Preoperative Conformal Radiotherapy Concurrently with Paclitaxel/Carboplatin in Gastric Cancer

Backgroundand objectives: Surgery is the primary therapy for localized gastriccancer, but even with the best results only 40% 5-year survival can be achievedwith the use of postoperative adjuvant chemoradiotherapy. Preoperative therapymight help increase the R0 resection rate, which is an independent predictor of5-year OS. Our study hypothesized that the concurrent combination ofcarboplatin-paclitaxel with radiation therapy would result in a pathological CRrate, which will be in turn associated with OAS and DFS benefits. Patientsand methods: prospective phase II study included 32 patients with locallyadvanced gastric adenocarcinoma including gastroesophageal junction whoreceived a combination of neoadjuvant conformal radiotherapy concurrently withcarboplatin-paclitaxel followed by surgery. Results: Pathological CR andR0 resection rates were 18.8% and 75% respectively. With a median follow up of24 months, 2 years disease-free survival was 28.1% and overall survival was51.3%. The regimen was tolerated with neither grade 4 toxicities nor deaths. Conclusion: Neoadjuvant radiotherapy concomitant withcarboplatin-paclitaxel chemotherapy is a well-tolerated approach for patientswith locally advanced gastric adenocarcinoma resulting in significantpathological CR and R0 resection margins as reflected by the good DFS and OS.