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Updated results of Maria Sklodowska-Curie National Research Institute of Oncology gastric cancer cohort: Indirect comparison between adjuvant chemoradiation and perioperative chemotherapy in gastric cancer patients
Background
Gastric cancer is associated with poor prognosis. Curative resection alone leads to a dismal outcome of gastric and GEJ adenocarcinoma. In the western gastric cancer patients are either treated with peri-operative chemotherapy or adjuvant chemoradiation. No direct comparisons of these two treatment strategies are available. In our referral gastric cancer center (NIO-PIB) we have changed in January 2013 the treatment protocol from adjuvant chemoradiation (like in INT-0116 study) to perioperative chemotherapy (ECF or CF regimen). Here we report the updated results of single institution indirect comparison of two treatment strategies in the treatment of gastric cancer patients.
Methods
139 consecutive pts who underwent gastrectomy between 2009-2015 treated at the NIO-PIB were identified in a cohort manner (2009-2012 radiochemotherapy: 60 pts; 2013-2015- perioperative chemotherapy: 79 pts). The patients’ clinical characteristics were collected from medical records. All patients were followed for relapse and survival with median observation time of 57 and 17 months for chemoradiation and perioperative chemotherapy respectively.
Results
The patients’ characteristics were similar in two groups including, age, sex, ECOG status and Lauren-classification types. The toxicity profile was similar in two cohorts, with only leukopenia reported more often in the chemoradiation group (grade 3-4: 43.3% vs 12.3%. p < 0.001) and low platelet count (grade 3-4: 6.7% vs 3.7%; p=0.19). There was a trend for excessive mucositis (p=0.067) and diarrhea (p=0.051) in the chemoradiation group. Vomiting more often observed in the peri-operative chemotherapy group (grade 3-4: 29.6% vs 13.3%, p=0.032). Notable, no differences were reported for neutropenia, fatigue and weight loss. Median OS for posoperative radiochemotherapy was 77.4 months (95% CI, 66.7-98.2 months) and mOS for perioperative chemotherapy was 40.5 months (95% CI, 46.6-63.8 months).
Conclusions
In reference cancer center radiochemotherapy is still good therapeutic option treatment. We should keep in mind that in chemotherapy arm, patients with occult peritoneal dissemination could be included.
Legal entity responsible for the study
The authors.
Funding
Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Disclosures
All authors have declared no conflicts of interest.
