Neoadjuvant treatment of gastric cancer: radiochemotherapy

1
(Neo-)adjuvant treatment of gastric cancer
radio-chemo-therapy?

• Tom Boterberg
• Department of Radiation Oncology
• University Hospital Gent

2
Criteria for adjuvant therapy

• Complete resection, no metastases
• High risk of relapse due to (occult) residual
  disease
• Treatment should increase disease-free period
  and/or cure rate
• Acceptable toxicity

3
Lim et al., JCO 2005
4
Postoperative chemotherapy?
Lim et al., JCO 2005
5
Any role for adjuvant R(CT)?
6
Is radiotherapy used optimally?
Delaney et al., Cancer 2004
7
What is the target volume?
Perez, Principles and Practice of Radiotherapy
8
Anatomical challenges
9
Modern radiotherapy
Jansen et al., JCO 2005
10
Adjuvant radiochemotherapy I

• Macdonald et al., NEJM 2001
• 556 pts gastric carcinoma GE junction
• Surgery versus surgery RCT
• 5-FU gt 45 Gy 5-FU gt 5-FU
• OS 27 months vs 36 months
• Time to relapse 19 vs 30 months
• Major problem extent of surgery

11
Intergroup Study INT-0116Results
Macdonald JS et al, ASCO GI Cancers Symposium
2004, Abstract 6.
12
Survival data
Macdonald et al., NEJM 2001
13
Adjuvant radiochemotherapy II

• Kim et al., IJROBP 2005
• 990 pts D2-resected gastric cancer
• Observational study (not randomized)
• 5-FU gt 45 Gy 5-FU gt 5-FU
• OS 63 vs 95 months
• Relapse-free survival 53 vs 76 months
• Selected from 3447 pts (no stage I)

14
Survival according to stage
Kim et al., IJROBP 2005
15
Survival data
Kim et al., IJROBP 2005
16
Is there a role for radiotherapy in gastric
cancer?

• Probably there is, but...

17
With care and consideration

• How to select patients (II-III?)
• Use modern radiotherapy techniques
• Addition of chemotherapy may make the difference
• What is the optimal timing?

18
Preoperative radiochemotherapy
Ajani et al., JCO 2004
19
Future role for radio(chemo)therapy?

• Postoperative radiochemotherapy a new standard?
  Is the chemotherapy satisfactory?
• Combination with recent biologicals with
  potential radiosensitising effect?
• What about docetaxel, CPT-11, oxaliplatin?
  Preliminary data in advanced disease
• Biological or immunological molecules?
• Timing of radio-chemotherapy?

20
MAGIC Trial ASCO 2005

• UK 1994-2002
• 503 patients
• Resectable gastric (74), oesophago-gastric
  junction (11) or distal oesophagus (15)
  adenocarcinoma
• Epirubicin, cisplatin, 5-FU (ECF)
• Surg. vs 3 x ECF Surgery 3 x ECF