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Volume 14, Number 5, 2009

Preoperative neoadjuvant chemoradiation for locally advanced gastric adenocarcinoma

Josef Dvorak, Bohuslav Melichar, Jiri Petera,  Karel Kabelac, Milan Vosmik, Pavel Vesely, Igor Sirak, Zdenek Zoul, Ales Ryska, Pavel Jandik

Summary:

Aims and Background

To evaluate toxicity and the radical resection rate in gastric adenocarcinoma treated with preoperative neoadjuvant chemoradiation.

Materials & Methods

32 patients, 22 males and 10 females with gastric adenocarcinoma, were treated with chemoradiation and hyperthermia.

Results

The neoadjuvant regimen was completed as planned in 19/32 (59 %) patients; in the remaining patients the intensity of chemotherapy had to be reduced because of haematological and gastrointestinal toxicity. Surgical stage was as follows: 2 patients pathologically complete response, 3 patients AJCC stage I.A, 5 patients stage I.B, 7 patients stage II, 7 patients stage III.A, 1 patient stage III.B, 7 patients stage IV. R0 resection was achieved in 19/32 (59%) patients, R1 in 2/32 (6%) patients and R2 in 11 (34%) patients. Downstaging after neoadjuvant chemoradiotherapy was achieved in 17/32 (53%) patients. At the date of evaluation (31 March 2009), 4 patients were still alive 58, 81, 86 and 98 months from the date of diagnosis. Median survival was 18 months (95% confidence interval: 13–38 months). One-year survival was 69% (95% confidence interval: 53%–85%). Four-year survival was 19% (95% C.I.: 5%–34%).

Conclusions

Preoperative neoadjuvant chemoradiotherapy has acceptable toxicity, and can lead to a high rate of R0 resections.

Signature: Rep Pract Oncol Radiother, 2009; 14(5) : 169-175


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http://www.sciencedirect.com/science/journal/15071367/19/2