Adjuvant chemoradiotherapy in patients with gastric cancer: Single-center experience

Year 2012, Volume: 20 Issue: 1, 8 - 12, 01.04.2012

Birsen Yücel Ebru Atasever Akkaş Yıllar Okur Nalan Babacan Mehmet Fuat Eren Turgut Kaçan Saadettin Kılıçkap

https://doi.org/10.17940/endoskopi.74840

Abstract

Background/aims: The purpose of this study was to review survival analysis, side effects and prognostic factors in patients with gastric cancer who were treated with adjuvant chemoradiotherapy. Materials and Methods: In this study, we retrospectively evaluated the data of 90 patients with gastric cancer followed at Cumhuriyet University Faculty of Medicine, Oncology Center. Results: This study analyzed the data of 90 patients (68 (76%) males, 22 (24%) females). The median follow-up was 19 months (range: 4-105). The two-year overall and disease-free survival rates were 62% and 58%, respectively. In univariate analysis, the factors that determined survival were grade (p: 0.039), T (p: 0.001) and N (p: 0.020) stages, weight loss (p: 0.001), Eastern Cooperative Oncology Group performance status (p: 0.002), anemia (p: 0.019), and hypoalbuminemia (p: 0.001). After multivariate analysis, weight loss (p: 0.008), T stage (p: 0.024) and Eastern Cooperative Oncology Group performance status (p: 0.033) were determined as indepenent prognostic factors that affect survival. The most frequent side effects were nausea and vomiting in 66 patients (73%), dyspepsia in 52 patients (58%), anemia in 45 patients (50%), neutropenia in 36 patients (40%), diarrhea in 34 patients (38%), and weight loss in 29 patients (32%). Conclusions: It was shown that the overall survival and disease-free survival in non-metastatic gastric cancer patients who received adjuvant chemoradiotherapy complied with the literature.

Keywords

Gastric cancer, chemoradiotherapy, survival, prognosis

Mide kanserli hastalarda adjuvan kemoradyoterapi: Tek merkez deneyimi

Abstract

Giriş ve Amaç: Bu çalışmada, adjuvan kemoradyoterapi ile tedavi edilen mide kanserli hastaların sağkalım analizi, tedavi yan etkileri ve sağkalımı etkileyen prognostik faktörlerin incelemesi amaçlandı. Gereç ve Yöntem: Çalışmada Cumhuriyet Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi Onkoloji Merkezinde takip edilen 90 mide kanserli hasta verileri retrospektif olarak incelendi. Bulgular: Çalışmada 68 (%76) erkek, 22 (%24) kadın toplam 90 hastanın verileri analiz edildi. Ortanca takip süresi 19 ay (4-105 ay) idi. İki yıllık genel sağkalım ve hastalıksız sağkalım sırasıyla %62 ve %58 idi. Tek değişkenli analizde hastaların sağkalımını grade (p:0,039), T evre (p:0,001), N evre (p:0,020), kilo kaybı (p: 0,001), ECOG performans durumu (p:0,002), anemi (p:0,019), hipoalbunemi (p:0,001) etkilerken, çok değişkenli analizde bağımsız prognostik faktörler kilo kaybı (p:0,008), T evresi (p:0,024) ve ECOG performans durumu (p:0,033) idi. Hastalarda en sık görülen yan etkiler; bulantı-kusma 66 (%73), dispepsi 52 (%58), anemi 45 (%50), nötropeni 36 (%40), ishal 34 (%38) ve kilo kaybı 29 (%32) hastada görüldü. Sonuç: Bu çalışmada, adjuvan kemoradyoterapi uygulanan mide kanserli hastaların genel ve hastalıksız sağkalımı literatür ile benzer sonuçlar göstermiştir. Bu hasta grubunun en önemli prognostik faktörleri ise kilo kaybı, T evresi ve ECOG performans durumu olarak belirlendi.

Keywords

Mide kanseri, kemoradyoterapi, sağkalım, prognoz

References

• Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.
• Dicken BJ, Bigam DL, Cass C, et al. Gastric adenocarcinoma. Ann Surg 2005;241:27-39.
• Yilmaz HH, Yazihan N, Tunca D, et al. Cancer trends and incidence and mortality patterns in Turkey. Jpn J Clin Oncol 2010;41:10-6.
• Wanebo H, Kenedy BJ, Chmiel J, et al. Cancer of the stomach: a patients care study by the American College of surgeons. Ann Surg 1993;218:583-92.
• MacDonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the sto- mach or gastrointestinal junction. N Engl J Med 2001;345:725-30.
• http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf (erişim tarihi: 20.02.2012)
• Crew KD, Neugut Al. Epidemiology of gastric carcinoma. World J Gas- troenterol 2006;12:354-62.
• Hermans J, Bonenkamp JJ, Boon MC, et al. Adjuvant therapy after cura- tive resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 1993;11:1441-7.
• Earl CC, Maroun JA. Adjuvantt chemotherapy after curative resection for gastric cancer in non-Asian patients: revisting a meta-analysis for rando- mized trials. Eur J Cancer 1999;36:1059-64.
• Hallisley MT, Dunn JA, Ward LC, Allum WH. The second British Sto- mach Cancer Group trial of adjuvant radiotherapy or chemoterapy in re- sectable gastric cancer: five-year follow-up. Lancet 1994;343:1309-12.
• MacDonald J, Smalley S, Benedetti J, et al. Postoperative combined radi- ation and chemotherapy improves disease-free survival (DFS) and ove- rall survival (OS) in resected adenocarcinoma of the stomach and gastro- esophageal junction. Update od the results of Intergroup Study INT- 0116 (SWOG 9008) [abstract]. Proc Am Soc Clin Oncol 2005:106.
• Kim S, Lim DH, Lee J, et al. An observational study suggesting clinical benefit for adjuvantt postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for ade- nocarcinoma of stomach. Int J Radiat Oncol Biol Phys 2005;63:1279-85.
• Okajima K. Prognostic factors of gastric cancer patients a study by uni- variate analysis (in Japanese, with English abstract). Jpn J Gastroenterol Surg 1997;30:700-11.
• Hochwald SN, Kim S, Klimstra DS, et al. Analysis of 154 actual 5-year survivors of gastric cancer. J Gastrointest Surg 2000;4:520-5.
• Gunji Y, Suzuki T, Hori S, et al. Prognostic significance of the number of metastatic lymph nodes in early gastric cancer. Dig Surg 2003;20:148-53.
• Marchet A, Mocellin S, Ambrosi A, et al. Italian Research Group for Gas- tric Cancer (IRGGC). The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer re- gardless of the type of lymphadenectomy: Results from an Italian multi- centric study in 1853 patients. Ann Surg 2007;245:543-52.