Postoperative chemotherapy in gastric cancer, consisting of etoposide, doxorubicin and cisplatin, followed by radiotherapy with concomitant cisplatin: A feasibility study

Shulman,Katerina; Haim,Nissim; Wollner,Mira; Bernstein,Zvi; Abdah-Bortnyak,Roxylana; Bar-Sela,Gil

doi:10.3892/ol.2012.617

May 2012 Volume 3 Issue 5

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May 2012 Volume 3 Issue 5

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Article

Postoperative chemotherapy in gastric cancer, consisting of etoposide, doxorubicin and cisplatin, followed by radiotherapy with concomitant cisplatin: A feasibility study

Authors:
- Katerina Shulman
- Nissim Haim
- Mira Wollner
- Zvi Bernstein
- Roxylana Abdah-Bortnyak
- Gil Bar-Sela
View Affiliations / Copyright

Affiliations: Division of Oncology, Rambam Health Care Campus, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31096, Israel
Pages: 1154-1158
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Published online on: February 24, 2012

https://doi.org/10.3892/ol.2012.617
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Abstract

The prognosis following surgical treatment of gastric carcinoma (GC) or gastroesophageal junction (GEJ) adenocarcinoma remains poor. Although adjuvant chemo-radiotherapy with 5-fluorouracil has been shown to be beneficial, a high rate of distant failure has been reported. Thus, the toxicity profile and efficacy of an intensified chemo-radiotherapy regimen following complete or near-complete resection of GC was evaluated. Patients who underwent surgery for GC were eligible for evaluation. Treatment consisted of four cycles of modified EAP: etoposide 100 mg/m2, days 1-3; cisplatin 27 mg/m2, days 1-3; and adriamycin 40 mg/m2, day 1; every 21 days, followed by a course of radiotherapy (45 Gy; 1.8 Gy/fr) combined with weekly cisplatin 40 mg/m2. In total, 40 patients were included in the analysis. Median follow-up was 34 months from the onset of chemotherapy. Microscopic stage IV disease and/or R1 resection were found in 11 patients. For these patients, the median progression-free survival was 6.5 months, and overall survival 9.5 months, compared to 25 and 54 months, respectively, for the remaining 29 patients. In the latter subgroup, longer disease-free survival was associated with average dose intensity of >90% for the four cycles of EAP. The predominant grade 3-4 toxicities during EAP-chemotherapy were hematological adverse events. Nevertheless, the rate of severe non-hematologic toxicity reached 60%. There was one toxicity-related mortality. During the chemo-radiotherapy course, 39% of patients experienced grade 3-4 non-hematologic toxicities. It was concluded that the high toxicity rate of this regimen does not justify further evaluation of this postoperative protocol. Chemo-radiotherapy for R1 or pathological microscopic M1 patients does not appear to be justified.

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1	Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA and Hamilton SM: Gastric adenocarcinoma. Review and considerations for future directions. Ann Surg. 241:27–39. 2005.PubMed/NCBI
2	Macdonald JS, Smalley SR, Benedetti J, et al: Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 345:725–730. 2001. View Article : Google Scholar
3	Cunningham D, Allum WH, Stenning SP, et al: Perioperative chemotherapy versus surgery alone for respectable gastroesophageal junction carcinoma. N Engl J Med. 355:11–20. 2006. View Article : Google Scholar
4	Goburn NG, Govindarajan A, Law CH, et al: Stage-specific effect of adjuvant therapy following gastric cancer resection: a population-based analysis of 4,041 patients. Ann Surg Oncol. 15:500–507. 2008. View Article : Google Scholar : PubMed/NCBI
5	Fiorica F, Cartei F, Enea M, et al: The impact of radiotherapy on survival in respectable gastric carcinoma: a meta-analysis of literature data. Cancer Treat Rev. 33:729–740. 2007. View Article : Google Scholar : PubMed/NCBI
6	Lim L, Michael M, Mann GB and Leong T: Adjuvant therapy in gastric cancer. J Clin Oncol. 23:6220–6232. 2005. View Article : Google Scholar : PubMed/NCBI
7	Haim N, Tsalik M and Robinson E: Treatment of gastric adeno-carcinoma with combination of etoposide, adriamycin and cisplatin (EAP): comparison between two schedules. Oncology. 51:102–107. 1994. View Article : Google Scholar : PubMed/NCBI
8	Bar-Sela G, Tsalic M, Steiner M, Wollner M and Haim N: Local recurrence following adjuvant chemotherapy without radiotherapy in completely resected stomach and gastroesopha- geal junction adenocarcinoma. Anticancer Res. 29:1853–1856. 2009.
9	Leong T, Joon DL, Willis D, et al: 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. Int J Radiat Oncol Biol Phys. 79:690–695. 2011. View Article : Google Scholar
10	Oechsle K, Bokemeyer C, Hartmann JT, Budach W, Trarbach T, Stahl M, et al: Four consecutive multicenter phase II trials of adjuvant chemoradiation in patients with completely resected high-risk gastric cancer: the experience of the German AIO/ARO/CAO group. J Cancer Res Clin Oncol. 135:163–172. 2009. View Article : Google Scholar : PubMed/NCBI
11	Orditura M, De Vita F, Muto P, Vitiello F, Murino P, Lieto E, Vecchione L, et al: Adjuvant chemoradiotherapy in patients with stage III or IV radically resected gastric cancer: a pilot study. Arch Surg. 145:233–238. 2010. View Article : Google Scholar : PubMed/NCBI
12	Fuchs C, Tepper J, et al: Postoperative adjuvant chemoradiation for gastric or gastroesophageal junction (GEJ) adenocarcinoma using epirubicin, cisplatin, and infusional (CI) 5-FU (ECF) before and after CI 5-FU and radiotherapy (CRT) compared with bolus 5-FU/LCV before and after CRT: intergroup Trial CALGB 80101. ASCO abstract 4003. 2011.
13	Schwartz G, Winter K, Minsky BD, et al: Randomized phase II trial evaluating two paclitaxel and cisplatin-containing chemoradiation regimens as adjuvant therapy in resected gastric cancer (RTOG-0114). J Clin Oncol. 27:1956–1962. 2009. View Article : Google Scholar
14	Bamias A, Karina M, Papakostas P, et al: A randomized phase III study of adjuvant platinum/docetaxel chemotherapy with or without radiation therapy in patients with gastric cancer. Cancer Chemother Pharmacol. 65:1009–1021. 2010. View Article : Google Scholar
15	Bang Y, Kim Y, et al: Adjuvant capecitabine and oxaliplatin for gastric cancer: results of the phase III CLASSIC Trial. ASCO abs. 40022011.

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Postoperative chemotherapy in gastric cancer, consisting of etoposide, doxorubicin and cisplatin, followed by radiotherapy with concomitant cisplatin: A feasibility study

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