Neoadjuvant radiation therapy does not increase perioperative morbidity among patients undergoing gastrectomy for gastric cancer

Abstract Objectives Gastric cancer remains one of the most fatal cancers, despite an intensive treatment regime of chemotherapy–surgery–chemotherapy. Peritoneal metastatic disease is commonly diagnosed post treatment regime and once established, patients are likely to die in 3–9 months. Systemic chemotherapy does not increase survival for these patients due to the poor vascularisation of this area. We are proposing the addition of pressurised intraperitoneal aerosol chemotherapy (PIPAC) to the treatment regime for curative patients as a preventive measure to reduce the risk of peritoneal metastases occurring. Methods This is a prospective, single centre, non-randomised, open-label pilot trial evaluating the addition of PIPAC to the standard multimodal treatment pathway. Patients will undergo standard neoadjuvant chemotherapy with four cycles of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT), then PIPAC, followed by gastrectomy. Four cycles of FLOT will be administered post-surgery. Primary outcome is safety and feasibility, assessed by perioperative morbidity and possible interruptions of the standard multimodal treatment pathway.

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Long-Term Results After Intraoperative Radiation Therapy for Gastric Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2007.07.2331 ◽

2008 ◽

Vol 70 (3) ◽

pp. 715-721 ◽

Cited By ~ 16

Author(s):

Oliver Drognitz ◽

Karl Henne ◽

Christian Weissenberger ◽

Gregor Bruggmoser ◽

Heike Göbel ◽

...

Keyword(s):

Gastric Cancer ◽

Radiation Therapy ◽

Long Term Results ◽

Intraoperative Radiation Therapy ◽

Intraoperative Radiation

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Survival Benefit of Adjuvant Radiation Therapy for Gastric Cancer following Gastrectomy and Extended Lymphadenectomy

International Journal of Surgical Oncology ◽

10.1155/2012/307670 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

R. A. Snyder ◽

E. T. Castaldo ◽

C. E. Bailey ◽

S. E. Phillips ◽

A. B. Chakravarthy ◽

...

Keyword(s):

Gastric Cancer ◽

Radiation Therapy ◽

Gastric Adenocarcinoma ◽

Survival Benefit ◽

Cox Regression ◽

Population Based ◽

Adjuvant Radiation ◽

Extended Lymphadenectomy ◽

Factors Affecting ◽

Gastric Cancer Patients

Purpose. Although randomized trials suggest a survival benefit of adjuvant chemotherapy and radiation therapy (XRT) for gastric adenocarcinoma, its use in patients who undergo an extended lymphadenectomy is less clear. The purpose of this study was to determine if a survival benefit exists in gastric cancer patients who receive adjuvant XRT following resection with extended lymphadenectomy.Methods. The SEER registry was queried for records of patients with resected gastric adenocarcinoma from 1988 to 2007. Multivariable Cox regression models were used to assess independent prognostic factors affecting overall survival (OS) and disease-specific survival (DSS).Results. Of 15,060 patients identified, 3,208 (21%) received adjuvant XRT. Adjuvant XRT was independently associated with improved OS (HR 0.67, CI 0.64–0.71) and DSS (HR 0.69, CI 0.65–0.73) in stages IB through IV (M0). This OS and DSS benefit persisted regardless of the extent of lymphadenectomy. Furthermore, lymphadenectomy with >25 LN resected was associated with improved OS and DSS compared with <15 LN or 15–25 LN.Conclusion. This population-based study shows a survival benefit of adjuvant XRT following gastrectomy that persists in patients who have an extended lymphadenectomy. Furthermore, removal of >25 LNs results in improved OS and DSS compared with patients who have fewer LNs resected.

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