The efficacy and the tolerance of postoperative radiochemotherapy in gastric cancer

Background: In this study we assessed the efficacy and the tolerance of postoperative radiochemotherapy in gastric cancer.
Material and methods: A group of 66 patients with gastric cancer after radical surgery was treated postoperatively with radiochemotherapy during 2003-2006. In this group were 47 men and 19 women. Median age was 57 years. Total gastrectomy was performed in 49 patients. Histologically adenocarcinomas dominated and stages pT2-T3 and pN1-N2. Radiochemotherapy was used in all cases. After the first cycle of chemotherapy with 5-fluorouracil (425 mg/m²) and leucovorin (20 mg/m²) patients were irradiated (45 Gy in 25 fractions). During radiotherapy they received 2 cycles of a reduced dose of 5-Fu (400 mg/m²) and leucovorin (20 mg/m²). After radiotherapy chemotherapy was continued (2 cycles).
Results: Fifty-three patients completed treatment as planned. Twenty-nine patients died. Thirty-seven are alive. The 1-, 2-and 5-year overall survival rates were 83, 62 and 50% respectively. Disease-free survival rates were 75, 59 and 48% respectively. Haematological toxicity was observed in 54% of patients. Gastrointestinal toxic effects were observed in 20 patients. Acute toxicity of liver, heart and lungs was not observed. In this group were identified independent prognostic factors which influence the overall survival: the stage of cancer and the number of involved lymph nodes.
Conclusions: Postoperative radiochemotherapy in patients with gastric cancer is effective and well tolerated. Independent prognostic factors which influence the overall survival are the stage of cancer, the number of involved lymph nodes and recurrence.