Yeh Yung-Sung, Huang Ming-Yii, Ma Cheng-Jen, Huang Ching-Wen, Tsai Hsiang-Lin, Chen Yen-Cheng, Li Ching-Chun, Yu Fang-Jung, Shih Hsiang-Yao, Wang Jaw-Yuan
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Oncol. 2020 Sep 7;2020:6931317. doi: 10.1155/2020/6931317. eCollection 2020.
Dismal outcomes in patients with locally advanced or metastatic gastric cancer (GC) highlight the need for effective systemic neoadjuvant treatment strategies to improve clinical results. Neoadjuvant multimodality strategies vary widely. This study compared the efficacy, safety, and clinical outcomes of neoadjuvant CCRT and chemotherapy for such patients.
Sixty-five patients with histologically confirmed locally advanced or metastatic GC following neoadjuvant CCRT or computed tomography (CT) were retrospectively enrolled between January 2010 and April 2019. Clinical outcomes included response, progression-free survival (PFS), and overall survival (OS), and toxicity was compared between the two groups.
Of the 65 patients, 18 (27.7%) were in the response group (2 patients with a complete response and 16 with a partial response) and 47 (72.3%) in the nonresponse group (29 patients with a stable disease and 18 with a progressive disease). Multivariate analysis revealed no independent response predictor between CCRT and chemotherapy groups (all > 0.05). Furthermore, results revealed no statistical differences in toxicity between the two groups (all > 0.05). With a follow-up median of 12 months (ranging 6-48 months), 12-month OS and PFS were 39.7% and 20.4% in the CCRT group and 30.3% and 13.2% in the chemotherapy group, respectively. The median OS and PFS were 14.0 months (95% CI 9.661-18.339) and 9.0 months (95% CI 6.805-11.195) in the CCRT group and 10.0 months (95% CI 6.523-13.477) and 8.0 months (95% CI 6.927-9.073) in the chemotherapy group, respectively. Both OS (=0.011) and PFS (=0.008) in patients with CCRT were significantly better than those in patients with chemotherapy alone.
Neoadjuvant CCRT achieved more favorable OS and PFS than did neoadjuvant chemotherapy alone, without significant increases of toxicity in patients. However, prospective randomized trials comparing treatment modalities are necessary to confirm the potential advantages of neoadjuvant CCRT.
局部晚期或转移性胃癌（GC）患者的预后不佳，凸显了需要有效的全身新辅助治疗策略来改善临床结果。新辅助多模式策略差异很大。本研究比较了新辅助同步放化疗（CCRT）和化疗对此类患者的疗效、安全性和临床结果。
回顾性纳入2010年1月至2019年4月期间65例经组织学证实为局部晚期或转移性GC且接受新辅助CCRT或计算机断层扫描（CT）的患者。临床结果包括缓解情况、无进展生存期（PFS）和总生存期（OS），并比较两组的毒性。
65例患者中，18例（27.7%）为缓解组（2例完全缓解，16例部分缓解），47例（72.3%）为无缓解组（29例病情稳定，18例病情进展）。多因素分析显示CCRT组和化疗组之间无独立的缓解预测因素（均>0.05）。此外，结果显示两组之间的毒性无统计学差异（均>0.05）。中位随访12个月（范围6 - 48个月），CCRT组的12个月OS和PFS分别为39.7%和20.4%，化疗组分别为30.3%和13.2%。CCRT组的中位OS和PFS分别为14.0个月（95%CI 9.661 - 18.339）和9.0个月（95%CI 6.805 - 11.195），化疗组分别为10.0个月（95%CI 6.523 - 13.477）和8.0个月（95%CI 6.927 - 9.073）。CCRT组患者的OS（=0.011）和PFS（=0.008）均显著优于单纯化疗患者。
新辅助CCRT比单纯新辅助化疗获得了更有利的OS和PFS，且患者毒性无显著增加。然而，需要进行比较治疗方式的前瞻性随机试验来证实新辅助CCRT的潜在优势。
