Concurrent Involved-field Radiotherapy And XELOX Chemotherapy In Gastric Cancer Patients With Postoperative Recurrence

Purpose:The aim of this study was to retrospectively observe gastric adenocarcinoma patients with postoperative recurrence and investigated the effects of concurrent involved-field radiotherapy and XELOX chemotherapy.Materials and Methods:From2008to2011,246patients underwent curative resection of gastric carcinoma were enrolled. A retrospective review was performed on55patients with loco-regional recurrence and32patients with distant recurrence. Among them,35patients with loco-regional recurrence and13oligometastatic patients received involved-field radiotherapy with a dose of40-60Gy by an intensity-modulated radiotherapy technique (IMRT) and concurrent XELOX (oxaliplatin80mg/m2, capecitabine1000mg/m2, twice daily,3week each cycle) chemotherapy.20patients with loco-regional recurrence and19patients (include15polymetastatic patients and4oligometastatic patients) with distant recurrence received XELOX chemotherapy.Results:The concurrent radiochemotherapy (CRT) group showed better overall response (including complete response and partial response) when compared with the XELOX chemotherapy group (83.3%vs.56.4%, P<0.05). Toxicity or adverse reactions were mainly hematologic toxicity and non-hematologic toxicity. With regard to hematologic toxicity, grade1or2toxicities were common in the2groups, grade3toxicities were observed in6cases, including1leukopenia and3thrombocytopenia in the CRT group,1leukopenia and1thrombocytopenia in the chemotherapy group, respectively. The rates for leukopenia, thrombocytopenia and anemia were43.8%,37.5%, and66.7%, respectively, in the CRT group and41%,30.8%, and61%, respectively, in the chemotherapy group. The gastrointestinal reactions in both groups included varying degrees of anorexia(37.5%vs.28.2%), nausea (25.1%vs.12.8%), vomiting (16.7%vs.15.4%), and diarrhea (31.3%vs.23.1%). Other toxicities, including hand-foot syndrome, neuropathy-sensory, and hepatic toxicity, were observed in a few cases in each group. There was no significant difference in the number of toxic reactions between the2groups (P>0.05). Patients receiving CRT trended toward a better median overall survival (OS) when compared with those receiving chemotherapy alone (12.1vs.8.1month, P<0.05). The trend were also seen in loco-regional(13.0vs.8.6month, P=0.05) and oligometastatic patients (11.1vs.7.5month, P=0.053), respectively. And the4oligometastatic patients who received XELOX chemotherapy was4.5,6,10and14months, respectively.Conclusions:Concurrent involved-field radiotherapy and XELOXshowed better responses andoverall symptom-control rates comparedwith XELOX chemotherapy alone in gastric cancer patients withpostoperative locoregional recurrence and oligometastatic. A trend of survival benefit from radiochemotherapy was also observed but needs to be further explored...