A pilot study of preoperative chemoradiotherapy for resectable gastric cancer

Background: The goals of this study were to assess the feasibility and toxi city of a regimen of preoperative chemoradiotherapy, surgery, and intraoper ative radiotherapy in the treatment of patients with potentially resectable gastric cancer. A secondary objective was to assess pathologic response to chemoradiotherapy in the treated tumors. Methods: Twenty-four patients were entered in the protocol. Treatment regim en consisted of 45 Gy of external beam radiotherapy with concurrent 5-FU gi ven as a continuous infusion at a dose of 300 mg/m(2). Patients were restag ed 4-6 weeks after chemoradiotherapy and then underwent surgical resection acid intraoperative radiotherapy to a dose of 10 Gy. Results: Twenty-three patients (96%) completed chemoradiotherapy in accorda nce with the study protocol. Nineteen (83%) of 23 patients who completed ch emoradiotherapy underwent surgical resection with D2 lymphadenectomy. Four patients (17%) had progressive disease and were not resected. The morbidity and mortality rates were 32% and 5%, respectively. Of the resected patient s, two (11%) had complete pathologic responses while 12 (63%) had pathologi c evidence of significant treatment effect. Conclusions: Preoperative chemoradiotherapy for gastric cancer can be deliv ered safely and is well tolerated. The rate of surgical complications is co nsistent with that of other recently reported prospective trials of gastrec tomy alone. Preoperative chemoradiotherapy resulted in significant patholog ic responses in the majority of treated tumors, and complete pathologic res ponses were achieved in some patients.