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

Kim, Sung; Lim, Do Hoon; Lee, Jeeyun; Kang, Won Ki; Macdonald, John S.; Park, Chan Hyung; Park, Se Hoon; Lee, Se‐Hoon; Kım, Kihyun; Park, Joon Oh; Kim, Won Seog; Jung, Chul Won; Park, Young Suk; Im, Young‐Hyuck; Sohn, Tae Sung; Noh, Jae Hyung; Heo, Jin Seok; Kim, Yong Il; Park, Chul Keun; Park, Keunchil

doi:10.1016/j.ijrobp.2005.05.005

Cited by 255 publications

(208 citation statements)

References 21 publications

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“…As a result, adjuvant treatment is thought merely to correct for inadequate surgery in these trials inadequate surgery was shown as the reason of adjuvant treatment benefit in Western patients. However, Kim et al (2005) confirmed the results of INT-0116 in a non-randomized trial on a population of D2-resected Eastern patients. In a recent meta-analyses by Ohri et al (2013) it has been shown that adjuvant RT in resectable gastric cancer improves both OS and PFS by 20% in the published randomized trials.…”

Section: Discussionsupporting

confidence: 69%

“…The MAGIC trial demonstrated that the addition of perioperative CT (ECF; epirubicin, cisplatin, fluorouracil) to surgery improves survival in a Western population of gastric cancer patients (Cunningham et al, 2006). The INT-0116 and MAGIC trials were both heavily criticized due to insufficient lymph node dissection in a significant proportion of eligible patients (Kim et al, 2005;Ohri et al, 2013). As a result, adjuvant treatment is thought merely to correct for inadequate surgery in these trials inadequate surgery was shown as the reason of adjuvant treatment benefit in Western patients.…”

Section: Discussionmentioning

confidence: 99%

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Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Mısırlıoğlu¹,

Coskun-Breuneval²,

Küçükpilakçi³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among highrisk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5-and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Mısırlıoğlu¹,

Coskun-Breuneval²,

Küçükpilakçi³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Disease stage was an independent prognostic factor either for OS or DFS. Although gastrectomy associated with lymph node dissection, depending on tumor location, is the main treatment of gastric cancer; control and survival rate at 5 years remains low, on the order of 20% to 30% in T3-T4 patients with positive lymph nodes [6,12]. In an attempt to prevent recurrence and increase the cure rate after surgery, multiple studies investigate the role of multimodal treatment approach [12].…”

Section: Discussionmentioning

confidence: 99%

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

Touil¹,

Loughlimi²,

Abbassi³

et al. 2017

J Cancer Sci Ther

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BackgroundGastric cancer is the second leading cause of cancer related death among men and the fourth among women, and thus represents a significant global health concern [1]. The disease is commonly diagnosed at a locally advanced stage, and surgery remains the main treatment; The overall survival rate of patients who underwent surgery alone is about 45% at 5 years, that has undergone few changes over the last decades [2,3].The curative treatment of gastric cancer requires surgical resection in less than 40% of cases [2,3]. Independent risk factors in the literature are tumor size (>4 cm), age (>70 years), proximal location, diffuse type of Lauren classification, tumor residue, Deep invasion (T3-T4), and the ratio of involved lymph nodes/total number (>20%) [4,5]. Locoregional recurrences on the tumor bed, on the anastomosis or in lymph nodes occur in 40% to 65% of the patients after resection with curative intent [6,7]. The frequency of this relapse makes regional radiotherapy an attractive possibility for adjuvant therapy [8].Various chemotherapy regimens used to prevent relapse and improve the poor survival rates provide small but statistically significant clinical benefit [9,10]. Finally, the intergroup of gastrointestinal cancers was the first to demonstrate in a phase III trial that concomitant radio-chemotherapy after complete gastric resection improves median relapse-free survival (30 vs 19 months, p<0.0001) and overall survival (36 vs 27 months, p<0.01) [11]. Following these results, postoperative radio-chemotherapy according to the Macdonald protocol became the new standard of care [11]. However, much concern remains regarding the toxicity of the regimen. 41% of patients had grade 3 digestive toxicity and 32% grade 4 [11]. The objective of our AbstractBackground: Several studies have shown that surgery alone is not enough in the management of early gastric cancer with locoregional relapse in 40% to 60%. The frequency of relapses makes regional radiotherapy an attractive possibility for adjuvant therapy. The survival benefit of adjuvant chemoradiation over surgery alone was first established by the US Intergroup 0116 study.

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“…A Korean observational study by Kim et al, however, did show a clinical benefi t of postoperative radiochemotherapy in a population of more than 500 patients after gastric cancer resection with a D2 lymph node dissection [13].…”

mentioning

confidence: 94%

Improving outcome for scirrhous gastric cancer

Hartgrink

2009

Gastric Cancer

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The curative treatment of gastric cancer has been basically only surgical. Many trials and comparative studies have tried to fi nd out to what extent surgery should be performed. There is a great difference between results from the East and the West. Comparative studies from Japan in the early 1990s showed an improved survival for D2 lymph node dissections over D1 and D0 dissections. In the Dutch gastric cancer and the British MRC gastric cancer randomized trials no signifi cant difference was found between D1 and D2 lymph node dissections [7,8]. It was suggested that the higher morbidity and mortality for D2 dissections probably had offset the possible benefi t in survival. Indeed, a subgroup analysis of patients who did not have a pancreatico-splenectomy showed a signifi cant survival benefi t after a D2 lymph node dissection over a D1.A more recent randomized trial from Taiwan by Wu et al. did show a signifi cant survival benefi t after a D3 lymph node dissection [9]. This result could probably be reached because there was no mortality in either arm; therefore, the theoretical benefi t of an extended lymph node dissection does become evident if mortality can be avoided. However, Sasako et al. found no difference in survival for a D2 dissection and a D2 dissection with para-aortal lymph node dissection in a large randomized trial in Japan [10]. The extent of surgery therefore seems to have reached its limits. The results for gastric cancer surgery remain poor especially for the more advanced stages.To further improve outcome, (neo-)adjuvant treatment with radiotherapy and/or chemotherapy has been tested in many regimens. Radiotherapy alone in an adjuvant setting has a modest favorable impact on locoregional control, but survival benefi t has not been proven. Radiotherapy preceding surgery, however, did show a signifi cant improvement in 3-and 5-year survival in a meta-analysis by Fiorica et al. [11]. Compliance of radiotherapy was 100% and there was no increase in anastomotic leakage or mortality. Despite these results Gastric cancer is still the second most common cause of cancer death in the world. Survival is related to the stage of the disease at diagnosis and to the histological profi le. From Japanese registry data it was shown that about 11% of all gastric cancers are scirrhous [1]. Together with lymphatic invasive forms of gastric cancer, they lead to metastasis even in earlier stages and therefore have poor prognosis. Improvement of survival could be achieved through prevention, early detection, and optimization of treatment.Prevention of gastric cancer seems to be the most logical approach to decrease cancer-related death. The exact cause of gastric cancer, however, is not always known. Epidemiologic studies show that smoking, food preservation, and low consumption of fresh fruit and vegetables are associated with an increased gastric cancer risk [2]. In addition, Helicobacter pylori is a major risk factor for the development of gastric cancer [3]. About 50% of the world population is affected with t...

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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

Cited by 255 publications

References 21 publications

Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Adjuvant Chemoradiation for Localized Gastric Adenocarcinoma: An Institutional Experience

Improving outcome for scirrhous gastric cancer

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