Preoperative versus postoperative chemo-radiotherapy for locally advanced gastric cancer: a multicenter propensity score-matched analysis

Abstract

Background Peri-operative chemo-radiotherapyplayed important rolein locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT). Methods From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups. Results The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p = 0.244), 78.7% vs. 65.7% (p = 0.017), 74.9% vs. 65.3% (p = 0.042) and 74.4% vs. 61.2% (p = 0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis. Conclusion Preoperative CRT showed advantages of oncologic outcome compared with postoperative CRT. Trial registration ClinicalTrial.gov NCT01291407, NCT03427684 and NCT04062058, date of registration: Feb 8, 2011.

Neoadjuvant versus adjuvant radiotherapy for resectable locally advanced gastric cancer: A SEER population analysis

“…There may be two mechanisms by which radiotherapy improves the survival of patients with radical gastrectomy. On one hand, preoperative radiotherapy can lower down tumor staging, make unresectable patients eligible for surgery, and improve the R0 resection rate [ 13 ]. On the other hand, radiotherapy helps to control micrometastasis [ 2 ].…”

“…After PSM, the preoperative group had better OS and DFS, better treatment compliance, and similar surgical complications compared with the preoperative group [ 14 ]. Similarly, Li and colleagues also found that patients with stage T 3/4 and/or N positive gastric cancer treated with surgery and preoperative CRT had better efficacy and survival than patients treated with surgery and postoperative CRT [ 13 ]. These results are in dispute with our findings.…”

“…At present, only a few studies directly compared the role of preoperative and postoperative RT in patients with LAGC, and have yielded conflicting results [ [13] , [14] , [15] , [16] ]. Even, one study suggested that RT should not be added to perioperative or adjuvant chemotherapy [ 17 ].…”