Adjuvant Bi-Weekly Combination of Cisplatin, Infusional 5-fluorouracil and Folinic Acid Followed by Concomitant Chemoradiotherapy with Infusional Fluorouracil for High Risk Operated Gastric and Gastroesophageal JunctionAdenocarcinoma

Purpose: Chemotherapy and radiotherapy are approved in clinical practice of adjuvant treatment of gastriccarcinoma. In present study, we retrospectively evaluated the efficacy and tolerability of an adjuvant treatmentprotocol including bi-weekly cisplatin, infusional 5-fluorouracil (5-FU) and folinic acid followed by continuous5-FU infusion during radiotherapy. Patients and
Methods: Between May 2005 and Dec 2008, 65 curativelyresected gastric and gastroesophageal junction adenocarcinoma patients (stage III in 38 and stage IV M0 in27) received chemotherapy including 50 mg/m2 cisplatin, 200 mg/m2 iv folinic acid, 5-FU 400 mg/m2 iv bolusfollowed by 5-FU 1600 mg/m2 46h-continuous infusion (CFF) bi-weekly. After 4 cycles of CFF, concomitant200 mg/m2/day continuous infusion 5-FU and 4500 cGy radiotherapy were administered for 5 weeks. After thischemoradiotherapy an additional 4 cycles of CFF were given.
Results: The median follow-up was 15 (6-36)months. Fifty seven (87.7%) patients completed at least 90% of the planned treatment. Median disease freesurvival was 18 months (95% CI:13.9-22.0) and median overall survival was 19 months (95% CI:15.2-22.8).Common adverse events of all grades were nausea and vomiting (53.8%), leucopenia (42.6%), anemia (30.7%)and diarrhea (20%). The most common grade 3 and 4 toxicities were leucopenia (9.2%), anemia (7.6%), febrileneutropenia (6.1%) and diarrhea (4.6%).
Conclusion: Bi-weekly CFF chemotherapy followed by continuous5-FU infusion during radiotherapy is an effective and tolerable regimen for locally advanced operated gastricand gastroesophageal junction adenocarcinoma.