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Objective The aim of this study was to investigate whether the addition of neoadjuvant chemoradiotherapy ( NACRT ) to surgery can improve outcomes better than neoadjuvant chemotherapy in terms of rate of R0 resection, pathological complete response ( pCR ) and side effects. Methods This exploratory study included primary gastric adenocarcinoma patients staged as clinical T4N0 or anyTN1-3. Intensity modulated radiotherapy was delivered of 40 to 50 Gy in 22 to 25 fractions,5 days/week.Concurrent chemotherapy regimens included S-1 or Capecitabine or a combination of Paclitaxel plus Carboplatin.Results Eleven eligible patients were enrolled. R0 and R2 resections were performed in 9 ( 9/11) and 1 patients, respectively.Peritoneal metastasis was found in 1 case during exploratory laparotomy.The pCR was observed in 1 patient with R0 resection ( 1/10 ) . Ten cases completed radiotherapy and 8 cases completed chemotherapy. Nausea ( 3/11 ) , vomit ( 2/11 ) and anorexia ( 2/11 ) were the most common Grade 3 toxicities. Conclusions NACRT showed an acceptable toxicity and promising activity in locally advanced gastric adenocarcinoma.
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ObjectiveTo compare the role of AJCC 6th and 7th TNM staging systems in predicting the long term survival of locally advanced gastric cancer patients after curative surgery. Methods All patients who met the following criteria were included for analyses: treated between January 2002 and December 2004, primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and at least more than D1 lymphadenectomy, pathologically staged as T3-4N0-1 M0, or any T, N2-3M0. Overall survival (OS), disease-free survival ( DFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were calculated and compared according to N and TNM stage of the two TNM staging systems (T stage were not analyzed due to its extremely unbalanced distribution). The N and TNM stage and other significant variables in univariate analyses were evaluated further for both OS and DFS by Cox regression. ResultsThe median follow-up time was 61 months. The follow-up rate was 92. 3％.Among the 297 enrolled patients, 56. 9％ of the patients had a stage migration between the two staging systems. According to 6th, no difference in DMFS was detected between different N and TNM stages (x2 =6. 65, P =0. 084 ; x2 =6. 61, P =0. 108 ). When using 7th, statistically significant difference was found in DMFS between different N stages ( x2 =9. 035,P =0. 029), and TNM stage also tended to have an influence on DMFS ( x2 =7.27,P =0. 064). The N and TNM stage had similar significant influence on OS, DFS and LRFS based on both staging systems ( x2 =9. 23 - 19. 00,P =0. 000 -0. 026 and x2 =11.67 - 19. 11 ,P =0. 000 -0. 009).In Cox regression, TNM stage was an independent prognostic variable for both OS and DFS based on these two staging systems (x2=9.05-25.51, P=0.000-0.003 ), but the 7thappeared to be a better predictor than the 6 th ( OS : RR =1.6 1 8 vs 1.4 9 6 ; DFS : RR =1.5 9 4 vs 1. 5 6 4 ).ConclusionsThe N and TNM stage in 7th TNM staging system are more predictive for DMFS than in 6th TNM staging system for locally advanced gastric cancer patients. The 7th TNM staging system provides a better prognostic estimation of both OS and DFS.
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Objective To identify high-risk group among gastric cancer patients treated with curative resection and more than D1 dissection, and investigate the indications for proper adjuvant therapy.Methods 297 patients who met the following enrolled criteria were retrospectively analyzed:treated between January 2002 and December 2004, primary gastric or gastroesophageal cancer, underwent curative gastrectomy and more than D1 lymphadenectomy, pathologically staged as T3-4N0-1M0,or TxN2-3M0.The overall survival (OS), disease-free survival (DFS), local-regional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were calculated, and possible prognostic factors were analyzed.Results The median follow-up time was 61 months.The follow-up rate was 92.3%.The 5-year OS, DFS, LRFS and DMFS were 57.9%, 52.2%, 70.6% and 71.7%, respectively.Four independent prognostic variables identified for OS, DFS, LRFS and DMFS using multivariate analysis were Borrmann type (Ⅰ+Ⅱ/Ⅲ+Ⅳ), total number of dissected lymph nodes (>18/≤18), number of positive lymph nodes (0-3/≥4), and 6th AJCC TNM stage (Ⅱ+Ⅲ a/Ⅲ b+ⅣM0)(χ2=3.94-16.34,P<0.05).If one unfavorable prognostic factor was scored as 1, according to the total scores of the four prognostic factors, four risk groups were generated as low (score:0), low-intermediate (score:1), high-intermediate (score:2) and high risk group (score:3 or 4).The 5-year OS, DFS, LRFS and DMFS were 85.7%, 61.0%, 58.6% and 38.6%(χ2=31.20,P<0.01) in low risk group, 85.2%, 61.3%, 48.1% and 31.8%(χ2=31.88,P<0.01) in low-intermediate risk group, 94.4%, 77.8%, 64.4% and 57.2%(χ2=18.36,P<0.01) in high-intermediate risk group and 87.9%, 75.0%, 74.2% and 55.5%(χ2=19.30,P<0.01) in high risk group.Conclusions Even with R0 resection and more than D1 lymphadenectomy, the outcome was poor for gastric cancer patients with two or more unfavorable prognostic factors.Prospective study is warranted to evaluate the efficacy of adjuvant concurrent chemoradiotherapy for this group of patients.
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Objective The benefit of adjuvant chemoradiotherapy remains controversial for gastric cancer patients treated with more than D1 dissection. This retrospective analysis is to distinguish the first site of recurrence in patients treated with curative resection and more than D1 dissection and to find any feasible adjuvant concurrent chemoradiotherapy recommendation for them. Methods All patients treated between January 2002 and December 2004 who met the following criteria were analyzed: primary gastric or gastroesophageal cancer, underwent curative gastrectomy ( UICC R0 ) and more than D1 lymphadenectomy,pathologically staged as T3-4N0-1 M0, or any Tx N2-3M0. There were 297 patients analyzed and 19.5%,52. 2%, 17. 8% , 10. 4% of patients had stage Ⅱ ( T3 N0 M0, T1 N2 M0 ), Ⅲa, Ⅲb and Ⅳ ( M0 ) diseases,respectively. 76. 1% of patients received adjuvant chemotherapy, while Only 2 patients underwent adjuvant radiotherapy. Failure patterns and the prognostic factors for locoregional recurrence were analyzed. Results The median follow-up time was 61 months and the follow-up rate was 92. 3%. 145 patients developed recurrence with a median recurrent time of 26 months. Locoregional recurrence was observed in 82 patients and distant metastasis in 79 patients. Gastric stump, anastomosis, intra-abdominal lymph nodes were the most common sites of locoregional recurrence. Liver and lung were the most frequent sites of distant metastasis. Prognostic variables for locoregional recurrence were identified after univariate analysis,including pathologic type ( χ2 = 11.50, P = 0. 009 ), total number of dissected lymph nodes ( χ2 = 6. 65,P =0. 010), the number of positive lymph node ( χ2 =5. 80,P =0. 016), lymph node capsular invasion ( χ2 =pathologic type, total number of dissected lymph nodes, lymph node capsular invation, AJCC TNM stage and Borrmann type were independent prognostic factors for locoregional recurrence ( χ2 = 6. 77,19. 33,17. 84 and 6. 02,P =0. 009,0. 000,0. 000 and 0. 014). ConclusionsLocoregional recurrence remains the main cause of failure for locally advanced gastric or gastroesophageal cancer patients even though the patients have had more than D1 lymphadenectomy. The role of adjuvant concurrent hemoradiotheray for those patients is warranted.
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Purpose:To evaluate the safety and efficacy of the box-shape field technique of radiotherapy for postoperative gastric carcinoma.Methods:Thirty-two patients of gastric carcinoma after subtotal or total gastrectomy with an extensive (D2) lymph-node dissection were irradiated with a total dose of 46～50Gy Gy of external box-shape field technical in 23-25 fractions by linac with 6-MV photons. All patients received concomitant chemotherapy which two cycles of paclitaxel (135mg/m~2 ) and cisplatin (70mg/m~2) in d1-3 and d29-31.Results:The overall survival,the relapse free survival of two years of all patients was 87.50% and 16.67%, respectively. 32 patients with treatment failure had recurrent disease, 4 (6.3%)in the liver,2(6.3%) in the peritoneum, 2(12.5%) in the anastomosis ,respectively. the plan of box-shape fields were evaluated with dose-volume histogram of three-dimensional therapy plan system, The 90% isodose line included the whole clinical target volume,and the dose of organat at rist was under the tolerance dose, except the dose of left kidney.Conclusions:The box-shape field technique of radiotherapy for postoperative gastric carcinoma were a technique which the dose distribution of clinical target volume was satisfaction ,and well tolerated with no severe side effects.[