-FU, 200 mg/m²/day. Results were compared to historical controls matched according to demographic parameters and tumor characteristics. Results: Eighteen patients were in stage II, 10 in stage IIIA, nine in stage IIIB and four in stage IVA. Twelve patients had an NO nodal status, 15 were NI, nine were N2 and five were N3. After a mean follow up of 32 months, 26 patients (63 percent) were alive. Five year overall survival was 49.6 percent for surgery plus radiochemotherapy compared to 30.7 percent for the historical group subjected only to surgery (p =0.002). Radiotherapy was associated with grade 1-2 toxicity and treatment was completed without interruptions in all patients. Chemotherapy was delayed temporarily in 3 patients. Conclusions: Adjuvant radio-chemotherapy improved overall survival in gastric cancer, compared to historical controls subjected only to surgical treatment.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Stomach Neoplasms/drug therapy , Stomach Neoplasms/radiotherapy , Adenocarcinoma/surgery , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Chemotherapy, Adjuvant , Fluorouracil/administration & dosage , Postoperative Care , Radiation Dosage , Radiotherapy, Adjuvant , Stomach Neoplasms/surgery , Survival RateABSTRACT
Background: Chemotherapy improves survival in advanced gastric cancer. However the most active combinations have a high level of toxicity that limits their use. Aim: To assess the response, toxicity and survival of patients with advanced gastric cancer, treated with oxaliplatin plus 5-fluorouracil/leucovorin (FOLFOX-4 chemotherapy). Material and methods: Patients with stage IVgastric cancer, according to the American Joint Committee on Cancer or with relapsed disease and functional capacity 0-2 of the South West Oncology Group, were included. FOLFOX-4 chemotherapy was used as first or second line treatment. The response to treatment and survival were assessed. Results: Between 2003 and 2006, 29 patients (median age 52.5 years, 69 percent males) were treated. FOLFOX-4 was given as first line treatment in 65 percent patients and as second line in 35 percent. There was a complete response in 4.6 percent, partial response in 68 percent, stable disease in 20.6 percent and progression in 6.8 percent. Toxicity was observed in 51 percent of patients, that was hematological and non hematological grade 3/4 in 14 percent. Median survival was 12.5 months. Conclusions: FOLFOX-4 chemotherapy was active in advanced gastric cancer and had a low level of toxicity.