Background: Neoadjuvant chemoradiation is an effective strategy for the treatment of locally advanced esophageal carcinoma because it can downstage tumors and improve resectability. Neoadjuvant chemotherapy has been shown to improve survival in patients with gastric cancer. The purpose of this study was to evaluate the feasibility of neoadjuvant chemoradiation for locally advanced gastric cancer.
Methods: A retrospective review identified 16 patients with biopsy-proven, locally advanced (T3/T4 or N1) gastric cancer that underwent neoadjuvant chemoradiation between 1997 and 2006 (41% with GE-junction involvement). Patients received external beam radiation with concurrent 5-FU or platinum-based chemotherapy. If restaging CT demonstrated no metastatic disease, surgical exploration was performed with the intent of performing gastrectomy.
Results: Five patients required hospitalization for treatment-related complications, but all patients were able to complete therapy. The median time from diagnosis to attempted gastrectomy was 104 days and the median time from completion of neoadjuvant therapy to attempted gastrectomy was 42 days. At the time of restaging, disease burden was evaluated: 3 patients showed evidence of local progression, 4 patients had decreased disease, and 9 patients had stable disease. All 16 patients underwent attempted gastrectomy. Gastrectomy was performed in 13 patients; in the remaining 3 metastatic disease was identified. In the gastrectomy patients, a complete histologic response was identified in 3 patients (19% of those treated neoadjuvantly), 8 patients had a partial response and 2 patients had no response. Two patients had positive margins and 8 patients had lymph node involvement. There was no perioperative mortality. Two gastrectomy patients developed anastomotic leaks that were treated conservatively. The median length of stay for patients undergoing gastrectomy was 10 days. The median survival for patients undergoing gastrectomy was 22 months.
Conclusions: Locally advanced gastric cancer carries a poor prognosis. Neoadjuvant chemoradiation was well tolerated and was associated with acceptable perioperative morbidity. Patients with complete or partial histologic responses may translate to improved rates of R0 resection.