Postoperative adjuvant Radiochemotherapy for patients with stage III or IV gastric cancer

Background and Purpose: It is known that radiotherapy or chemotherapy alone don't represent a standard of care as adjuvant treatment for patients with advanced gastric cancer that underwent surgical resection. The purpose in the approach of this cancer is to find an adjuvant treatment that can affect overall survival. Phase 2 studies and randomized trials suggest that a multimodal approach with chemo radiotherapy (CT-RT) can improve overall survival. We analyze the feasibility and toxic effects of chemo radiotherapy (CT-RT) as a post surgical adjuvant treatment in a cohort of patients with high risk gastric cancer. Methods: We enrolled 48 patients with advanced gastric cancer (Stage III and IV, M0). These patients were submitted to surgical resection and all of them, within 6 weeks, underwent adjuvant chemotherapy with FOLFOX-4 (ie, a combination of folinic acid, fluorouracil, and oxaliplatin) for 8 cycles and concomitant radiotherapy (45 Gy in 25 daily fractions over 5 weeks). Radiotherapy started after the first 2 cycles of FOLFOX-4. Chemotherapy schedule was reduced by 25% during the period of the contemporary radiotherapy treatment. Results: All patients except one ended the combined adjuvant treatment. We observed severe hematologic adverse effects only in less than 10% of patients (4 patients); regarding gastrointestinal toxic effects they occurred in 33% of patients and specifically we noted G1-G3 grade toxicity and no G4 toxicity. Disease-free and overall survival at 1, 2, and 3 years was superior to in untreated patients. One to 3-years Median disease-free and overall survival rates were 27 months and 15 months respectively. Conclusions: A combined trial with chemo radiotherapy (CT-RT) as adjuvant treatment represents an effective approach for patients with resected advanced gastric cancer.