Patterns of Response After Preoperative Treatment in Gastric Cancer
Presented in part at the 50th Annual Meeting of the American Society for Radiation Oncology, September 21–25, 2008, Boston, MA.
Received 30 December 2009; received in revised form 24 February 2010; accepted 3 March 2010. published online 26 July 2010. Corrected Proof
Purpose
To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution.
Methods and Materials
From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3–4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4–6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment.
Results
Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%.
Conclusions
The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.
∗Division of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
†Division of Medical Oncology, Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
‡Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
§Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
Reprint requests to: Juan A. Diaz-Gonzalez, M.D., Department of Oncology, Clinica Universidad de Navarra, Avda. Pio XII 36, Pamplona 31008. Spain. Tel: (+34) 948-255-400; Fax: (+34) 948-255-500
Conflict of interest: J.M. Garcia-Foncillas is a consultant with Roche Pharmaceuticals Division and with Sanofy-Aventis. J.M. Garcia-Foncillas has received research grants from Sanofy-Aventis and from Roche.
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