Preoperative Conformal Radiotherapy Concurrently with Paclitaxel/Carboplatin in Gastric Cancer

Abstract

Background and objectives: Surgery is the primary therapy for localized gastric cancer, but even with the best results only 40% 5-year survival can be achieved with the use of postoperative adjuvant chemoradiotherapy. Preoperative therapy might help increase the R0 resection rate, which is an independent predictor of 5-year OS. Our study hypothesized that the concurrent combination of carboplatin-paclitaxel with radiation therapy would result in a pathological CR rate, which will be in turn associated with OAS and DFS benefits. Patients and methods: prospective phase II study included 32 patients with locally advanced gastric adenocarcinoma including gastroesophageal junction who received a combination of neoadjuvant conformal radiotherapy concurrently with carboplatin-paclitaxel followed by surgery. Results: Pathological CR and R0 resection rates were 18.8% and 75% respectively. With a median follow up of 24 months, 2 years disease-free survival was 28.1% and overall survival was 51.3%. The regimen was tolerated with neither grade 4 toxicities nor deaths. Conclusion: Neoadjuvant radiotherapy concomitant with carboplatin-paclitaxel chemotherapy is a well-tolerated approach for patients with locally advanced gastric adenocarcinoma resulting in significant pathological CR and R0 resection margins as reflected by the good DFS and OS.

Total neoadjuvant therapy for locally advanced gastric cancer and esophagogastric junction adenocarcinoma: study protocol for a prospective, multicenter, single-arm, phase II clinical trial

“…Ahmed et al included 32 patients with GC who received NCRT. The pCR rate was 18.8% and the 2-year OS was 51.3% [ 30 ]. Although, some phase II clinical trial has found the value of NCRT in middle and distal GC, it still needs evidence from larger sample size prospective clinical trials.…”

“…Gradually, as D2 resection has become more widespread, the value of adjuvant chemoradiotherapy has been challenged, especially after the results of the ARTIST 2 trial were published [ 5 ]. Recently, some phase II or III studies have verified the value of neoadjuvant radiotherapy for locally advanced GC and EGJ cancer in terms of local control and the R0 reaction rate [ 6 , 7 ]. With advancements in neoadjuvant therapy, the MAGIC, FFCD and FLOT4 trials have confirmed that perioperative chemotherapy will improve patient prognosis [ 8 – 10 ].…”