645P - Induction chemotherapy, chemo-radiotherapy and surgery in locally advanced gastric cancer (GC) patients: Long term results from a single institution

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Gastric Cancer
Surgical Oncology
Biological Therapy
Radiation Oncology
Presenter Patricia Martin Romano
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors P. Martin Romano1, N. Buil2, L. Arbea3, J.P. Fusco4, E. Castanon Alvarez5, L. Zubiri2, L. Ceniceros2, J. Subtil4, A. Chopitea6, J.L. Hernandez-Lizoain7, J. Rodriguez8
  • 1Medical Oncology, Clinica Universidad de Navarra, 31008 - Pamplona/ES
  • 2Department Of Oncology, Clínica Universidad de Navarra, 31008 - Pamplona/ES
  • 3Radiation Oncology, clinica universidad de navarra, 31008 - pamplona/ES
  • 4Oncology Department, Clinica Universidad de Navarra, 31008 - Pamplona/ES
  • 5Oncology Department, Clinica Universitaria de Navarra, 31008 - Pamplona/ES
  • 6Oncology, Clinica Universidad de Navarra, Pamplona/ES
  • 7General Surgery, Clinica Universidad de Navarra, Pamplona/ES
  • 8Medical Oncology, clinica universidad de navarra, pamplona/ES



Multimodal therapy is the standard of care in locally advanced esophagogastric adenocarcinomas. However, most trials include both, GEJ and GC. We aimed to specifically rule out in gastric cancer patients the R0 rate, pathological response degree, patterns of recurrence and long-term outcomes when treated with induction chemotherapy (ICT), followed by chemoradiotherapy (CRT) and salvage surgery.


Patients (pts) with CT scan and endoscocopic ultrasound (EUS) T2-4 and/or N+ M0 GC were retrospectively analyzed. The neoadjuvant strategy consisted of 3-4 cycles of chemotherapy followed by CRT (weekly chemotherapy concurrently with daily external beam radiotherapy up to 45 Gy). Surgery was scheduled 4 to 6 weeks after the end of CRT. Pathological response was graded according to the Becker criteria. We have applied a nonlinear mixed effects (NLME) modeling to evaluate the impact of dynamic changes in tumor size, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) on the clinical outcome of these patients.


From November 2004 to July 2013, 60 pts [M/F: 42/18, median age 60 (range 36-76), T2/T3/T4a/T4b: 2/24/26/8; N0/N + , 6/54; Diffuse/Intestinal: 35/25] were retrospectively analyzed. Thirty-four and 54 patients were stages by EUS as T4 or N +, respectively. Median preoperative NLR and PLR were both 2.43 and 148. Forty-nine pts underwent radical surgery (total/partial gastrectomy: 33/16) with an R0 resection rate of 92%. Pathological response according to Becker criteria was grade Ia (12%), grade Ib (39%), grade II (22%) and grade III (2%). pN0 was achieved in 26 pts (53,1%). Median harvested nodes were 13. Median DFS for pN0 and pN+ pts was NR and 23 months, respectively (p = 0.01), whereas median OS for pN0 and pN+ was NR and 30 months, respectively (p = 0.009). Among resected pts, distant failures were reported 22 pts, most of them in the peritoneal cavity (55%). After a median follow-up of 30 months (range 4-95 months) the 5-year overall and disease-free survival, were 31% and 39%, respectively.


Our data suggest that a three-step strategy is feasible and active in locally advanced gastric cancer patients. The NMLE population modeling to evaluate the impact of dynamic markers on the clinical outcome will be presented at the meeting.


All authors have declared no conflicts of interest.