Neoadjuvant Chemoradiotherapy in Non-cardia Gastric Cancer Patients - Does it Improve Survival?

Background: Survival rates after resection of advanced gastric cancer are extremely poor. An increasingnumber of patients with gastric carcinomas (GC) are therefore being treated with preoperative chemotherapy. Weevaluated 36 month survival rate of GC patients that were treated by adding a neoadjuvant chemoradiotherapybefore gastrostomy.Materials and
Methods: Patients with stage II or III gastric adenocarcinomas were enrolled.The patients divided into two groups: (A) Neoadjuvant group that received concurrent chemoradiation beforesurgery (4500cGy of radiation at 180cGy per day plus chemotherapy with cisplatin and 5-fluorouracil, in the firstand the end four days of radiotherapy). Resection was attempted 5 to 6 weeks after end of chemoradiotherapy.(B) Adjuvant group that received concurrent chemo-radiation after surgical resection.
Results: Two (16.7%)patients out of 12 patients treated with neoadjuvant chemo-radiotherapy and 5 (38.5%) out of 13 in thesurgery group survived after 36 months. These rates were not significantly different with per protocol andintention-to-treat analysis. The median survival time of patients in group A and B were 13.4 and 21.6 months ,respectively, again not significantly different. Survival was significantly greater in patients with well differentiatedadenocarcinoma in group B than in group A (p<0.004).
Conclusions: According to this study we suggest surgerythen chemoradiotherapy for patients with well differentiated gastric adenocarcinoma rather than otherapproaches. Additional studies with greater sample size and accurate matching relying on cancer molecularbehavior are recommended.