NEOADJUVANT CHEMORADAIATION IN POTENTIANALLY RESECTABLE ADENOCARCINOMA OF STOMACH AN OBSERVATIONAL STUDY

Abstract

Background: Gastric cancer is among the first five cancers in the valley with a male preponderance (male: female -3.17: 1). According to a cross-sectional study conducted between January 1, 2009, and December 31, 2011, at our institute, out of 8648 patients who were diagnosed with cancer, stomach cancer was recorded in 776 (90%) patients (590 males and 186 females) with a median age of 55 yrs for males and 60 yrs for females. Also, this was the third most common cancer in men and 6th most common in women.

Objectives:

i) To assess pathological response after neoadjuvant chemoradiation,

ii) To assess outcomes in terms of local control of the disease,

iii) To assess chemo radiation-associated acute toxicity grades 1 to 5, and

iv) To assess 3-year overall survival.

Material and methods: It was a prospective study. Patient recruitment in this study was done from the patients registered under RCC SKIMS from 2017 t 2019. Informed consent was obtained from all the patients who have volunteered for the study. Clinical staging workup of all patients included complete history examination, height /weight, BSA and ECOG performance status.

RESULTS: We conducted this study from September 2017 to May 2019 in the department of Radiation Oncology Regional Cancer Center SKIMS. During this period the total number of patients registered was 9783, out of whom 861 were gastric carcinoma; out of these total 861 gastric carcinoma patients, we enrolled 25 patients for the present study to treat them with neoadjuvant concurrent chemoradiation followed by surgery (multimodality treatment).

Conclusions: Looking at the main evidence reported in the literature about the role of radiotherapy in the multimodal management of gastric adenocarcinomas, some problems are still evident in terms of clarity of the classification, patient selections in the trial, and evaluation of results. Nevertheless, we can summarize that the integration of preoperative radiotherapy before surgery is highly effective over surgery alone, providing significantly improved results in terms of local control and survival, with acceptable toxicity rates. In this setting, radiotherapy should be administered at least to a total dose of 40-45 Gy (with conventional fractionation) and associated with concomitant chemotherapy.