Preoperative Concurrent Chemoradiotherapy Versus Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: Phase II Randomized Study

Xin Wang, Dong-Bing Zhao, Lin Yang, Yihebali Chi, Hong Zhao, Li-Ming Jiang, Jun Jiang, Yuan Tang, Ning Li, Wen-Yang Liu, Li-Zhou Dou, Shuang-Mei Zou, Li-Yan Xue, Jian-Song Ren, Yan-Tao Tian, Xu Che, Chun-Guang Guo, Xiao-Feng Bai, Yue-Min Sun, Shu-Lian Wang, Yong-Wen Song, Yue-Ping Liu, Hui Fang, Ye-Xiong Li, Jing Jin, Xin Wang, Dong-Bing Zhao, Lin Yang, Yihebali Chi, Hong Zhao, Li-Ming Jiang, Jun Jiang, Yuan Tang, Ning Li, Wen-Yang Liu, Li-Zhou Dou, Shuang-Mei Zou, Li-Yan Xue, Jian-Song Ren, Yan-Tao Tian, Xu Che, Chun-Guang Guo, Xiao-Feng Bai, Yue-Min Sun, Shu-Lian Wang, Yong-Wen Song, Yue-Ping Liu, Hui Fang, Ye-Xiong Li, Jing Jin

Abstract

Objective: We evaluated and compared the efficacy and safety of neoadjuvant chemoradiotherapy (NACRT) versus neoadjuvant chemotherapy (NACT) for locally advanced gastric cancer (LAGC) in a single-center randomized phase II trial.

Methods: Patients with LAGC were enrolled and received either NACT or NACRT, followed by gastrectomy and adjuvant chemotherapy. The primary endpoint was an R0 resection rate.

Results: We enrolled 75 patients: 75.7% (NACT, 28/37 patients) and 76.3% (NACRT, 29/38 patients) underwent surgery; R0 resection rates were 73.0% (27/37) and 73.7% (28/38), respectively. The NACRT group had significantly better major pathological response than the NACT group (37.9% vs 17.9%, p = 0.019). Between-group postoperative complications were not significantly different. The median follow-up was 59.6 months; 5-year overall survival (OS) rate was 50.1% (NACT) and 61.9% (NACRT); neither group reached the median OS; median progression-free survival was 37.3 and 63.4 months, respectively.

Conclusions: S-1-based NACRT did not improve the R0 resection rate, although it presented better tumor regression with similar safety to NACT.

Trial registration: ClinicalTrial.gov NCT02301481.

Keywords: chemoradiotherapy; chemotherapy; gastric neoplasm; neoadjuvant therapy; surgery.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wang, Zhao, Yang, Chi, Zhao, Jiang, Jiang, Tang, Li, Liu, Dou, Zou, Xue, Ren, Tian, Che, Guo, Bai, Sun, Wang, Song, Liu, Fang, Li and Jin.

Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Survival of the NACT and NACRT groups in the ITT population. (A) OS; (B) PFS.
Figure 3
Figure 3
Survival of patients in the NACT and NACRT groups with R0 resection. (A) OS; (B) DFS; (C) LRFS; (D) DMFS.

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