FACO International Workshop
Prognosis and recurrent patterns in patients of advanced gastric cancer treated with neoadjuvant chemoradiotherapy
演題番号 : FWS7-4
1:Department of Surgery, School of Medicine, Keio University
Because of curative surgery is regarded as the only option for cure in patients with highly advanced gastric cancer, the prognosis still remains unfavorable. We previously reported phase I studies of neoadjvant chemoradiotherapy (CRT) of S-1 plus cisplatin to improve the prognosis of advanced cases. In this study, we examined the prognosis and recurrent sites of patients in these studies.
Between March 2010 and July 2012, 22 patients were entered to these trials. After neoadjuvant treatment of CRT, a curative gastrectomy with extended (D2) lymph node dissection was planned.
Twenty-two patients (cStageIIIA / IIIB / IV : 8/11/3) were enrolled into this analysis and 18 patients were performed gastrectomy after neoadjuvant CRT. Three patients refused surgical treatment and 1 patient was performed gastro-jejunum bypass because of cancer invasion to the duodenum, transverse colon and pancreas. 14 of 18 patients who underwent gastric surgery showed a histological response to CRT (grade 1b or more effective), including 3 patients with a pathological complete response (grade 3).
The 3-year disease free survival rate of gastrectomy group was 55.6% and 3-year overall survival rate was 88.9%. The 3-year overall survival rate of all patients was 90.4%. Nine of 18 patients who were treated with surgical treatment had the recurrence event. Five patients were the peritoneum dissemination and 4 patients were distant lymph node metastasis.
Of 14 (77.8%) patients showed histological response to CRT. In addition, this study showed favorable prognosis of cases with advanced gastric cancer. Neoadjvant CRT might expected as a precious strategy for advanced gastric cancer.