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Outcomes after complete pathologic response (pCR) to neoadjuvant treatment for gastric and gastroesophageal junction (GEJ) adenocarcinoma.

75 Background: pCR is rare following neoadjuvant chemotherapy (NAChemo) ± radiation therapy (RT) for locally advanced gastric/GEJ adenocarcinoma. Recurrence and survival after pCR are not well characterized.


METHODS
A retrospective review of a prospective database identified patients with pCR after NAChemo ± RT for gastric/GEJ adenocarcinoma. Recurrence, overall survival (OS), recurrence free survival (RFS), and disease specific survival (DSS) were analyzed.


RESULTS
From 1985 - 2010, 2,676 patients underwent resection for gastric/GEJ adenocarcinoma, and 714 (27%) received NAChemo ± RT. There were 102 (14%) patients with a pCR. 60 patients (8%) had adequate pre-operative staging and follow-up and comprised the study group: 47 (78%) GEJ and 13 (22%) gastric tumors. 51 (85%) received neoadjuvant RT. With 46 month median follow-up, 14 patients (23%; 12 GEJ, 2 gastric) developed a recurrence (Table); 13 of 14 (93%) occurred within 2 years of follow-up with a median time to recurrence of 13.5 months. 5 (42%) recurred in the CNS. Median time to death after recurrence was 11.5 months. 5-year OS, RFS, and DSS were 56%, 70%, and 65%, respectively.


CONCLUSIONS
pCR occurs in less than 15% of cases after neoadjuvant therapy for gastric and GEJ adenocarcinoma. Despite a pCR, there is a significant risk of recurrence and cancer-specific death during follow-up. As CNS recurrence is more prevalent in this group of patients, whole brain imaging should be considered. [Table: see text] No significant financial relationships to disclose.