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Abstract
BACKGROUND AND PURPOSE:
To evaluate the safety and efficacy of preoperative chemotherapy (CTx) followed by chemoradiotherapy (CCRT) for high-risk gastric cancer (GC).

METHODS AND MATERIALS:
The inclusion criteria were as follows: (1) Borrmann type 4; (2) large Borrmann type 3 (≥8 cm); (3) single bulky (≥3 cm × 1) or multiple lymph nodes (≥1.5 cm × 3). Patients received two 21-day courses of induction CTx of TS-1 (35 mg/m2, p.o, twice daily on days 1-14), docetaxel (30 mg/m2, i.v., days 1 and 8), and cisplatin (30 mg/m2, i.v., days 1 and 8) followed by CCRT (two courses of TS-1 and cisplatin in combination with 45 Gy radiation).

RESULTS:
Forty-two patients were enrolled between March 2014 and February 2016, and 39 of these completed sequential CTx and CCRT. Among the 33 patients who underwent R0 resection, the pathologic response rate was 39.4% [no residual carcinoma (n = 5, 15.2%), with 1-10% residual carcinoma (n = 8, 24.2%)]. Overall, 4 patients (12.1%) were pathologic stage 0, 7 (21.2%) were stage I, 10 (30.3%) were stage II, and 12 (36.4%) were stage III. The overall survival rate at 3 years was 77.9% for stages 0 and I, 66.8% for stages II-III, and 33.3% for unresectable cases (P = 0.001). Toxicity was mild to moderate with grade 4 neutropenia (n = 1) and neutropenic fever (n = 1) as the most prominent side-effects.

CONCLUSIONS:
Sequential CTx and CCRT prior to surgery are feasible and effective for high-risk GC.

TRIAL REGISTRATION NUMBER:
NCT02495493.

Author information

Kim HS1, Koom WS2, Baek SE3, Kim HI4, Jung M1, Beom SH1, Kang B1, Kim H5, Chang JS2, Choi YY4, Son T4, Cheong JH4, Noh SH4, Kim EH6, Park JC6, Shin SK6, Lee SK6, Lee YC6, Shin SJ7, Chung H8, Jung I9, Chung HC10, Lim JS3, Hyung WJ11, Rha SY12.
1
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Radiology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
4
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
5
Department of Pathology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
6
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine Seoul, Republic of Korea.
7
Departments of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea.
8
Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea.
9
Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea.
10
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Sciences, Seoul, Republic of Korea.
11
Department of Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: WJHYUNG@yuhs.ac.
12
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea; Song-Dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Sciences, Seoul, Republic of Korea. Electronic address: rha7655@yuhs.ac.