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Gastric cancer recurrence after resection and adjuvant chemoradiation

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objectives

Surgery remains the primary therapy for locally advanced gastric cancer, but locoregional recurrence (LRR) has been documented in up to 68.6 % of patients with surgery alone. Peri- or post-operative adjuvant treatment improves survival. The objective of this study is to examine rates and patterns of recurrence following resection and adjuvant chemoradiation.

Methods

We reviewed consecutive patients undergoing adjuvant chemoradiation (45 Gy/25 with 5-FU-based chemotherapy) for resected gastric adenocarcinoma (Stages Ib-IV) at the Princess Margaret Cancer Centre between January 1, 2000, and November 30, 2009. Site of first disease recurrence, overall survival (OS) and relapse-free rates (RFR) was determined.

Results

Among 197 patients identified, median age was 58.4 (range 21.6–79.5) years and median follow-up 28.7 (range 4.0–99.4) months. The majority were male (62.9 %), with stage II (33.0 %) or III (39.6 %) disease. Three-year OS and RFR were 66.7 and 57.7 % respectively; 71 patients relapsed. Isolated LRR was seen in 14 (7.1 %), while 48 (24.4 %) had isolated distant and 9 (4.6 %) had both LRR and distant relapses. In multivariate analysis, only T-category is a significant predictor for RFR (p = 0.009), whilst age (p = 0.03), T-category (p = 0.001), N-category (p = 0.02) and type of surgery (p = 0.046) were significant predictors for OS.

Conclusions

Isolated LRR in this study was uncommon. The predominant pattern was distant failure. This is in keeping with other studies that have observed lower rates of LRR with adjuvant chemoradiation after curative resection of gastric cancer.

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Conflict of interest

Jasmin Loh, Steve MacLellan, Allan Okrainec, Helen Mackay, Lindsay Jacks, Jenna Sykes, Zahra Kassam, Tatiana Conrad, Ida Khalili and Jolie Ringash declare that they have no conflict of interest.

Ethical standards statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of informed consent

All patients provided informed consent prior to receiving treatment. Statement of informed consent for study participation was not applicable, as the study reported here was a retrospective analysis of patients receiving “standard-of-care” treatment. The manuscript does not contain any specific patient-identifying data.

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Authors and Affiliations

  1. Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada

    Jasmin Loh, Helen MacKay, Lindsay Jacks, Jenna Sykes, Zahra Kassam, Tatiana Conrad & Jolie Ringash

  2. University Health Network, Toronto, ON, Canada

    Steve MacLellan, Allan Okrainec & Ida Khalili

Authors
  1. Jasmin Loh
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  2. Steve MacLellan
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  3. Allan Okrainec
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  4. Helen MacKay
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  5. Lindsay Jacks
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  6. Jenna Sykes
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  7. Zahra Kassam
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  8. Tatiana Conrad
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  9. Ida Khalili
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  10. Jolie Ringash
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Correspondence to Jasmin Loh.

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Loh, J., MacLellan, S., Okrainec, A. et al. Gastric cancer recurrence after resection and adjuvant chemoradiation. J Radiat Oncol 4, 79–85 (2015). https://doi.org/10.1007/s13566-015-0183-x

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  • DOI: https://doi.org/10.1007/s13566-015-0183-x

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