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03.09.2021 | Gastrointestinal Oncology

Neoadjuvant versus Postoperative Chemoradiotherapy is Associated with Improved Survival for Patients with Resectable Gastric and Gastroesophageal Cancer

verfasst von: Daniel W. Kim, MD, MBA, Grace Lee, MD, Theodore S. Hong, MD, Guichao Li, MD, Nora K. Horick, MS, Eric Roeland, MD, Florence K. Keane, MD, Christine Eyler, MD, PhD, Lorraine C. Drapek, DNP, David P. Ryan, MD, Jill N. Allen, MD, David Berger, MD, Aparna R. Parikh, MD, MS, John T. Mullen, MD, Sam J. Klempner, MD, Jeffrey W. Clark, MD, PhD, Jennifer Y. Wo, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2022

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Abstract

Background

The optimal timing of chemoradiotherapy (CRT) for patients with localized gastric cancer remains unclear. This study aimed to compare the survival outcomes between neoadjuvant and postoperative CRT for patients with gastric and gastroesophageal junction (GEJ) cancer.

Methods

This retrospective study analyzed 152 patients with gastric (42%) or GEJ (58%) adenocarcinoma who underwent definitive surgical resection and received either neoadjuvant or postoperative CRT between 2005 and 2017 at the authors’ institution. The primary end point of the study was overall survival (OS).

Results

The median follow-up period was 37.5 months. Neoadjuvant CRT was performed for 102 patients (67%) and postoperative CRT for 50 patients (33%). The patients who received neoadjuvant CRT were more likely to be male and to have a GEJ tumor, positive lymph nodes, and a higher clinical stage. The median radiotherapy (RT) dose was 50.4 Gy for neoadjuvant RT and 45.0 Gy for postoperative RT (p < 0.001). The neoadjuvant CRT group had a pathologic complete response (pCR) rate of 26% and a greater rate of R0 resection than the postoperative CRT group (95% vs. 76%; p = 0.002). Neoadjuvant versus postoperative CRT was associated with a lower rate of any grade 3+ toxicity (10% vs. 54%; p < 0.001). The multivariable analysis of OS showed lower hazards of death to be independently associated neoadjuvant versus postoperative CRT (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.36–0.91; p = 0.020) and R0 resection (HR 0.50; 95% CI 0.27–0.90; p = 0.021).

Conclusions

Neoadjuvant CRT was associated with a longer OS, a higher rate of R0 resection, and a lower treatment-related toxicity than postoperative CRT. The findings suggest that neoadjuvant CRT is superior to postoperative CRT in the treatment of gastric and GEJ cancer.

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Titel: Neoadjuvant versus Postoperative Chemoradiotherapy is Associated with Improved Survival for Patients with Resectable Gastric and Gastroesophageal Cancer
verfasst von: Daniel W. Kim, MD, MBA
Grace Lee, MD
Theodore S. Hong, MD
Guichao Li, MD
Nora K. Horick, MS
Eric Roeland, MD
Florence K. Keane, MD
Christine Eyler, MD, PhD
Lorraine C. Drapek, DNP
David P. Ryan, MD
Jill N. Allen, MD
David Berger, MD
Aparna R. Parikh, MD, MS
John T. Mullen, MD
Sam J. Klempner, MD
Jeffrey W. Clark, MD, PhD
Jennifer Y. Wo, MD
Publikationsdatum: 03.09.2021
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 1/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10666-y

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Neoadjuvant versus Postoperative Chemoradiotherapy is Associated with Improved Survival for Patients with Resectable Gastric and Gastroesophageal Cancer