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Patterns of response after preoperative treatment in gastric cancer.

Authors :: Díaz-González JA
Rodríguez J
Hernández-Lizoain JL
Ciérvide R
Gaztañaga M
San Miguel I
Arbea L
Aristu JJ
Chopitea A
Martínez-Regueira F
Valentí V
García-Foncillas J
Martínez-Monge R
Sola JJ
Source :: International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2011 Jul 01; Vol. 80 (3), pp. 698-704. Date of Electronic Publication: 2010 Jul 23.
Publication Year :: 2011
Abstract: 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.<br />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.<br />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%.<br />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.<br /> (Copyright © 2011 Elsevier Inc. All rights reserved.)