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Title: The Effect of Neoadjuant Chemoradiotherapy Compared with Neoadjuant Chemotherapy on Regression of Gastric Cancer. RJMS. 2018; 25 (167)
URL: http://rjms.iums.ac.ir/article-1-4652-en.html
Abstract:   (585 Views)

Title: The Effect of Neoadjuant Chemoradiotherapy Compared with Neoadjuant Chemotherapy on Regression of Gastric Cancer
Background: Gastric cancer is an aggressive disease with a poor prognosis and is considered as one of the main causes of cancer death in the world. Initial treatment of gastric cancer is surgery, but to achieve tumor free margin is difficult in some cases, particularly tumors of the cardia. Therefore, this study was performed to compare the effect of neoadjuant chemoradiotherapy with neoadjuant chemotherapy on regression of cancer of the gastric cardia.  
Materials & Methods: In this randomized clinical trial, 30 patients with cancer of the gastric cardia referred to Besat hospital in Hamedan were investigated. All patients had adenocarcinoma and were in stage 3 of disease (based on TNM). The patients divided into two groups; the first group (neoadjuant chemoradiotherapy, n = 15) received chemotherapy with 5-fluorouracil/leucovorin (5-FU/LV) and then, after the last course, concurrent chemoradiotherapy was performed with a total dose of 45 Gy and 25 fractions. In the second group (neoadjuvant chemotherapy, n = 15), patients received three courses of 5-FU/LV regimen (no radiotherapy). Then, for two groups of patients after at least 4 weeks following the end of treatment, re-staging was performed by computed tomography scan via double-contrast (orally and intravenously). At this step, the patient's current and primary status was compared. In the next step, all patients underwent subtotal radical gastrectomy. Surgical specimens were examined for tumor size and negative margin. After complete recovery and repair of the patient's wounds (about 3 to 4 weeks after surgery), the chemotherapy period was completed until the end of 6 courses with 5-FU/LV regimen. The primary outcome of the study was the reduction of tumor stage (TNM) after neoadjuvant treatment and the secondary outcome of the study was to increase the survival rate (overall, one and two-year survival rates) of the patients. The collected data were analyzed by SPSS-16.
Results: There was no statistically significant difference between two groups in terms of mean age and gender of the patients (P = 0.75, P = 0.56, respectively). There was no significant difference between two groups in terms of age, sex and tumor size before treatment (P < 0.05). However, in terms of T after treatment, N before and after treatment, tumor margin and life status in patients, significant diffferences were observed (P <0.05). In the first group (neoadjuvant chemoradiotherapy), was observed reduction in tumor size in 12 patients (80.0%)(one patient had complete response), and in the second group (neoadjuvant chemotherapy), in 3 patients (20.0%) was observed. To achieve free margin in the first group, 14 cases (93.3%) and in the second group, 2 cases (13.3%) had free margin that in terms of tumor size (P = 0.0001) and free margin (P = 0.04), significant difference was observed between two groups.
Discussion & Conclusion: The results of this study showed that neoadjuvant chemoradiotherapy in patients with cancer of the gastric cardia significantly caused tumor regression, and in addition to facilitating surgical resection, achieve to adequate free margin also be possible. Hence, it is superior to neoadjuvant chemotherapy alone. In addition, various factors such as sex can play a decisive role in the survival rate of patients.

Type of Study: Research | Subject: General Surgery

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