Upper GI 2017

Pre-operative chemoradiotherapy: phase I-II studies

Authors

Patients RT

Chemotherapy

Surgery Outcome

Allal et al. IJROBP 2005; Ann Oncol 2003

N=19 T3-4 or N+

Median dose 38.4 Gy (hyperfx)

2 cycles of Cisplatin (100 mg/m 2 ) d1; 5FU (800 mg/m 2 ) d1-4; leucovorin (60 mg bid) d1-4 Second cycle during RT 2 cycles of Cisplatin (20 mg/m 2 ) d 1-5; 5FU (200 mg/m 2 ) 21 days; leucovorin (20 mg 2 ) d1, 8, 15 During RT: 5FU (300 mg/m 2 ) dd conti. iv

D2 with (sub) total gastric resection

R0 resection 100% pCR+pPR 47% 2yr OS 71% R0 resection 70% pCR+pPR 54% 2yr OS 54%

Ajani et al. JCO 2004

N=34 T2-3, Nany or T1N1

45 Gy/25 fx

D2 Median number lymph nodes examined: 16

Lowy et al. Ann Surg Oncol 2001

N=24 ≥T2 and/or N+

45 Gy/25 fx 10 Gy intra-operative

5FU c.i. (300 mg/m 2 )

83% D2 Rest PD 98% S 78% R0

11% pCR 63% sign treatment effect

Ajani et al. JCO 2005

N=41 T2-3N0-1 T1N1

45 Gy/25 fx

2 induction courses of fluorouracil, paclitaxel and cisplatin; 5FU and paclitaxel concurrent with RT

pCR 20% pPR 15%

Ajani et al. JCO 2006

N=43 assessable [20 institutions]

45 Gy/25 fx

2 induction courses with 5FU, leucovorin and cisplatin; fluorouracil and paclitaxel

50% D2

pCR 26% R0 77%

concurrent with RT

T2-3N0-1 or T1N1

Med surv 23.2 m 1yr surv 72%

Wydmanski et al. R&O 2007

N=40 TNM??

45 Gy/25 fx

4 5FU and LV based schedules (1st and last week of RT)

80% S (D2)

R0 94% pCR 17.5% pPR 20% 2yr surv 63%

Saikawa et al. IJROBP 2008

N=29 evaluable

40 Gy/20 fx

S1 (60 mg/m2/d) and Cisplatin (6 mg/m 2 /d)

33% S D2; > 10 months

R0: 100% pCR: 4/30 (13.3%) Med surv 25 m

Trip et al. R&O 2014 N=25

45 Gy/25 fx

weekly carboplatin and paclitaxel concurrent with RT

84% D1+

R0: 72% pCR: 16%

II-IV (M0)

Combined 19 - 43 pts 40 - 45 Gy 5FU/cis-/carboplatin/ paclitaxel

D2

R0: 70 - 100% pCR: 11 - 26%

From: Trip et al. Transl Gastrointest Cancer 2015