Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view
The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradi...
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| Veröffentlicht in: | British journal of cancer 2004-07, Vol.91 (1), p.11-17 |
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| creator | Lim, D H Kim, D Y Kang, M K Kim, Y I Kang, W K Park, C K Kim, S Noh, J H Joh, J W Choi, S H Sohn, T S Heo, J S Park, C H Park, J O Lee, J E Park, Y J Nam, H R Park, W Ahn, Y C Huh, S J |
| description | The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed. |
| doi_str_mv | 10.1038/sj.bjc.6601896 |
| format | Article |
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In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.</description><identifier>ISSN: 0007-0920</identifier><identifier>EISSN: 1532-1827</identifier><identifier>DOI: 10.1038/sj.bjc.6601896</identifier><identifier>PMID: 15162146</identifier><identifier>CODEN: BJCAAI</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Adenocarcinoma - drug therapy ; Adenocarcinoma - mortality ; Adenocarcinoma - radiotherapy ; Adenocarcinoma - surgery ; Aged ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biological and medical sciences ; Biomedical and Life Sciences ; Biomedicine ; Cancer Research ; Chemotherapy, Adjuvant ; Clinical ; Disease-Free Survival ; Drug Resistance ; Epidemiology ; Female ; Fluorouracil - administration & dosage ; Follow-Up Studies ; Gastrectomy ; Humans ; Leucovorin - administration & dosage ; Male ; Medical sciences ; Middle Aged ; Molecular Medicine ; Neoplasm Recurrence, Local ; Oncology ; Radiotherapy, Adjuvant ; Stomach Neoplasms - drug therapy ; Stomach Neoplasms - mortality ; Stomach Neoplasms - radiotherapy ; Stomach Neoplasms - surgery ; Survival Rate ; Treatment Failure ; Tumors</subject><ispartof>British journal of cancer, 2004-07, Vol.91 (1), p.11-17</ispartof><rights>The Author(s) 2004</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Jul 5, 2004</rights><rights>Copyright © 2004 Cancer Research UK 2004 Cancer Research UK</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-189008eefe334c3b8ab08e477ec3d034bac4e3c59224ed3b6d0c004a7b8e58c23</citedby><cites>FETCH-LOGICAL-c483t-189008eefe334c3b8ab08e477ec3d034bac4e3c59224ed3b6d0c004a7b8e58c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364765/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364765/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15958550$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15162146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, D H</creatorcontrib><creatorcontrib>Kim, D Y</creatorcontrib><creatorcontrib>Kang, M K</creatorcontrib><creatorcontrib>Kim, Y I</creatorcontrib><creatorcontrib>Kang, W K</creatorcontrib><creatorcontrib>Park, C K</creatorcontrib><creatorcontrib>Kim, S</creatorcontrib><creatorcontrib>Noh, J H</creatorcontrib><creatorcontrib>Joh, J W</creatorcontrib><creatorcontrib>Choi, S H</creatorcontrib><creatorcontrib>Sohn, T S</creatorcontrib><creatorcontrib>Heo, J S</creatorcontrib><creatorcontrib>Park, C H</creatorcontrib><creatorcontrib>Park, J O</creatorcontrib><creatorcontrib>Lee, J E</creatorcontrib><creatorcontrib>Park, Y J</creatorcontrib><creatorcontrib>Nam, H R</creatorcontrib><creatorcontrib>Park, W</creatorcontrib><creatorcontrib>Ahn, Y C</creatorcontrib><creatorcontrib>Huh, S J</creatorcontrib><title>Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view</title><title>British journal of cancer</title><addtitle>Br J Cancer</addtitle><addtitle>Br J Cancer</addtitle><description>The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.</description><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - radiotherapy</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cancer Research</subject><subject>Chemotherapy, Adjuvant</subject><subject>Clinical</subject><subject>Disease-Free Survival</subject><subject>Drug Resistance</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fluorouracil - administration & dosage</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy</subject><subject>Humans</subject><subject>Leucovorin - administration & dosage</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular Medicine</subject><subject>Neoplasm Recurrence, Local</subject><subject>Oncology</subject><subject>Radiotherapy, Adjuvant</subject><subject>Stomach Neoplasms - drug therapy</subject><subject>Stomach Neoplasms - mortality</subject><subject>Stomach Neoplasms - radiotherapy</subject><subject>Stomach Neoplasms - surgery</subject><subject>Survival Rate</subject><subject>Treatment Failure</subject><subject>Tumors</subject><issn>0007-0920</issn><issn>1532-1827</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc2LFDEQxYMo7rh69ShBEE8zm4_uTtrDgqyfsKAHPYfqdPVMmu5kTDIr89-bYRp3PXgKxful3iseIS8523Am9VUaN91oN03DuG6bR2TFaynWXAv1mKwYY2rNWsEuyLOUxjK2TKun5ILXvBG8alYkfoecMfpEw0AHcNMhInWebiHl6Cy1EK3zYQYKQ-HoB3GW0OYwHyn4ntodziFC70LeYYT98R0Fepohu-Bp8DZMYetSfpvoncPfz8mTAaaEL5b3kvz89PHHzZf17bfPX2_e365tpWUuN7SMacQBpays7DR0ZayUQit7JqsObIXS1q0QFfaya3pmGatAdRprbYW8JNfnvftDN2Nv0ecIk9lHN0M8mgDO_Kt4tzPbcGeEbCrV1GXB62VBDL8OmLIZwyH6ktkI0bZKtfLksjlDNoaUIg5_DTgzp4pMGk2pyCwVlQ-vHsa6x5dOCvBmASBZmIYI3rr0gGtrXdescFdnLhXJbzHex_uP9R8Fa604</recordid><startdate>20040705</startdate><enddate>20040705</enddate><creator>Lim, D H</creator><creator>Kim, D Y</creator><creator>Kang, M K</creator><creator>Kim, Y I</creator><creator>Kang, W K</creator><creator>Park, C K</creator><creator>Kim, S</creator><creator>Noh, J H</creator><creator>Joh, J W</creator><creator>Choi, S H</creator><creator>Sohn, T S</creator><creator>Heo, J S</creator><creator>Park, C H</creator><creator>Park, J O</creator><creator>Lee, J E</creator><creator>Park, Y J</creator><creator>Nam, H R</creator><creator>Park, W</creator><creator>Ahn, Y C</creator><creator>Huh, S J</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20040705</creationdate><title>Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view</title><author>Lim, D H ; Kim, D Y ; Kang, M K ; Kim, Y I ; Kang, W K ; Park, C K ; Kim, S ; Noh, J H ; Joh, J W ; Choi, S H ; Sohn, T S ; Heo, J S ; Park, C H ; Park, J O ; Lee, J E ; Park, Y J ; Nam, H R ; Park, W ; Ahn, Y C ; Huh, S J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-189008eefe334c3b8ab08e477ec3d034bac4e3c59224ed3b6d0c004a7b8e58c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adenocarcinoma - drug therapy</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - radiotherapy</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cancer Research</topic><topic>Chemotherapy, Adjuvant</topic><topic>Clinical</topic><topic>Disease-Free Survival</topic><topic>Drug Resistance</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fluorouracil - administration & dosage</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy</topic><topic>Humans</topic><topic>Leucovorin - administration & dosage</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Molecular Medicine</topic><topic>Neoplasm Recurrence, Local</topic><topic>Oncology</topic><topic>Radiotherapy, Adjuvant</topic><topic>Stomach Neoplasms - drug therapy</topic><topic>Stomach Neoplasms - 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In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>15162146</pmid><doi>10.1038/sj.bjc.6601896</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma - drug therapy Adenocarcinoma - mortality Adenocarcinoma - radiotherapy Adenocarcinoma - surgery Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences Biomedical and Life Sciences Biomedicine Cancer Research Chemotherapy, Adjuvant Clinical Disease-Free Survival Drug Resistance Epidemiology Female Fluorouracil - administration & dosage Follow-Up Studies Gastrectomy Humans Leucovorin - administration & dosage Male Medical sciences Middle Aged Molecular Medicine Neoplasm Recurrence, Local Oncology Radiotherapy, Adjuvant Stomach Neoplasms - drug therapy Stomach Neoplasms - mortality Stomach Neoplasms - radiotherapy Stomach Neoplasms - surgery Survival Rate Treatment Failure Tumors |
| title | Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view |
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