Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

  • Published : 2014.11.06
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Abstract

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high-risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.

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References

  1. Agboola O (1994). Adjuvant treatment in gastric cancer. Cancer Treat Rev, 20, 217-240. https://doi.org/10.1016/0305-7372(94)90001-9
  2. Cunningham D, Allum WH, Stenning SP, et al (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 355, 11-20. https://doi.org/10.1056/NEJMoa055531
  3. Czito BG, Palta M, Willett CG (2013). Stomach cancer. In: "Perez and Bradys Principles and Practice of Radiation Oncology 6th edition", Eds Halperin EJ, Wazer DE, Perez CA, Brady LW. Lippincott Williams &Wilkins, Philadelphia pp. 1165-88.
  4. de Aretxabala X, Konishi K, Yonemura Y, et al (1987). Node dissection in gastric cancer. Br J Surg, 74, 770-773. https://doi.org/10.1002/bjs.1800740904
  5. Dockerty M (1964). In "Cancer of the Stomach, Pathologic Aspects of Primary Malignant Neoplasms of the Stomach", eds ReMine W, Priestley J, Berkson J, WB Saunders, Philadelphia, PA, p 173.
  6. Douglass HO Jr, Nava HR (1985). Gastric adenocarcinomamanagement of the primary disease. Semin Oncol, 12, 32-45.
  7. Gao LL, Feng L, Yao ST, et al (2011). Molecular mechanisms of celery seed extract induced apoptosis via s phase cell cycle arrest in the BGC-823 human stomach cancer cell line. Asian Pac J Cancer Prev, 12, 2601-6.
  8. Hajmanoochehri F, Mohammadi N, Nasirian N, Hosseinkhani M (2013). Patho-epidemiological features of esophageal and gastric cancers in an endemic region: a 20-year retrospective study. Asian Pac J Cancer Prev, 14, 3491-7. https://doi.org/10.7314/APJCP.2013.14.6.3491
  9. Hartgrink HH, van de Velde CJ, Putter H, et al (2004). Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol, 22, 2069-77. https://doi.org/10.1200/JCO.2004.08.026
  10. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  11. Jing YM, Guo SX, Zhang XP, et al (2012). Association between C1019T polymorphism in the connexin 37 gene and Helicobacter pylori infection in patients with gastric cancer. Asian Pac J Cancer Prev, 13, 2363-7. https://doi.org/10.7314/APJCP.2012.13.5.2363
  12. Kim S, Lim DH, Lee J, et al (2005). An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys, 63, 1279-85. https://doi.org/10.1016/j.ijrobp.2005.05.005
  13. Lee J, Lim Do H, Kim S, et al (2012). Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol, 30, 268-73. https://doi.org/10.1200/JCO.2011.39.1953
  14. Macdonald JS, Smalley SR, Benedetti J, et al (2001). Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 345, 725-30. https://doi.org/10.1056/NEJMoa010187
  15. Martoni A, Cricca A, Guaraldi M, et al (1989). A randomized clinical trial with a weekly regimen of 5-fluorouracil with or without folinic acid in advanced gastrointestinal adenocarcinomas: a preliminary report. J Chemother, 1, 197-202.
  16. Ohri N, Garg MK, Aparo S, et al (2013). Who Benefits From Adjuvant Radiation Therapy for Gastric Cancer? A Meta-Analysis. Int J Radiat Oncol Biol Phys, 86, 330-5. https://doi.org/10.1016/j.ijrobp.2013.02.008
  17. Serlin O, Keehn RJ, Higgins GA Jr, et al (1977). Factors related to survival following resection for gastric carcinoma: analysis of 903 cases. Cancer, 40, 1318-29. https://doi.org/10.1002/1097-0142(197709)40:3<1318::AID-CNCR2820400349>3.0.CO;2-9
  18. Smalley SR, Benedetti JK, Haller DG, et al (2012). Updated Analysis of SWOG-Directed Intergroup Study 0116: A Phase III Trial of Adjuvant Radiochemotherapy Versus Observation After Curative Gastric Cancer Resection. J Clin Oncol, 30, 2327-33. https://doi.org/10.1200/JCO.2011.36.7136
  19. Songun I, Putter H, Kranenbarg EM, et al (2010). Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 11, 439-49. https://doi.org/10.1016/S1470-2045(10)70070-X
  20. Takeda S, Taguchi T, Ohta J, et al (1995). A cooperative late phase II trial of l-leucovorin and 5-fluorouracil in the treatment of advanced gastric cancer. l-Leucovorin and 5-FU Study Group (Japan Western Group). Gan To Kagaku Ryoho, 22, 903-10.
  21. Tamura S, Takeno A, Miki H (2011). Lymph node dissection in curative gastrectomy for advanced gastric cancer. Int J Surg Oncol, 2011, 748-5.
  22. Van Cutsem E, Van de Velde C, Roth A, et al (2008). Expert opinion on management of gastric and gastro-oesophageal junction adenocarcinoma on behalf of the European Organisation for Research and Treatment of Cancer (EORTC).-gastrointestinal cancer group. Eur J Cancer, 44, 182-194. https://doi.org/10.1016/j.ejca.2007.11.001
  23. Vanhoefer U, Wilke H, Weh HJ, et al (1994). Weekly highdose 5-fluorouracil and folinic acid as salvage treatment in advanced gastric cancer. Ann Oncol, 5, 850-1.
  24. Wani M, Afroze D, Makhdoomi M, et al (2012). Promoter methylation status of DNA repair gene (hMLH1). in gastric carcinoma patients of the Kashmir valley. Asian Pac J Cancer Prev, 13, 4177-81. https://doi.org/10.7314/APJCP.2012.13.8.4177
  25. Zhang WY, Zhang WJ, Bai Y, et al (2013). Impact of adjuvant chemotherapy cycles on prognosis of resectable stomach cancer: a retrospective analysis. Asian Pac J Cancer Prev. 14, 381-6. https://doi.org/10.7314/APJCP.2013.14.1.381
  26. Zhu WG, Xua DF, Pu J, et al (2012). A randomized, controlled, multicenter study comparing intensitymodulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection. Radiother Oncol, 104, 361-6. https://doi.org/10.1016/j.radonc.2012.08.024

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