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Title: Adjuvant Chemoradiation for Gastric Cancer Using Epirubicin, Cisplatin, and 5-Fluorouracil Before and After Three-Dimensional Conformal Radiotherapy With Concurrent Infusional 5-Fluorouracil: A Multicenter Study of the Trans-Tasman Radiation Oncology Group

Purpose: The INT0116 study has established postoperative chemoradiotherapy as the standard of care for completely resected gastric adenocarcinoma. However, the optimal chemoradiation regimen remains to be defined. We conducted a prospective, multicenter study to evaluate an alternative chemoradiation regimen that combines more current systemic treatment with modern techniques of radiotherapy delivery. Methods and Materials: Patients with adenocarcinoma of the stomach who had undergone an R0 resection were eligible. Adjuvant therapy consisted of one cycle of epirubicin, cisplatin, and 5-FU (ECF), followed by radiotherapy with concurrent infusional 5-FU, and then two additional cycles of ECF. Radiotherapy was delivered using precisely defined, multiple-field, three-dimensional conformal techniques. Results: A total of 54 assessable patients were enrolled from 19 institutions. The proportion of patients commencing Cycles 1, 2, and 3 of ECF chemotherapy were 100%, 81%, and 67% respectively. In all, 94% of patients who received radiotherapy completed treatment as planned. Grade 3/4 neutropenia occurred in 66% of patients with 7.4% developing febrile neutropenia. Most neutropenic episodes (83%) occurred in the post-radiotherapy period during cycles 2 and 3 of ECF. Grade 3/4 gastrointestinal toxicity occurred in 28% of patients. In all, 35% of radiotherapy treatment plans contained protocol deviations that were satisfactorily amended beforemore » commencement of treatment. At median follow-up of 36 months, the 3-year overall survival rate was estimated at 61.6%. Conclusions: This adjuvant regimen using ECF before and after three-dimensional conformal chemoradiation is feasible and can be safely delivered in a cooperative group setting. A regimen similar to this is currently being compared with the INT0116 regimen in a National Cancer Institute-sponsored, randomized Phase III trial.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ;  [6] ; ;  [7] ;  [8] ;  [9]
  1. Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)
  2. Department of Radiation Oncology, Austin Health, Melbourne, Victoria (Australia)
  3. Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)
  4. Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales (Australia)
  5. Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia (Australia)
  6. Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland (Australia)
  7. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)
  8. Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)
  9. Division of Hematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)
Publication Date:
OSTI Identifier:
21491635
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 79; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2009.11.042; PII: S0360-3016(09)03613-X; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANTINEOPLASTIC DRUGS; CARCINOMAS; COMBINED THERAPY; STOMACH; URACILS AZINES; BODY; DIGESTIVE SYSTEM; DISEASES; DRUGS; GASTROINTESTINAL TRACT; HETEROCYCLIC COMPOUNDS; HYDROXY COMPOUNDS; MEDICINE; NEOPLASMS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; PYRIMIDINES; THERAPY