Skip to main content

Advertisement

SpringerLink
Log in

Comparison of two different adjuvant treatment modalities for pN3 gastric cancer patients after D2 lymph node dissection: can we avoid radiotherapy in a subgroup of patients?

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Adjuvant chemoradiotherapy (CRT) is the standard of care for gastric cancer patients in the USA. However, in countries where D2 lymph node dissection is performed, the effect of radiotherapy on locoregional recurrence is controversial. The aim of this study is to compare the outcomes in pN3 gastric cancer patients following two adjuvant treatment modalities: chemotherapy (CT) and CRT after D2 lymph node dissection. Between 2005 and 2009, 71 gastric cancer patients who underwent D2 lymph node dissection and had pTanyN3M0 stage (according to AJCC 6th edition) were identified. Fifty-three patients were treated with CT and 18 patients received CRT. CRT consisted of bolus fluorouracil (FU) 425 mg/m2 and leucovorin 20 mg/m2 before, after, and during radiotherapy. For the CT arm, treatment protocols consisted of combination therapies involving FU and cisplatin as the backbone. Median overall survival (OS) and disease-free survival (DFS) rates for all patients were 26.3 months (15–37.7 months) and 12.5 months (8–17.1 months). Median OS in CT arm was 26.8 months and it was 34.2 months for CRT arm (p = 0.74). DFS rates did not differ statistically either (p = 0.56, 12.5 and 15.2 months for CT and CRT, respectively). Locoregional recurrence rates were also similar (p = 0.63). Only metastatic/dissected lymph node ratio (≥0.75) was identified as a prognostic factor in both univariate and multivariate analyses for DFS. Comparison of CT versus CRT for N3 stage gastric cancer patients with D2 lymph node dissection did not reveal any statistically significant difference in survival rates and locoregional recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dockerty M. Pathologic aspects of primary malignant neoplasms of the stomach. In: ReMine W, Priestley J, Berkson J, editors. Cancer of the stomach. Philadelphia: Saunders; 1964. p. 173.

    Google Scholar 

  2. Kennedy BJ. TNM classification for stomach cancer. Cancer. 1970;26:971–83.

    Article  PubMed  CAS  Google Scholar 

  3. Gunderson LL, Hoskins RB, Cohen AC, Kaufman S, Wood WC, Carey RW. Combined modality treatment of gastric cancer. Int J Radiat Oncol Biol Phys. 1983;9:965–75.

    Article  PubMed  CAS  Google Scholar 

  4. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.

    Article  PubMed  CAS  Google Scholar 

  5. Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, et al. 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. 2012;30(19):2327–33.

    Article  PubMed  CAS  Google Scholar 

  6. Lee J, Lim DH, Kim S, Park SH, Park JO, Park YS, et al. 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. 2012;30(3):268–73.

    Article  PubMed  CAS  Google Scholar 

  7. Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: fifth Edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer. 2000;88(4):921–32.

    Article  PubMed  CAS  Google Scholar 

  8. Chae S, Lee A, Lee JH. The effectiveness of the new 7th UICC N classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 5th/6th and 7th UICC N classification. Gastric Cancer. 2011;14:166–71.

    Article  PubMed  Google Scholar 

  9. Kim S, Lim DH, Lee J, et al. 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. 2005;63:1279–85.

    Article  PubMed  Google Scholar 

  10. Leong CN, Chung HT, Lee KM, Shakespeare TP, Mukherjee RK, Wong LC, et al. Outcomes of adjuvant chemoradiotherapy after a radical gastrectomy and a D2 node dissection for gastric adenocarcinoma. Cancer J. 2008;14(4):269–75.

    Article  PubMed  CAS  Google Scholar 

  11. Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245(4):543–52.

    Article  PubMed  Google Scholar 

  12. Huang CM, Lin BJ, Lu HS, Zhang XF, Li P, Xie JW. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol. 2008;21(14):4383–8.

    Article  Google Scholar 

  13. Lee SY, Hwang I, Park YS, Gardner J, Ro JY. Metastatic lymph node ratio in advanced gastric carcinoma: a better prognostic factor than number of metastatic lymph nodes? Int J Clin Oncol. 2010;36(6):1461–7.

    Google Scholar 

  14. Cirera L, Balil A, Batiste-Alentorn E, et al. Randomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancer. J Clin Oncol. 1999;17:3810–5.

    PubMed  CAS  Google Scholar 

  15. Neri B, Cini G, Andreoli F, Boffi B, Francesconi D, Mazzanti R, et al. Randomized trial of adjuvant chemotherapy versus control after curative resection for gastric cancer: 5-year follow-up. Br J Cancer. 2001;84:878–80.

    Article  PubMed  CAS  Google Scholar 

  16. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.

    Article  PubMed  CAS  Google Scholar 

  17. Janunger KG, Hafstrom L, Glimelius B. Chemotherapy in gastric cancer: a review and updated meta-analysis. Eur J Surg. 2002;168:597–608.

    Article  PubMed  CAS  Google Scholar 

  18. Sun P, Xiang JB, Chen ZY. Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer. Br J Surg. 2009;96:26–33.

    Article  PubMed  CAS  Google Scholar 

  19. Kwon HC, Kim MC, Kim KH, Jang JS, Oh SY, Kim SH, et al. Adjuvant chemoradiation versus chemotherapy in completely resected advanced gastric cancer with D2 nodal dissection. Asia Pac J Clin Oncol. 2010;6(4):278–85.

    Article  PubMed  Google Scholar 

  20. Zhu WG, Xua DF, Pu J, Zong CD, Li T, Tao GZ, et al. A randomized, controlled, multicenter study comparing intensity-modulated radiotherapy plus concurrent chemotherapy with chemotherapy alone in gastric cancer patients with D2 resection. Radiother Oncol. 2012;104:361–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

All authors state that the article is novel and original and have made substantial contributions to the information and/or material submitted for publication. All have read and approved the final manuscript and agreed to its submission. No authors have a substantial direct or indirect commercial financial incentive associated with the publication of the article.

Author information

Authors and Affiliations

  1. Medical Oncology Department, Institute of Oncology, Istanbul University, Capa, Istanbul, Turkey

    Leyla Kilic, Meltem Ekenel, Ibrahim Yildiz, Serkan Keskin, Fatma Sen & Faruk Aykan

  2. Medical Oncology Department, Bilim University Beyoglu, Istanbul, Turkey

    Cetin Ordu

  3. Radiation Oncology Department, Bezmialem Vakif University, Fatih, Istanbul, Turkey

    Zeynep Gural

  4. Department of General Surgery, Istanbul University, Capa, Istanbul, Turkey

    Oktar Asoglu

  5. Radiation Oncology Department, Institute of Oncology, Istanbul University, Capa, Istanbul, Turkey

    Ahmet Kizir

Authors
  1. Leyla Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cetin Ordu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meltem Ekenel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ibrahim Yildiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serkan Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fatma Sen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zeynep Gural
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Oktar Asoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ahmet Kizir
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Faruk Aykan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cetin Ordu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kilic, L., Ordu, C., Ekenel, M. et al. Comparison of two different adjuvant treatment modalities for pN3 gastric cancer patients after D2 lymph node dissection: can we avoid radiotherapy in a subgroup of patients?. Med Oncol 30, 660 (2013). https://doi.org/10.1007/s12032-013-0660-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-013-0660-2

Keywords

Search

Navigation