Abstract
PurposeTo evaluate the efficacy and toxicity of preoperative chemoradiation with image-guided IMRT in locally advanced resectable gastric cancer patients.Patients and methodsPatients with locally advanced (T3/T4 or N+) gastric cancer treated with neoadjuvant chemoradiotherapy followed by surgery between Jan 2013 and June 2019 in PUMCH were retrospectively analyzed. Radiotherapy(IMRT 45Gy/25#/5weeks) were delivered with megavolt computed tomography performed before every delivery to ensure the accuracy repeatability of gastric filling during treatment, with concurrent chemoctherapy(Capecitabine alone or XELOX*2 cycles). ResultsA total of 95 patients were included in the study with 93 patients (97.9%) had stage cT3/T4, 85 patients (89.5%) had stage N+.The location of the tumors was in the upper 1/3 in 85 patients (89.5%). Alltogether 93/95(97.9%) patients finished the neoadjuvant chemoradiation, 80 patients (84.2%) underwent gastric resection(58 D2 and 22 D1 gastrectomy). Pathology downstaging was observed in 68 patients (85.0%), including 66 patients (82.5%) with T downstaging and 56 patients (70.0%) with N downstaging. 11 patients (13.75%) obtained pathological complete response (pCR). The median follow-up was 44.7 months (19-96 months). Compared with the clinical efficacy of neoadjuvant chemotherapy in the previous literature, the clinical efficacy of image-guided IMRT combined with concurrent chemotherapy in patients with locally advanced resectable gastric cancer was improved, the 5-year OS, LRFS, and DMFS rates of patients were 46.98% (95% CI: 38.60%-55.36%), 86.55% (95% CI: 79.11%-93.99%), and 60.71% (95% CI: 51.49%-69.93%), respectively.Grades 3-4 leukopenia, anemia,and thrombocytopenia were observed in 13 (13.68%) patients, 9 (9.47%) patients, and 5 (5.26%) patients, respectively. Multivariate analysis demonstrated that pCR was significant prognostic factor for OS (HR =11.211, 95% CI: 1.500–83.813, P = 0.024).ConclusionCompared with the previous literature results of preoperative neoadjuvant chemotherapy for patients with gastric cancer, the application of image-guided IMRT(45Gy/25#/5weeks) combined with chemotherapy in preoperative neoadjuvant therapy for patients with locally advanced gastric cancer can achieve improved clinical efficacy, with higher rates of OS, LRFS, and DMFS, good tolerance of concurrent chemoradiotherapy with acceptable side effects.
Feasibility and Efficacy of Preoperative Chemoradiation Therapy in Patients With Locally Advanced Gastric Cancer
