672P - A retrospective evaluation of efficacy and tolerability of two different adjuvant chemoradiotherapy regimens in operable node-positive gastric carc...

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Tahsin Ozatli
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors T. Ozatli, U.Y. Yalcintas Arslan, A.S. Ekinci, O. Bal, O. Esbah, F. Basal, E. Eraslan, N. Alkis, B. Oksuzoglu
  • Department Of Medical Oncology, Ankara Dr.A.Y.Oncology Research and Education Hospital, 06200 - ANKARA/TR

Abstract

Aim

Optimal adjuvant treatment in gastric cancer (GC) patients (pts) with D2 lymph node dissection (D2LND) is still undefined. The aim of this retrospective study was to evaluate the efficacy and tolerability of two different adjuvant chemoradiotherapy (ACRT) regimens in operable node-positive GC pts with D2LND.

Methods

138 curatively resected GC pts who underwent D2LND and had node-positive disease were included in this study. They received ACRT between January 2006 and March 2013 in Ankara Oncology Hospital. Pts treated with Intergroup 0116 ACRT protocol were named as arm A (54.3%, n = 75). Pts received biweekly cisplatin (50 mg/m2 on day 1) plus infusional 5-fluorouracil/folinic acid (CFF) and radiation therapy concurrent with bolus 5-FU were included in arm B (45.7%, n = 63). Also, the study population was divided into two different subgroups: Pts who completed all planned ACRT (75.4%, n = 104), and pts who did not complete the planned ACRT in spite of dose reduction and/or delaying and best supportive care (24.6%, n = 34 ).

Results

Median follow-up was 30 ( range:6-120) months(mts). Completion rate of ACRT: 80% for arm A and 70% for arm B (p = .23). Grade 3-4 toxicity rate was greater in group B than group A (32.4% vs 67.6%, p <0.0001). But, FEN and toxic death were similar (3 vs 3 and 4 vs 3, respectively). More pts in arm B had N3 disease and diffuse histology (40% vs 68.3% and 42.7% vs 69.8%, respectively).In case of N3 disease, neither DFS nor OS have improved in group B compared with group A (15 vs 27 mts, p = 0.10 and 23 vs 30 mts, p = .20, respectively). Pts with diffuse GC in arm A have lived longer and have experienced less recurrence than arm B (52 vs 25 mts, p = .10 and 30 vs 17 mts, p = .022, respectively). Recurrence risk for pts who received all planned ACRT was reduced nearly four-fold compared with the others [Hazard Ratio (HR) 3.94, 95%confidence interval (CI): 1.84-6.12,p < 0.0001]. Risk of death for pts who received all planned ACRT also decreased more than three-fold when compared to pts who did not (HR 3.36, 95% CI:2.17-7.16, p < 0.0001).

Conclusions

Adjuvant CFF plus CRT are not able to change the prognosis of pts who had lymph node-positive GC with D2LND even if receiving for N3 disease and diffuse histology, but toxicity is increased by the treatment . Completion of ACRT is the more important predictor for survival in curatively resected GC.

Disclosure

All authors have declared no conflicts of interest.