Neoadjuvant chemotherapy, radical resection with intraoperative radiation therapy (IORT): Improved treatment for gastric adenocarcinoma

Background. Adenocarcinoma of the stomach and gastroesophageal junction res ults in substantial morbidity, locoregional recurrence, and death. Surgical procedures, even with adjuvant therapy, have not significantly improved su rvival. This study evaluated the toxicity, response rate, locoregional cont rol, and survival of patients with locally advanced gastric cancer that was treated with neoadjuvant multimodality therapy. Methods. Patients with stage IIIA or early stage IV gastric adenocarcinoma received neoadjuvant 5-fluorouracil, Leucovorin, Adriamycin, and Cisplatin and underwent gastrectomy or esophagogastrectomy with intraoperative radiot herapy (IORT; 1000 cGY) to the gastric bed and postoperative radiation ther Results. Nine of 15 patients (60%) with transmural extension and/or nodal m etastases received IORT There were 2 pathologically complete responses at t he primary site. Eleven of 15 patients (73%) had tumor in perigastric lymph nodes; however, 9 of 15 patients (60%) had mucin-filled nodes without tumo r cells. Neoadjuvant treatment did not increase operative morbidity rates. Ten of 15 patients (67%) remain free of disease (median, 27 months; range, 6-60 months). Five patients died 13 to 41 months (median, 17 months after d iagnosis. Conclusions. Neoadjuvant multimodality therapy with neoadjuvant 5-fluoroura cil, Leucovorin, Adriamycin, and Cisplatin, radical resection with IORT and postoperative radiation therapy is safe, can downstage tumors, provides im proved locoregional control, and appears to cause significant tumor regress ion that may result in long-term survival or cure.