|
|
Back to 2015 Annual Meeting Program
Adjuvant Therapy Completion RATES in Patients With Gastric Cancer Undergoing Perioperative Chemotherapy Versus a Surgery-First Approach
Eva Fuentes*1, Rima Ahmad1, Theodore S. Hong2, Eunice L. Kwak3, David W. Rattner1, John T. Mullen1
1Surgery, Massachusetts General Hospital, Boston, MA; 2Radiation Oncology, Massachusetts General Hospital, Boston, MA; 3Medical Oncology, Massachusetts General Hospital, Boston, MA
Background: Delayed recovery after gastrectomy may preclude the administration of adjuvant therapy in a significant percentage of patients who undergo elective gastrectomy as the initial therapy for gastric adenocarcinoma. Accordingly, many centers are administering as much therapy as possible prior to surgery, at a time when it is better tolerated. This study sought to compare the rates of receipt of adjuvant therapy in patients with localized gastric cancer treated either with surgery first or with perioperative chemotherapy (CTX), consisting of several cycles of preoperative CTX, followed by surgery, followed by additional postoperative CTX.
Methods: Clinicopathologic and treatment variables of 158 patients undergoing potentially curative, elective gastrectomy for stages Ib-IIIc gastric adenocarcinoma from 2001-2013 were reviewed. All patients were recommended to have adjuvant CTX, and it was assumed that all node-positive and margin-positive patients were recommended to have adjuvant radiation therapy (XRT). We identified 93 patients undergoing a surgery-first approach (SURG) and 65 patients undergoing perioperative CTX (PERIOP). Patients with gastroesophageal junction tumors and those lost to follow-up were excluded.
Results: Patients in the SURG group were older, more likely to have distal tumors, and less likely to undergo an esophagogastrectomy or total gastrectomy or a D2 lymphadenectomy than patients in the PERIOP group. The distribution of ASA scores was not significantly different between the two groups. Patients in the SURG group were much less likely than those in the PERIOP group to receive: (1) at least one cycle of chemotherapy (56% vs 100%, p<0.001); (2) all recommended systemic therapy (44% vs 69%, p=0.002); (3) adjuvant XRT (44% vs 61%, p=0.09); and (4) all recommended systemic and XRT combined (37% vs 57%, p=0.015). Forty-one (44%) patients in the SURG group did not receive any adjuvant chemotherapy due to surgical complications (n=19, 46%), patient refusal (n=13, 32%), or disease progression (n=9, 22%). Of the 48 ASA class III patients who had surgery first, only 22 (46%) received any adjuvant CTX, whereas 22 of the 26 (85%) ASA class III patients in the PERIOP group received all of the recommended pre-op CTX, and 58% received all of the recommended pre-op and post-op CTX.
Conclusions: Fewer than 40% of patients with adenocarcinoma of the stomach who undergo a surgery-first approach receive all recommended adjuvant CTX and XRT, as opposed to nearly 60% of patients treated with perioperative CTX, including patients of poorer performance status. Neoadjuvant therapy should be strongly considered for all patients with locoregionally advanced adenocarcinomas of the stomach.
Back to 2015 Annual Meeting Program
|
