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Postoperative Intraperitoneal 5-Fluoro-2′-Deoxyuridine Added to Chemoradiation in Patients Curatively Resected (R0) for Locally Advanced Gastric and Gastroesophageal Junction Adenocarcinoma

Authors
  • Cohen, Deirdre J.1
  • Newman, Elliot2
  • Iqbal, Syma3
  • Chang, Richard Y.1
  • Potmesil, Milan1
  • Ryan, Theresa1
  • Donahue, Bernadine4
  • Chandra, Anurag4
  • Liu, Mengling5
  • Utate, Minerva1
  • Hiotis, Spiros6
  • Pachter, Leon H.2
  • Hochster, Howard7
  • Muggia, Franco1
  • 1 New York University Cancer Center, NYU Medical Center, Division of Medical Oncology, New York, NY, USA , New York (United States)
  • 2 New York University Cancer Center, NYU Medical Center, Division of Surgical Oncology, New York, NY, USA , New York (United States)
  • 3 University of Southern California, Division of Medical Oncology, Norris Comprehensive Cancer Center, Los Angeles, CA, USA , Los Angeles (United States)
  • 4 New York University Cancer Center, NYU Medical Center, Division of Radiation Oncology, New York, NY, USA , New York (United States)
  • 5 New York University Medical Center, NYU School of Medicine, Division of Biostatistics, New York, NY, USA , New York (United States)
  • 6 Tisch Cancer Institute, Mount Sinai Medical Center, Division of Surgical Oncology, New York, NY, USA , New York (United States)
  • 7 Yale Cancer Center, Yale Medical Center, Division of Medical Oncology, New Haven, CT, USA , New Haven (United States)
Type
Published Article
Journal
Annals of Surgical Oncology
Publisher
Springer - Society of Surgical Oncology
Publication Date
Jul 19, 2011
Volume
19
Issue
2
Pages
478–485
Identifiers
DOI: 10.1245/s10434-011-1940-8
Source
Springer Nature
Keywords
License
Yellow

Abstract

PurposeChemoradiation after surgery for locally advanced gastric cancer improves overall and relapse-free survival compared with observation. However, locoregional recurrences remain high. Accordingly, we instituted this pilot/feasibility study, including intraperitoneal 5-fluoro-2′-deoxyuridine (IP FUDR) as part of the treatment.MethodsGastric/gastroesophageal junction adenocarcinoma stage Ib–IV (M0) patients who underwent R0 resection were eligible and had IP catheters inserted at time of surgery. IP FUDR (3 g/dose/day) was given during study days 1–3 and 15–17 before combined 5-fluorouracil, leucovorin, and external beam radiation (45 Gy). Endpoints included toxicity, completion rate, locoregional recurrence, and survival.ResultsTwenty-eight patients (22 men) were enrolled from 2002–2006 at two institutions; their median age was 59.5 years. After R0 resection, a median 22 (range, 8–102) lymph nodes were examined, and 22 patients had positive nodes. AJCC stages were IB (n = 8), II (n = 10), IIIA (n = 5), IIIB (n = 1), and IV (n = 4). Full-dose IP FUDR and chemoradiation treatment was completed in 20 and 25 patients, respectively. At nearly 4-year median follow-up, 11 patients were disease-free, 5 were alive with disease, 7 were dead of disease, and 1 was dead from other cause; 4 have been lost to follow-up. Recurrences were local in one, intra-abdominal in six, distant in two, multiple sites in two, and unknown in one. The median relapse-free survival is 65.3 months, and the median overall survival has not yet been reached.ConclusionsIP FUDR before chemoradiation after R0 gastric cancer resection is well tolerated without compromising completion of postoperative adjuvant treatment. Larger randomized trials studying IP FUDR as part of gastric cancer multidisciplinary treatment are needed to prove efficacy in reducing regional recurrence and improving survival.

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