B30Adjuvant chemotherapy in stage II and III resected gastric cancer: clinical data from a single center experience

Background: surgery is the only potential treatment for gastric cancer, which is mainly diagnosed in advanced stage. Adjuvant chemotherapy potentially increase survival in resected gastric cancer. Aim of the study: we retrospectively reviewed data from 157 patient diagnosed with gastric cancer from January 2012 to November 2015 and treated at Oncology Unit of Humanitas Gavazzeni. We observed outcome of 84 patients with stage II and III resected cancer undergoing adjuvant treatment or follow-up. Results: we observed 157 patients (M/F: 116/41), median age 69.2 years (range 26.7-88),stage at diagnosis was I/II/III/IV in 19/15/69/54. 84 patients with stage II and III were potentially candidate to adjuvant chemotherapy (CT); 38/84 (45.2%) received adjuvant CT (16 ECX, 15 deGramont, 3 PFL, 2 ECF, 1 CX, 1 FOLFOX). Treatment was excluded in the remnant pts due to age >70yrs, poor performance status, comorbidities, and postsurgical complications. Median number of cycles was 10 (range 1-12) in deGramont schedule and 6 (range 1-7) in platinum/fluoropirimidine combinations. Recurrence rate was 57.9% (22/38) in adjuvant therapy and 22% (10/46) in surgery alone patients. Median DFS was 20.8 (2.4-149) in adjuvant CT and 16.8 months (range 1-208) in surgery alone; median OS was 30 months (range 7-153) in adjuvant CT and 22.7 months in surgery alone (range 0.7-253). Median DFS was 20.5 (range 4-49) and 24.3 months (range 2.4-149) in 5FU alone and platinum combinations respectively. Median OS was 26.7 months (range 7-49) in 5FU and 31.5 months (range 5.4-149) in platinum combinations. Progression rate was 6/15 (40%) in 5Fu alone and 16/23 (69%) in patients treated with platinum combination. Treatment was well tolerated, with no G3-G4 toxicity in deGramont schedule; in platinum combinations toxicity profile was: 7 (30%) G3-G4 neutropenia, 1 (4.3%) G3 thrombocytopenia and 1 (4.3%) G4 mucositis. Conclusion: adjuvant chemotherapy is administered in about 50% of patients undergoing surgery. No significant survival difference was observed between surgery alone and adjuvant chemotherapy maybe due to selection criteria: adjuvant treatment was administered in patients with higher stage of disease and in better clinical conditions. Our data confirm no significant differences among patient treated with FU alone and platinum combinations chemotherapy in adjuvant setting.