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Adjuvant chemoradiotherapy for gastric adenocarcinoma: Kaiser institutional experience with INT 0116.

14114 Background: The standard of care for resectable gastric or gastroesophageal adenocarcinoma is total or partial gastrectomy followed by adjuvant chemoradiotherapy as defined by the Intergroup 0116 study. We have reviewed our institutional experience with this regimen in hopes of defining patient subsets which are most likely to benefit, as well as those who are least likely to benefit, such that alternative therapies may be recommended.


METHODS
A retrospective review was conducted for 38 consecutive patients treated for gastric or gastroesophageal adenocarcinoma with total or partial gastrectomy followed by chemoradiotherapy. Chemotherapy was with 5-FU 425 mg/m2/day and Leukovorin 20 mg/m2. Radiotherapy was with 45 Gy in 25 fx delivered through AP-PA fields or a 3-field technique, at the discretion of the treating physician.


RESULTS
The median patient age is 55 years old. The median follow-up is 29 months. There were 14 D0 resections, 21 D1 resections, and 3 D2 resections. The number of patients with N0, N1, N2, and N3 disease are respectively 4, 20, 11, 3. One patient did not complete treatment due to disease progression. There were positive margins in 8 patients. Four patients developed fatal treatment-related complications. Median overall survival for patients with positive margins is 19 months and for negative margins is 34 months. Median overall survival for N0/N1 patients is 36 months and for N2/N3 patients is 22 months. Eighteen patients recurred at a median of 14 months - 5 locally, 9 regionally in the abdomen, and 4 distantly. Death occurred in 16/18 recurrences.


CONCLUSIONS
The overall survival of patients in this study is consistent with previously-reported data. The adequacy of surgical resection is relevant as it affects nodal staging. Positive margin status and advanced nodal involvement are predictors for poor outcomes, indicating that alternative therapies may be more appropriate for these patients given the potential toxicity of the current recommended treatments. No significant financial relationships to disclose.