By Ric Susman
SAN FRANCISCO -- January 19, 2009 -- Patients who undergo neoadjuvant chemoradiation before surgery for treatment of gastric cancer achieve a median overall survival that exceeds 5 years.
"The overall survival for gastric cancer patients receiving neoadjuvant chemoradiation resection compares favourably to already published reports of treatment with just adjuvant chemoradiation or preoperative chemotherapy," said DeBashish Bose, MD, Johns Hopkins Hospital, Baltimore, Maryland, on behalf of the Gastric Cancer Multidisciplinary Group.
"It appears that extended regional lymphadenectomy in select patients is in fact associated with a better overall survival for the patient," he noted on January 15 here at the American Society of Clinical Oncology's 6th Gastrointestinal Cancers Symposium (ASCO-GI).
The symposium was cosponsored by the American Gastrointestinal Association Foundation, the American Society for Radiation Oncology, and the Surgery of Surgical Oncology.
Dr. Bose and colleagues performed a retrospective review of patient records from 1995 to 2005, identifying 3,918 patients who had been diagnosed with gastric cancer. Of these patients, 471 (12.0%) had potentially resectable gastric cancer and underwent pretreatment staging laparoscopy. Within this subgroup 254 (53.9%) received neoadjuvant chemoradiation and of these, 182 (71.7%) were resected.
"Further, for those patients who had the resection after the neoadjuvant chemoradiation, 166 (91.2%) had a complete resection with no microscopic residual tumour," Dr. Bose said.
The research team found that median overall survival for the 169 patients who had completed neoadjuvant chemoradiation and who had undergone resection was 5.1 years.
However, the 131 patients who were treated with extended (D3) lymphadenectomy achieved a median overall survival of 7.6 years compared with 3.3 years for the 51 patients treated with less extensive lymphadenectomy (P = .04).
In the cohort, 166 patients were able to undergo an R0 resection or negative margins. The median overall survival for these patients was 5.6 years, a statistically significant difference when compared with the 16 patients who had R1/R2 resection, who had a subsequent overall survival of 1.9 years (P = .004).
Dr. Bose reported that nodal involvement also had an impact on patient outcomes. Better survival was seen among those patients who had more lymph node dissection, but there was a worse outcome among patients who had a greater number of lymph nodes involved.
The retrospective analysis did not receive industry funding.
[Presentation title: Association of Neoadjuvant Chemoradiation With Improved Survival in Resectable Gastric Cancer. Abstract 76]
E-Mail this DGDispatch to a colleague
