Neoadjuvant chemoradiation for potentially resectable gastric cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14724-e14724
Author(s):  
Michael E. Barfield ◽  
Brian R. Untch ◽  
Justin T. Arcury ◽  
Brian G. Czito ◽  
Christopher Willett ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Metastatic Disease ◽  
Disease Free Survival ◽  
Complete Response ◽  
External Beam Radiation ◽  
Cross Sectional ◽  
Beam Radiation ◽  
Resectable Disease ◽  
Platinum Based Chemotherapy ◽  
Resectable Gastric Cancer

e14724 Background: Outcomes are poor in patients with gastric cancer, and recurrence is common. Perioperative chemotherapy and adjuvant chemoradiation therapy (CRT) improve survival in patients with resectable disease. Experience with neoadjuvant CRT for potentially resectable disease is limited, and its role remains undefined. We report our experience using neoadjuvant CRT for potentially resectable gastric cancer. Methods: An IRB-approved, retrospective review from 1994 to 2007 identified 23 patients with biopsy-proven, potentially resectable gastric cancer. Patients had T2/T3 and/or N1 disease and no evidence of metastatic disease by endoscopic ultrasound and cross-sectional imaging. All underwent neoadjuvant external beam radiation with concurrent 5-FU or platinum-based chemotherapy followed by restaging and surgery if appropriate. Results: Of the 23 patients, 20 completed neoadjuvant CRT and surgical exploration. Two patients (n=2) had radiographic disease progression during neoadjuvant CRT and did not undergo resection. One patient (n=1) developed a perforated gastric ulcer during CRT and underwent emergent resection. The median time from diagnosis to surgery and completion of neoadjuvant CRT to surgery was 104 days and 37.5 days, respectively. Gastrectomy was performed in 17 (85%) patients who completed neoadjuvant CRT. Metastatic disease was identified in the remaining 3 (15%) patients. Following gastrectomy, a complete pathologic response was observed in 4 (23.5%) patients, a partial response in 11 (64.7%) patients, and no response was identified in 2 (11.8%) patients. One (6%) patient had microscopic positive margins, and 9 (53%) had positive lymph nodes. There was no perioperative mortality. Two (11.8%) patients had anastomotic leaks, which were managed non-operatively. The median length of stay was 10 days. The median disease-free survival was 10.5 months, and median overall survival was 19.6 months. Conclusions: Gastric cancer carries a poor prognosis. Surgical resection after neoadjuvant CRT has low treatment-associated morbidity and mortality. Survival and complete response rates are comparable to published series. Further evaluation of this treatment strategy is warranted to assess its efficacy.

Perioperative FLOT in elderly patients with resectable gastric cancer: Subgroup analysis from the observational RealFLOT study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4548-4548
Author(s):  
Elisa Giommoni ◽  
Ferdinando De Vita ◽  
Irene Pecora ◽  
Francesco Iachetta ◽  
Antonia Strippoli ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Elderly Patients ◽  
Safety Profile ◽  
Treatment Strategy ◽  
Age Groups ◽  
Disease Free Survival ◽  
Complete Response ◽  
Postoperative Phase ◽  
Real World Data ◽  
Resectable Gastric Cancer

4548 Background: The treatment strategy for patients with resectable gastric cancer changed in the last few years with perioperative treatments. FLOT regimen (fluorouracil, oxaliplatin, docetaxel) turned out to be feasible and effective, offering significant improvement in survival outcomes. However, the safety profile of triplet therapies for elderly patients deserves a special attention and, consequently, the best treatment strategy for these patients is still debated. Methods: Focusing on the elderly patient population (age ≥65 years), real-world data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma (T≥2 and/or N+) enrolled in the observational RealFLOT study were collected. Results: A total of 206 patients with resectable gastric or GEJ adenocarcinoma received perioperative FLOT at 15 Italian centers in routine clinical practice, between September 2016 and September 2019. The median age was 63 years (range 36-77) and 43% of patients enrolled (n = 89) were ≥65 years. Among elderly patients, 46 (52%) received FLOT for at least 4 full-dose cycles in the preoperative phase, 82 (92%) underwent surgery, and 56 (62%) started the postoperative phase. The primary end point of the study, pathological complete response (pCR) rate, was similar among patients aged ≥65 and < 65 (6.7% vs 7.7%, respectively). The distribution of pathological stages did not differ according to age (p = 0.473), and disease-free survival (DFS) is unrelated to the age of patients (log-rank 0.57; p = 0.89). The incidence of grade (G) 3-4 adverse events (AEs) was similar in the two age groups (Table) and the 30-day mortality rates after surgery did not differ according to age. Conclusions: FLOT regimen demonstrated to be feasible and safe in elderly patients since no differences were observed in terms of pCR, DFS and safety profile according to age. [Table: see text]

Adjuvant chemoradiotherapy versus chemotherapy for resectable gastric cancer: A systematic review and meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4066-4066
Author(s):  
Yu Yang Soon ◽  
Cheng Nang Leong ◽  
Jeremy Chee Seong Tey ◽  
Ivan Weng Keong Tham ◽  
Jiade Jay Lu
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Adjuvant Chemoradiotherapy ◽  
Free Survival ◽  
Platinum Based Chemotherapy ◽  
Resectable Gastric Cancer ◽  
Disease Free

4066 Background: The benefits of adjuvant chemo-radiotherapy (ChRT) over chemotherapy (Ch) for resectable gastric cancer are currently unclear. We performed a systematic review and meta-analysis (direct and indirect) of published randomized controlled trials (RCT) to compare the effects of adjuvant chemo-radiotherapy with chemotherapy on overall and disease-free survival for patients with resectable gastric cancer. Methods: We searched MEDLINE and CENTRAL from the date of inception and annual meeting proceedings of ASCO and ASTRO from 1999 to November 2012 for RCTs comparing adjuvant ChRT with Ch, adjuvant ChRT with surgery alone and adjuvant Ch with surgery alone. The primary outcome was overall survival (OS); secondary outcomes included disease-free survival (DFS) and toxicity. Hazard ratios (HR), confidence intervals (CI) and p values (p) were estimated with fixed effects models using Revman 5.1. Results: We found five trials comparing adjuvant ChRT with Ch (n = 1110), three trials comparing adjuvant ChRT with surgery alone (n = 651) and 31 trials comparing adjuvant Ch with surgery alone (n = 8273). Meta-analysis of direct comparison trials showed that adjuvant ChRT significantly improved both OS (HR 0.79, 95% CI 0.64-0.98, p = 0.03) and DFS (HR 0.76, 95% CI 0.64-0.92, p = 0.004) when compared with Ch. Subgroup analyses showed that the effects on OS and DFS were similar regardless of use of D2 nodal dissection, intensity modulated radiotherapy techniques, fluorouracil or platinum-based chemotherapy. There were no significant differences in toxicity between the two groups. The results for the direct and indirect comparisons were statistically consistent. Conclusions: There was a significant survival benefit of adjuvant chemo-radiotherapy over chemotherapy, with no increase in toxicity for patients with resected gastric cancer. Future efforts should also focus on predictive markers, and toxicity or quality-of-life assessments, to individualize adjuvant therapy and optimize the therapeutic ratio.

scholarly journals Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Manon Dubois ◽  
Henry Abi Rached ◽  
Alexandre Escande ◽  
Frédéric Dezoteux ◽  
Franck Darloy ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Early Stage ◽  
Cox Model ◽  
Combined Treatment ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Merkel Cell ◽  
Beam Radiation ◽  
Metastatic Relapse

Abstract Purpose Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. Methods All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant. Results Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98). Conclusion Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae.

scholarly journals The Efficacy and Safety of (Neo)Adjuvant Therapy for Gastric Cancer: A Network Meta-analysis

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 80 ◽  
Author(s):  
Tom van den Ende ◽  
Emil ter Veer ◽  
Mélanie Machiels ◽  
Rosa Mali ◽  
Frank Abe Nijenhuis ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Curative Resection ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Perioperative Chemotherapy ◽  
Curative Intent ◽  
Radio Therapy ◽  
Credible Intervals ◽  
Resectable Gastric Cancer

Background: Alternatives in treatment-strategies exist for resectable gastric cancer. Our aims were: (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized-controlled-trials on the curative treatment of resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant chemo(radio)therapy regimens, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95% CrIs). Results: NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9714 patients). Compared to taxane-based-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95% CrI = 0.38–0.91) and perioperative-chemotherapy regimens without a taxane (HR = 0.79, 95% CrI = 0.58–1.15) were inferior in OS. After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95% CrI = 0.28–0.80). Conclusions: For resectable gastric cancer, (1) taxane-based perioperative-chemotherapy was the most promising treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine was the most promising regimen after curative resection. More research is warranted to confirm or reproach these findings.

Disease-specific survival outcomes in lymph node–positive patients with prostate cancer treated with radiotherapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 182-182 ◽  
Author(s):  
G. Crehange ◽  
V. K. Weinberg ◽  
A. Izaguirre ◽  
C. C. Hsu ◽  
I. J. Hsu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
Primary Therapy ◽  
Newly Diagnosed ◽  
Beam Radiation ◽  
Androgen Ablation ◽  
Disease Free

182 Background: Involvement of regional lymph nodes (LN+) at the time of prostate cancer (PCa) diagnosis is widely regarded as an adverse prognostic factor associated with poor outcome. No commonly utilized treatment, composed of any combination of androgen ablation, surgery and radiation, has proven to be superior for survival. This study will evaluate the clinical survival outcomes of patients (pts) with newly diagnosed LN+ PCa at the University of California San Francisco (UCSF). Methods: All newly diagnosed LN+ PCa pts treated with External Beam Radiation Therapy (EBRT) as primary therapy or after surgery, each with and without androgen ablation between 1987 and 2009 were included. All pts had confirmed pathologic or radiologic LN+ whereas none had evidence of metastases on the work up. Cause Specific Survival (CSS), Disease Free survival (DFS) and biochemical control were measured from the start of treatment. PSA failure was determined by the Phoenix definition after EBRT and by a confirmed PSA >1 ng/mL following RP+EBRT. Results: A retrospective analysis identified 91 pts with LN+ at the time of diagnosis (75.8% high risk pts) with disease follow-up. Thirty-four (37%) were managed with exclusive EBRT alone (eRT), 18 pts (20%) with a combination of radical prostatectomy (RP) and adjuvant EBRT (RP+aRT) and 39 pts (43%) were treated with a combination of RP + salvage RT (RP+sRT). Overall 78% of patients also received hormone therapy (HT): 74.0% with eRT, 89% with RP+aRT and 79% with RP+sRT. The 10 years CSS estimates was 89% for eRT, 0% after RP+aRT and 88% after RP+sRT. The 10 years DFS estimates was 33% for eRT, 0% after RP+aRT and 75% after RP+sRT. Among pts remaining disease free the median follow-up is 38 mos for eRT, 26 mos for RP+aRT and 64 mos for RP+sRT. The last PSA for these patients was <0.1 for 85% of all patients which included 47% following eRT, 100% after RP+aRT and 97% after RP+sRT. There were 7 deaths due to PCa occurring between 5 and 73 mos from the start of EBRT. Conclusions: The results of the current analysis indicate that some pts with LN+ from PCa have prolonged disease free outcomes; and for these men, aggressive treatment may be appropriate. No significant financial relationships to disclose.

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
pp. 536-541 ◽  
Author(s):  
CHARLES J. ROSSER ◽  
RAMSAY CHICHAKLI ◽  
LAWRENCE B. LEVY ◽  
DEBORAH A. KUBAN ◽  
LEWIS G. SMITH ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

Biochemical Disease-Free Survival in Men Younger Than 60 Years With Prostate Cancer Treated With External Beam Radiation

2002 ◽  
Vol 168 (2) ◽  
pp. 536-541 ◽  
Author(s):  
Charles J. Rosser ◽  
Ramsay Chichakli ◽  
Lawrence B. Levy ◽  
Deborah A. Kuban ◽  
Lewis G. Smith ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Free Survival ◽  
Disease Free

scholarly journals Combined chemotherapy and irradiation in anaplastic thyroid carcinoma

2003 ◽  
Vol 11 (3) ◽  
pp. 187-187
Author(s):  
Ivica Pejcic ◽  
Svetislav Vrbic ◽  
Mirjana Scekic
Keyword(s):  
Thyroid Carcinoma ◽  
Randomized Study ◽  
Distant Metastases ◽  
Complete Response ◽  
Anaplastic Thyroid Carcinoma ◽  
External Beam Radiation ◽  
Treatment Modalities ◽  
Combined Chemotherapy ◽  
Optimal Sequence ◽  
Beam Radiation

Background: Anaplastic thyroid carcinoma (ATC) is a very rare and extremely aggressive cancer; patient's death usually occurs rapidly after diagnosis with a mean survival of six months in the majority of individual research series. Treatment of ATC ranges from surgery, radiotherapy, chemotherapy, or a combination of these regimes. Yet, the optimal sequence of treatment modalities has not been established. Methods: From 1997 to 2002 six consecutive patients with a histological diagnosis of ATC were treated with combined chemotherapy and irradiation at our Clinic for Oncology, Clinical Center Ni?. Five of these patients were females and 1 male, aged between 28 and 71 years (mean age: 57 years). None of them had distant metastases at the time of diagnosis. Extrathyroidal extension was present in 3 patients with invasion into skin and hypoderm. Treatment consisted of doxorubicin 60 mg/m 2 plus cisplatin 60 mg/m 2 every three weeks. Total doses ranged between 158-375 mg/m 2 for doxorubicin and 183-380 mg/m 2 for cisplatin. External beam radiation to the neck was administered, at a daily dose of 1.2 Gy, up to total doses ranging between 45-60 Gy. Results: One patient achieved a complete response (CR) and one patient achieved a partial response (PR). Three patients had stable disease. One patient with CR progressed during follow-up and died 18 months from bone and brain metastases. The treatment was moderately well tolerated, although all patients experienced some mild form of toxicity; neutropenia occurred in all patients, but none of them required hospital admission. Median survival was 8 months (range: 4-18 months). Conclusion: We concluded that the present regimen produces meaningful responses for patients with localized ATC. A randomized study is needed to determine the effect on survival.

scholarly journals Single fraction radiotherapy is more acceptable than multi-fraction radiotherapy to palliate the metastatic bone pain

2017 ◽  
Vol 45 (3) ◽  
pp. 151-155
Author(s):  
Sadia Sharmin ◽  
Md Zillur Rahman Bhuiyan ◽  
Atiar Rahman ◽  
Sarwar Alam
Keyword(s):  
Pain Relief ◽  
Bone Pain ◽  
Radiation Treatment ◽  
Symptom Relief ◽  
Complete Response ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Single Fraction ◽  
Significant Difference ◽  
Metastatic Bone Pain

One of the main goals of palliative radiation treatment is the relief of pain or dysfunction caused by the bone metastasis. Most patients achieve pain relief after irradiation. The striking clinical observation is that some patients experience symptom relief within 24hrs after the irradiation. This quasi experimental study was carried out in the department of Oncology, BSMMU from January 2014 to June 2014 with the intention to compare the role of single fraction and multiple fraction radiotherapy in the management of bone secondaries as regard as potency for pain relief. A total of 100 patients with age up to 70 years and of any sex having cytologically or histologically proven malignant diseases with the painful bone metastases in single or multiple sites without pathological fracture were selected for the study. They had no history of previous radiotherapy on the treatment site. Patients were divided in to two Arm A and Arm B with 50 patients in each arm. Arm A was treated with single (8 Gy) fraction radiotherapy and Arm B was treated with multiple fraction (30 Gy) radiotherapy i.e. 300 cGy per fraction in 10 fractions, 5 days a week for two weeks by telecobalt or orthovoltage machine. 44 patients in Arm A & 46 patients in Arm B completed the study. Onset of pain relief after completion of 4th week radiation were 68% in Arm A and 67.4% in Arm B . It was observed that, after 8th week of radiation 81.8% in Arm A and 86% in Arm B were relieved from pain. According to histological typing, 45% in Arm A & 52% patients in Arm B had complete response; 40% in Arm A & 37% patients in Arm B had partial response and overall distribution of no response of patient in Arm A was 18% and in Arm B was 7%. Metastatic bone pain represents one of the major indications in the external beam radiation therapy today.The disease can be efficiently treated by the use of either single fraction or multifraction radiotherapy without any significant difference in response to rate and early toxicities.Bangladesh Med J. 2016 Sep; 45 (3): 151-155

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