Gastrointestinal Cancer

PV 04 - Poster Viewing Q&A - Session 4

TU_12_2478 - Is the Time between Surgery and Radiochemotherapy an Important Factor for Local Control in Locally Advanced Gastric Cancer

Tuesday, September 17
2:45 PM - 4:00 PM
Location: ASTRO Innovation Hub

Is the Time between Surgery and Radiochemotherapy an Important Factor for Local Control in Locally Advanced Gastric Cancer
Z. A. Alicikus1, B. Aydin1, S. Derici2, T. Yavuzsen3, and I. B. Gorken4; 1Dokuz Eylul University Department of Radiation Oncology, Izmir, Turkey, 2Dokuz Eylul University Department of Gastrointestinal surgery, Izmir, Turkey, 3Dokuz Eylul University Department of Medical Oncology, Izmir, Turkey, 4Dokuz Eylul University Department of Radiation Oncology, Izmır, Turkey

Purpose/Objective(s): To evaluate the effect of time between surgery and adjuvant radiochemotherapy (RCT) on local disease control in patients with locally advanced gastric cancer (LAGC).

Materials/Methods: This retrospective study consisted of 190 patients who underwent radical gastrectomy (R0) for gastric cancer from October 2001 to April 2018. All patients underwent total or subtotal gastrectomy and D2 lymph node dissection. Then, all patients underwent adjuvant concurrent RCT with infusion 5-FU / oral capacitabine and 5-FU-based chemotherapy. External beam radiation therapy was delivered total dose 4500 cGy in 25 fractions with 3D-conformal or volumetric modulated arc therapy (VMAT) technique. The effect of time between surgery and RCT on local control was evaluated. The Kaplan Meier and Log-Rank analysis were used to identify significance.

Results: The median follow-up time was 29 (4-202) months. The median age was 58 (24-84) years and 70% of the patients were male. The tumor locations were corpus (49%), antrum (34%), cardia (14%) and linitis plastica (3%). Total gastrectomy was performed in 59% patients while 41% patients had subtotal gastrectomy. According to AJCC 2017-TNM staging system, the stage distribution of patients were stage IIa in 13%, stage IIb in 18%, stage IIIa in 29%, stage IIIb in 32% and stage IIIc in 9%, respectively. The most common histopathology was adenocarcinoma (76%). The lymphovasculer and perineural invasion were present in 66% and 64% of patients, respectively. The median time to the beginning of RCT after surgery was 133 (29-239) days. In 34% patients adjuvant RCT was started in the first 120 days after surgery. The 2 and 5 year local recurrence-free survival (LRFS) rates were 91% and 87% in all patients, 96% and 96% in time <120 days between surgery and RCT while 88% and 82% in time ≥120 days (p=0.022). The overall (OS) and disease-free survival (DFS) rates were 72% and 65% at 2 years, 51% and 55% at 5 years, respectively. The time were not found as a statistically significant factor for OS (p = 0.947) and DSF (p = 0.537).

Conclusion: Local disease control is an important issue in LAGC and delay of more than 120 days in the beginning of adjuvant radiochemotherapy after surgery may cause loss of LRFS up to 14%. Therefore, the time to start RCT after surgery in the first 120 days as a important factor for local control should consider.

Author Disclosure: Z.A. Alicikus: None. B. Aydin: None. S. Derici: None. T. Yavuzsen: None.

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