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

  • Published : 2014.11.06


Background: Survival rates after resection of advanced gastric cancer are extremely poor. An increasing number of patients with gastric carcinomas (GC) are therefore being treated with preoperative chemotherapy. We evaluated 36 month survival rate of GC patients that were treated by adding a neoadjuvant chemoradiotherapy before 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 before surgery (4500cGy of radiation at 180cGy per day plus chemotherapy with cisplatin and 5-fluorouracil, in the first and 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 the surgery group survived after 36 months. These rates were not significantly different with per protocol and intention-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 differentiated adenocarcinoma in group B than in group A (p<0.004). Conclusions: According to this study we suggest surgery then chemoradiotherapy for patients with well differentiated gastric adenocarcinoma rather than other approaches. Additional studies with greater sample size and accurate matching relying on cancer molecular behavior are recommended.


  1. Ajani JA, Mansfield PF, Janjan N, et al (2004). Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol, 22, 2774-80.
  2. Bittoni A, Faloppi L, Giampieri R, Cascinu S (2012). Selecting the best treatment for an individual patient. Recent Results Cancer Res, 196, 307-18.
  3. Blank S, Rachakonda S, Keller G, et al (2014). A retrospective comparative exploratory study on two methylentetrahydrofolate reductase (MTHFR) polymorphisms in esophagogastric cancer: the A1298C MTHFR polymorphism is an independent prognostic factor only in neoadjuvantly treated gastric cancer patients. BMC Cancer, 14, 58.
  4. Buergy D, Lohr F, Baack T, et al (2012). Radiotherapy for tumors of the stomach and gastroesophageal junction-a review of its role in multimodal therapy. Radiat Oncol, 7, 192.
  5. Degiuli M, Sasako M, PontiA, Calvo F (2004). Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer, 90, 1727-32.
  6. Du CY, Chen JG, Zhou Y, et al (2012). Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer. World J Gastroenterol, 18, 3610-16.
  7. Edge S, Byrd DR, Compton CC,et al editors (2010). American Joint Committee on Cancer (AJCC). AJCC cancer staging manual, 7th edition. New York: Springer Verlag, 1-649.
  8. Ferlay J, Shin HR, Bray F, et al (2008). Estimates of worldwide burden of cancer in 2008: GLOBOCAN. Int J Cancer, 127, 2893-917.
  9. Garcia M, Ward EM, Center MM, et al (2008). Global Cancer Facts & Figures. 2007 [], [online]. Accessed Aug 20.
  10. Greenlee RT, Murray T, Bolden S, Wingo PA (2000). Cancer statistics. CA Cancer J Clin, 50, 7-33.
  11. Henning GT, Schild SE, Stafford SL, et al (2000). Results of irradiation or chemoirradiation Following resection of gastric adenocarcinoma. Int J Radiat Oncol Biol Phys, 46, 589-98.
  12. Janunger KG, Hafstrom L, Glimelius B (2002). Chemotherapy in gastric cancer: A review and updated meta-analysis. Eur J Surg, 168, 597-608.
  13. Jemal A, Siegel R, Xu J, Ward E (2010). Cancer statistics. CA Cancer J Clin, 60, 277-300.
  14. Jiang Y, Ajani JA (2010).Multidisciplinary management of gastric cancer. Curr Opin Gastroenterol, 26, 640-6.
  15. Klautke G, Foitzi T, Ludwig K, et al (2004). Neoadjuvant radiochemotherapy in locally advanced gastric carcinoma. Strahlenther Onkol, 180, 695-700.
  16. Kundel Y, Purim O, Idelevich E, et al (2011). Postoperative chemoradiation for resected gastric cancer-is the macdonald regimen tolerable? a retrospective multi-institutional study. Radiat Oncol, 6,127.
  17. Lee WC, Yusof MM, Lau FN, Phua VC (2013). Preoperative long course chemoirradiation in a developing country for rectal carcinoma: Kuala Lumpur hospital experience. Asian Pac J Cancer Prev, 14, 3941-4.
  18. Liao Y, Yang ZL, Peng JS, Xiang J, Wang JP (2013). Neoadjuvant chemotherapy for gastric cancer: a meta-analysis of randomized, controlled trials. J Gastroenterol Hepatol, 28, 777-82.
  19. Mari E, Floriani I, Tinazzi A, et al (2000). Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomized trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomidell'Apparato Digerente). Ann Oncol, 11, 837-43.
  20. Matsuda S, Takahashi T, Fukada J, et al (2014). Phase I study of neoadjuvant chemoradiotherapy with S-1 plus biweekly cisplatin for advanced gastric cancer patients with lymph node metastasis: -KOGC04-. Radiat Oncol, 9, 9.
  21. Ott K, Sendler A, Becker K, et al (2003). Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study. Gastric Cancer, 6,159-67. P
  22. arkin DM, Ferlay J, Curado MP, et al (2010). Fifty years of cancer incidence: CI5 I-IX. Int J Cancer, 127, 2918-27.
  23. Patel SH, Kooby DA (2011). Gastric adenocarcinoma surgery and adjuvant therapy. Surg Clin North Am, 91, 1039-77.
  24. Pepek JM, Chino JP, Willett CG, et al (2013). Preoperative chemoradiotherapy for locally advanced gastric cancer. Radiat Oncol, 8, 6.
  25. Roshanaei G, Ghannad MS, Jafarabadi MA, Faradmal J, Sadighi S ( 2011). Prognostic impact of risk factors in patients with gastric cancer in Iran. Asian Pac J Cancer Prev, 12, 3005-8.
  26. Roth AD, Allal AS, Brundler MA, et al (2003). Neoadjuvant radiochemotherapy for locally advanced gastric cancer: a phase I-II study. Ann Oncol, 14, 110-5.
  27. Sadighi S, Raafat J, Mohagheghi MA, Meemary F (2005). Gastric carcinoma: 5 year experience of a single institute. Asian Pac J Cancer Prev, 6, 195-6.
  28. Saghier AA, Kabanja JH, Afreen S, Sagar M (2013). Gastric Cancer: Environmental Risk Factors, Treatment and Prevention. J Carcinogene Mutagene, 14, 8.
  29. Shafaghi A, Mansour-Ghanaei F, Joukar F, et al (2013). Serum gastrin and the pepsinogen I/II ratio as markers for diagnosis of premalignant gastric lesions. Asian Pac J Cancer Prev, 14, 3931-6.
  30. Wang S, Zheng G, Chen L, Xiong B (2011). Effect of HER-2/neu Over-expression on prognosis in gastric cancer: a metaanalysis. Asian Pac J Cancer Prev, 12, 1417-23.
  31. Wilke H, Preusser P, Fink U, et al (1989). Preoperative chemotherapy in locally advanced and nonresectable gastric cancer. A phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol, 7, 1318-26.
  32. Wysocka B, Kassam Z, Lockwood G, et al (2010). Interfraction and respiratory organ motion during conformal radiotherapy in gastric cancer. Int J Rad Oncol Bio Phys, 77, 53-9.

Cited by

  1. Proposal of a Nomogram for Predicting Survival in Patients with Siewert Type II Adenocarcinoma of the Esophagogastric Junction After Preoperative Radiation pp.1534-4681, 2019,