Adjuvant chemotherapy plus concurrent chemoradiotherapy (CCRT) in advanced gastric adenocarcinoma treatment as standard of care
Date Issued
2020
Author(s)
Lazarova, Emilija
Berat, Meri
Abstract
Introduction. Despite a worldwide decline in incidence based on GLOBOCAN 2018 data,
stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer. In 90% of cases, its
histology is adenocarcinoma, either of the intestinal type or of diffuse. Helicobacter pylori infection,
smoking, salt and nitrate-rich foods are the most important factors of risk. The interactions between
dietary factors, environmental factors and the development of gastric cancer are well described with
clearly identified dietary exposures strongly associated with gastric cancer induction and prevention.
Postoperative fluoropyrimidine-based CCRT and chemotherapy is standard adjuvant treatment of
resected gastric adenocarcinoma.
Materials and methods. Patients with subtotal gastrectomy and D1 lymph node dissection
were treated with 2 cycles of Capecitabine (DD 2500 mg/m2 po bid/21day cycle) followed by
chemoradiotherapy and another of 2 cycles chemotherapy with Capecitabine (DD 2500 mg/m2 po
bid/21d cycle). CT simulation with oral contrast application was performed followed by delineation of
target volumes and organs at risk according to CRITICS protocol. 3D conformal postoperative
chemoirradiation was delivered with standard fractionation (TTD 50.4 Gy/1.8 Gy) with concurrent
application of Capecitabine 1650mg/m2/bid/d1-5. Adjuvant treatment was delivered in
postoperative period of 6 months.
Results. Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS)
and improves quality of life. CT-based 3D conformal treatment planning and delivery of
postoperative chemoirradiation is minimum standard of care of gastric cancer treatment.
Conclusion. Multidisciplinary decision making team approach is preferred. Primary treatment
option for patients with potentially resectable locoregional gastric tumors is surgery. The guidelines
have included postoperative chemo/chemoradiotherapy treatment depending of tumor stage, nodal
status, extent of lymph node dissection and other risk factors (differentiation, lymphovascular
invasion, neural invasion, surgical margins). Adjuvant chemotherapy and chemoradiotherapy
prolongs disease free survival (DFS) and improves quality of life.
Keywords: Gastric cancer, chemoirradiation, CCRT, DFS, 3D conformal, postoperative
stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer. In 90% of cases, its
histology is adenocarcinoma, either of the intestinal type or of diffuse. Helicobacter pylori infection,
smoking, salt and nitrate-rich foods are the most important factors of risk. The interactions between
dietary factors, environmental factors and the development of gastric cancer are well described with
clearly identified dietary exposures strongly associated with gastric cancer induction and prevention.
Postoperative fluoropyrimidine-based CCRT and chemotherapy is standard adjuvant treatment of
resected gastric adenocarcinoma.
Materials and methods. Patients with subtotal gastrectomy and D1 lymph node dissection
were treated with 2 cycles of Capecitabine (DD 2500 mg/m2 po bid/21day cycle) followed by
chemoradiotherapy and another of 2 cycles chemotherapy with Capecitabine (DD 2500 mg/m2 po
bid/21d cycle). CT simulation with oral contrast application was performed followed by delineation of
target volumes and organs at risk according to CRITICS protocol. 3D conformal postoperative
chemoirradiation was delivered with standard fractionation (TTD 50.4 Gy/1.8 Gy) with concurrent
application of Capecitabine 1650mg/m2/bid/d1-5. Adjuvant treatment was delivered in
postoperative period of 6 months.
Results. Adjuvant chemotherapy and chemoradiotherapy prolongs disease free survival (DFS)
and improves quality of life. CT-based 3D conformal treatment planning and delivery of
postoperative chemoirradiation is minimum standard of care of gastric cancer treatment.
Conclusion. Multidisciplinary decision making team approach is preferred. Primary treatment
option for patients with potentially resectable locoregional gastric tumors is surgery. The guidelines
have included postoperative chemo/chemoradiotherapy treatment depending of tumor stage, nodal
status, extent of lymph node dissection and other risk factors (differentiation, lymphovascular
invasion, neural invasion, surgical margins). Adjuvant chemotherapy and chemoradiotherapy
prolongs disease free survival (DFS) and improves quality of life.
Keywords: Gastric cancer, chemoirradiation, CCRT, DFS, 3D conformal, postoperative
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