Phase II trial of preoperative sequential chemotherapy followed by chemoradiotherapy for high-risk gastric cancer

Hyo Song Kim, Woong Sub Koom, Song Ee Baek, Hyoung Il Kim, Minkyu Jung, Seung Hoon Beom, Beodeul Kang, Hyunki Kim, Jee Suk Chang, Yoon Young Choi, Taeil Son, Jae Ho Cheong, Sung Hoon Noh, Eun Hye Kim, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Su Jin Shin, Hyunsoo ChungInkyung Jung, Hyun Cheol Chung, Joon Seok Lim, Woo Jin Hyung, Sun Young Rha

    Research output: Contribution to journalArticle

    Abstract

    Background and purpose: To evaluate the safety and efficacy of preoperative chemotherapy (CTx) followed by chemoradiotherapy (CCRT) for high-risk gastric cancer (GC). Methods and materials: The inclusion criteria were as follows: (1) Borrmann type 4; (2) large Borrmann type 3 (≥8 cm); (3) single bulky (≥3 cm × 1) or multiple lymph nodes (≥1.5 cm × 3). Patients received two 21-day courses of induction CTx of TS-1 (35 mg/m2, p.o, twice daily on days 1–14), docetaxel (30 mg/m2, i.v., days 1 and 8), and cisplatin (30 mg/m2, i.v., days 1 and 8) followed by CCRT (two courses of TS-1 and cisplatin in combination with 45 Gy radiation). Results: Forty-two patients were enrolled between March 2014 and February 2016, and 39 of these completed sequential CTx and CCRT. Among the 33 patients who underwent R0 resection, the pathologic response rate was 39.4% [no residual carcinoma (n = 5, 15.2%), with 1–10% residual carcinoma (n = 8, 24.2%)]. Overall, 4 patients (12.1%) were pathologic stage 0, 7 (21.2%) were stage I, 10 (30.3%) were stage II, and 12 (36.4%) were stage III. The overall survival rate at 3 years was 77.9% for stages 0 and I, 66.8% for stages II–III, and 33.3% for unresectable cases (P = 0.001). Toxicity was mild to moderate with grade 4 neutropenia (n = 1) and neutropenic fever (n = 1) as the most prominent side-effects. Conclusions: Sequential CTx and CCRT prior to surgery are feasible and effective for high-risk GC. Trial registration number: NCT02495493.

    Original languageEnglish (US)
    Pages (from-to)143-149
    Number of pages7
    JournalRadiotherapy and Oncology
    Volume140
    DOIs
    StatePublished - Nov 2019

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    Keywords

    • Gastric cancer
    • Preoperative chemoradiotherapy
    • Preoperative chemotherapy

    ASJC Scopus subject areas

    • Hematology
    • Oncology
    • Radiology Nuclear Medicine and imaging

    Cite this

    Kim, H. S., Koom, W. S., Baek, S. E., Kim, H. I., Jung, M., Beom, S. H., Kang, B., Kim, H., Chang, J. S., Choi, Y. Y., Son, T., Cheong, J. H., Noh, S. H., Kim, E. H., Park, J. C., Shin, S. K., Lee, S. K., Lee, Y. C., Shin, S. J., ... Rha, S. Y. (2019). Phase II trial of preoperative sequential chemotherapy followed by chemoradiotherapy for high-risk gastric cancer. Radiotherapy and Oncology, 140, 143-149. https://doi.org/10.1016/j.radonc.2019.06.029