Paclitaxel-based chemoradiotherapy in localized gastric carcinoma: Degree of pathologic response and not clinical parameters dictated patient outcome

Jaffer A. Ajani, P. F. Mansfield, C. H. Crane, T. T. Wu, S. Lunagomez, P. M. Lynch, N. Janjan, B. Feig, J. Faust, J. C. Yao, R. Nivers, J. Morris, P. W. Pisters

Research output: Contribution to journalArticle

210 Citations (Scopus)

Abstract

Purpose: Preoperative chemoradiotherapy may increase the RO (curative) resection rate, overall survival (OS) duration, and disease-free survival (DFS) duration. We evaluated paclitaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma to determine its feasibility, impact on the RO resection rate, type of pathologic response, OS, and DFS. Patients and Methods: Patients with operable, localized gastric, or gastroesophageal adenocarcinoma were eligible. Staging included endoscopic ultrasonography (EUS) and laparoscopy. Patients received two 28-day cycles of induction chemotherapy of fluorouracil, paclitaxel, and cisplatin followed by 45 Gy of radiation and concurrent fluorouracil plus paclitaxel. The cancer was restaged and surgery was attempted. Postsurgery pathologic findings and RO resection were correlated with OS and DFS. Results: Forty-one patients were enrolled. Most carcinomas were proximal (83%) and pretreatment stage EUST3 (85%). Forty patients (98%) underwent surgery, and 78% had an RO resection. We observed a pathologic complete response (pathCR) rate of 20% and a pathologic partial response (pathPR) rate of 15% (< 10% residual cancer cells in the resected specimen). No pretreatment parameter (sex, cancer location, baseline T stage, or baseline N stage) predicted the type of postsurgery pathologic response, OS, or DFS. However, pathCR (P = .02), pathCR + pathPR (P = .006), RO resection (P < .001), and postsurgery T and N stages (P = .01 and P < .001, respectively) were associated with OS. Same parameters were significantly correlated with DFS. Toxicity was manageable. Conclusion: The type of pathologic response but not pretreatment parameters was associated with OS and DFS. Efforts to increase the rate of pathologic response and better systemic cancer control are warranted.

Original languageEnglish (US)
Pages (from-to)1237-1244
Number of pages8
JournalJournal of Clinical Oncology
Volume23
Issue number6
DOIs
StatePublished - Feb 20 2005
Externally publishedYes

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Chemoradiotherapy
Paclitaxel
Disease-Free Survival
Stomach
Carcinoma
Survival
Induction Chemotherapy
Fluorouracil
Adenocarcinoma
Radiation Dosage
Neoplasms
Endosonography
Residual Neoplasm
Laparoscopy
Survival Rate

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Paclitaxel-based chemoradiotherapy in localized gastric carcinoma : Degree of pathologic response and not clinical parameters dictated patient outcome. / Ajani, Jaffer A.; Mansfield, P. F.; Crane, C. H.; Wu, T. T.; Lunagomez, S.; Lynch, P. M.; Janjan, N.; Feig, B.; Faust, J.; Yao, J. C.; Nivers, R.; Morris, J.; Pisters, P. W.

In: Journal of Clinical Oncology, Vol. 23, No. 6, 20.02.2005, p. 1237-1244.

Research output: Contribution to journalArticle

Ajani, JA, Mansfield, PF, Crane, CH, Wu, TT, Lunagomez, S, Lynch, PM, Janjan, N, Feig, B, Faust, J, Yao, JC, Nivers, R, Morris, J & Pisters, PW 2005, 'Paclitaxel-based chemoradiotherapy in localized gastric carcinoma: Degree of pathologic response and not clinical parameters dictated patient outcome', Journal of Clinical Oncology, vol. 23, no. 6, pp. 1237-1244. https://doi.org/10.1200/JCO.2005.01.305
Ajani, Jaffer A. ; Mansfield, P. F. ; Crane, C. H. ; Wu, T. T. ; Lunagomez, S. ; Lynch, P. M. ; Janjan, N. ; Feig, B. ; Faust, J. ; Yao, J. C. ; Nivers, R. ; Morris, J. ; Pisters, P. W. / Paclitaxel-based chemoradiotherapy in localized gastric carcinoma : Degree of pathologic response and not clinical parameters dictated patient outcome. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 6. pp. 1237-1244.
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title = "Paclitaxel-based chemoradiotherapy in localized gastric carcinoma: Degree of pathologic response and not clinical parameters dictated patient outcome",
abstract = "Purpose: Preoperative chemoradiotherapy may increase the RO (curative) resection rate, overall survival (OS) duration, and disease-free survival (DFS) duration. We evaluated paclitaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma to determine its feasibility, impact on the RO resection rate, type of pathologic response, OS, and DFS. Patients and Methods: Patients with operable, localized gastric, or gastroesophageal adenocarcinoma were eligible. Staging included endoscopic ultrasonography (EUS) and laparoscopy. Patients received two 28-day cycles of induction chemotherapy of fluorouracil, paclitaxel, and cisplatin followed by 45 Gy of radiation and concurrent fluorouracil plus paclitaxel. The cancer was restaged and surgery was attempted. Postsurgery pathologic findings and RO resection were correlated with OS and DFS. Results: Forty-one patients were enrolled. Most carcinomas were proximal (83{\%}) and pretreatment stage EUST3 (85{\%}). Forty patients (98{\%}) underwent surgery, and 78{\%} had an RO resection. We observed a pathologic complete response (pathCR) rate of 20{\%} and a pathologic partial response (pathPR) rate of 15{\%} (< 10{\%} residual cancer cells in the resected specimen). No pretreatment parameter (sex, cancer location, baseline T stage, or baseline N stage) predicted the type of postsurgery pathologic response, OS, or DFS. However, pathCR (P = .02), pathCR + pathPR (P = .006), RO resection (P < .001), and postsurgery T and N stages (P = .01 and P < .001, respectively) were associated with OS. Same parameters were significantly correlated with DFS. Toxicity was manageable. Conclusion: The type of pathologic response but not pretreatment parameters was associated with OS and DFS. Efforts to increase the rate of pathologic response and better systemic cancer control are warranted.",
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T1 - Paclitaxel-based chemoradiotherapy in localized gastric carcinoma

T2 - Degree of pathologic response and not clinical parameters dictated patient outcome

AU - Ajani, Jaffer A.

AU - Mansfield, P. F.

AU - Crane, C. H.

AU - Wu, T. T.

AU - Lunagomez, S.

AU - Lynch, P. M.

AU - Janjan, N.

AU - Feig, B.

AU - Faust, J.

AU - Yao, J. C.

AU - Nivers, R.

AU - Morris, J.

AU - Pisters, P. W.

PY - 2005/2/20

Y1 - 2005/2/20

N2 - Purpose: Preoperative chemoradiotherapy may increase the RO (curative) resection rate, overall survival (OS) duration, and disease-free survival (DFS) duration. We evaluated paclitaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma to determine its feasibility, impact on the RO resection rate, type of pathologic response, OS, and DFS. Patients and Methods: Patients with operable, localized gastric, or gastroesophageal adenocarcinoma were eligible. Staging included endoscopic ultrasonography (EUS) and laparoscopy. Patients received two 28-day cycles of induction chemotherapy of fluorouracil, paclitaxel, and cisplatin followed by 45 Gy of radiation and concurrent fluorouracil plus paclitaxel. The cancer was restaged and surgery was attempted. Postsurgery pathologic findings and RO resection were correlated with OS and DFS. Results: Forty-one patients were enrolled. Most carcinomas were proximal (83%) and pretreatment stage EUST3 (85%). Forty patients (98%) underwent surgery, and 78% had an RO resection. We observed a pathologic complete response (pathCR) rate of 20% and a pathologic partial response (pathPR) rate of 15% (< 10% residual cancer cells in the resected specimen). No pretreatment parameter (sex, cancer location, baseline T stage, or baseline N stage) predicted the type of postsurgery pathologic response, OS, or DFS. However, pathCR (P = .02), pathCR + pathPR (P = .006), RO resection (P < .001), and postsurgery T and N stages (P = .01 and P < .001, respectively) were associated with OS. Same parameters were significantly correlated with DFS. Toxicity was manageable. Conclusion: The type of pathologic response but not pretreatment parameters was associated with OS and DFS. Efforts to increase the rate of pathologic response and better systemic cancer control are warranted.

AB - Purpose: Preoperative chemoradiotherapy may increase the RO (curative) resection rate, overall survival (OS) duration, and disease-free survival (DFS) duration. We evaluated paclitaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma to determine its feasibility, impact on the RO resection rate, type of pathologic response, OS, and DFS. Patients and Methods: Patients with operable, localized gastric, or gastroesophageal adenocarcinoma were eligible. Staging included endoscopic ultrasonography (EUS) and laparoscopy. Patients received two 28-day cycles of induction chemotherapy of fluorouracil, paclitaxel, and cisplatin followed by 45 Gy of radiation and concurrent fluorouracil plus paclitaxel. The cancer was restaged and surgery was attempted. Postsurgery pathologic findings and RO resection were correlated with OS and DFS. Results: Forty-one patients were enrolled. Most carcinomas were proximal (83%) and pretreatment stage EUST3 (85%). Forty patients (98%) underwent surgery, and 78% had an RO resection. We observed a pathologic complete response (pathCR) rate of 20% and a pathologic partial response (pathPR) rate of 15% (< 10% residual cancer cells in the resected specimen). No pretreatment parameter (sex, cancer location, baseline T stage, or baseline N stage) predicted the type of postsurgery pathologic response, OS, or DFS. However, pathCR (P = .02), pathCR + pathPR (P = .006), RO resection (P < .001), and postsurgery T and N stages (P = .01 and P < .001, respectively) were associated with OS. Same parameters were significantly correlated with DFS. Toxicity was manageable. Conclusion: The type of pathologic response but not pretreatment parameters was associated with OS and DFS. Efforts to increase the rate of pathologic response and better systemic cancer control are warranted.

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