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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.

Juan A. Díaz-González, M.D.Corresponding Author Informationemail address, Javier Rodríguez, M.D., José L. Hernández-Lizoain, M.D., Raquel Ciérvide, M.D., Miren Gaztañaga, M.D., Iñigo San Miguel, M.D., Leire Arbea, M.D., J. Javier Aristu, M.D., Ana Chopitea, M.D., Fernando Martínez-Regueira, M.D., Víctor Valentí, M.D., Jesús García-Foncillas, M.D., Rafael Martínez-Monge, M.D., Jesús J. Sola, M.D.§

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

Corresponding Author InformationReprint 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.

PII: S0360-3016(10)00421-9

doi:10.1016/j.ijrobp.2010.02.054