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Adjuvant radiochemotherapy in locally advanced gastric cancer

Treatment results and analysis of possible prognostic factors

Adjuvante Radiochemotherapie beim lokal fortgeschrittenen Magenkarzinom

Behandlungsergebnisse und Analyse möglicher prognostischer Faktoren

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Abstract

Background

The aim of this study was to report the clinical outcome and toxicity of radiochemotherapy in locally advanced gastric cancer (LAGC) patients treated according to the Intergroup 116 trial protocol in our institution.

Methods

We retrospectively reviewed 105 patients with LAGC treated with radical surgery and adjuvant radiochemotherapy. We analyzed overall survival (OS), disease-free survival (DFS), locoregional failure-free survival (LFS), prognostic factors and toxicity.

Results

The mean follow-up was 96.48 months. The majority of tumors were T3–T4 (75%) and 86.6% had nodal metastases. The OS, DFS and LFS rates to 3 years were 53.48%, 52.75% and 81.65%, respectively and to 5 years 40%, 46.73% and 76.77% respectively. The univariate analysis showed that N stage < N2, TN stage < IIIA, R0 resection and N‑ratio < 3 were statistically significant prognostic factors for OS and DFS, T stage < T4 for OS and N‑ratio < 3 for LFS. The group with D2 lymphadenectomy had worse LFS than the D1 group (65.2% vs 88.1%, respectively, p = 0.039) probably due to a significant difference in the proportion node positive patients in the D2 group (94% vs. 78%; p = 0.027). In the multivariate analysis, only R0 resection was statistically significant factor for improved OS (p = 0.018). Acute grade III–IV gastrointestinal and hematologic toxicity rates were 8.5% and 15.2%, respectively and 89.5% completed treatment as planned.

Conclusion

Our results are consistent with those of the Intergroup-0116 trial for LAGC in terms of survival. This regimen is well tolerated and with acceptable toxicity. An R0 resection was an independent prognostic factor for improved OS.

Zusammenfassung

Hintergrund und Ziel

Das Ziel dieser Studie ist es, über die klinischen Ergebnisse und die Toxizität der adjuvanten Radiochemotherapie bei lokal fortgeschrittenem Magenkarzinom (LFM) entsprechend der Intergroup-0116-Studie in unserem Krankenhaus zu berichten.

Methode

Es erfolgte eine retrospektive Auswertung von 105 Patienten mit LFM, welche mittels Operation und adjuvanter Radiochemotherapie behandelt wurden. Wir analysierten das Gesamtüberleben (OS), das krankheitsfreie Überleben (DFS), das lokoregional freie Überleben (LFS) sowie prognostische Faktoren und Toxizität.

Ergebnisse

Die mediane Beobachtungszeit betrug 96,48 Monate. Die Mehrheit der Tumoren waren T3–T4 (75 %) und 86,6 % waren lymphogen metastasiert. Das OS, DFS und LFS betrugen 53,48 %, 52,75 % und 81,65 % nach 3Jahren bzw. 40 %, 46,73 % und 76,77 % nach 5 Jahren. Die univariate Analyse zeigte, dass N‑Stadium < N2, TN-Stadium < IIIA, R0-Resektion und N‑Ratio < 3 statistisch signifikante prognostische Faktoren bezüglich OS und DFS waren; T‑Stadium < T4 für OS und N‑Ratio < 3 für LFS. Die Gruppe mit D2-Lymphadenektomie hatte ein schlechteres LFS als die D1-Gruppe (65,2 % vs. 88,1 %; p = 0,039), vermutlich hervorgerufen durch einen signifikanten Unterschied in der Patientenverteilung mit Lymphknotenmetastasen in D2 (94 % vs. 78 %; p = 0,027).

In der multivariaten Analyse war lediglich die R0-Resektion ein statistisch signifikanter Faktor für ein verbessertes OS (p = 0,018). Akute gastrointestinale und hämatologische Toxizität Grad III–IV traten bei 8,5 % bzw. 15,2 % auf. 89,5 % der Therapien konnten wie geplant abgeschlossen werden.

Schlussfolgerung

Unsere Resultate zeigen, dass das Überleben nach adjuvanter Radiochemotherapie bei Patienten mit LFM, welche in unserem Institut behandelt wurden, vergleichbar war mit der Intergroup 0116. Auch wurde die Behandlung mit akzeptabler Toxizität gut toleriert. R0-Resektion war ein unabhängiger prognostischer Faktor für ein verbessertes OS.

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Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9,100, 28034, Madrid, Spain

    Mercedes Martín Sánchez

  2. Department of Radiation Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain

    Maria Ángeles Pérez Escutia, Sandra Guardado Gonzales, Ana María Cabezas Mendoza, Arantxa Campos Bonel, Héctor Pérez Montero, Rafael D’Ambrosi & José Fermín Pérez-Regadera Gómez

  3. Department of Statistics, Hospital Universitario 12 de Octubre, Madrid, Spain

    David Lora Pablos

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  1. Mercedes Martín Sánchez
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  2. Maria Ángeles Pérez Escutia
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Correspondence to Mercedes Martín Sánchez.

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Martín Sánchez, M., Pérez Escutia, M.Á., Lora Pablos, D. et al. Adjuvant radiochemotherapy in locally advanced gastric cancer. Strahlenther Onkol 193, 1005–1013 (2017). https://doi.org/10.1007/s00066-017-1173-2

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