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The journal «ONCOSURGERY» 2012, Vol.4, No 3

Combined modality treatment in patients with gastric cancer (prolonged neoadjuvant chemoradiotherapy + D2 gastrectomy): short-term outcomes in clinical study Phase II

Skoropad VYu, Berdov BА, Evdokimov LV, Neborak YuТ

Federal State Institution «Medical Radiological Research Center» of the Russian Ministry of Health and Social Development, Obninsk, Russia
Contact: Skoropad VYu, e-mail:

The short-term results of study of new combined modality treatment option for gastric cancer – preoperative prolonged chemoradiotherapy (radiotherapy with total dose of 45 Gy and daily dose fractionation, chemotherapy – modified regimen XELOX) with radical surgery (D2 gastrectomy) Phase II are represented in the article. The study included 13 patients with morphologically verified gastric cancer сT2N1-3, сT3-4N0-3; М0. Preoperative chemoradiotherapy was shown to be well tolerated by patients (toxic reactions of I-II degree prevailed) and was fully completed. Clinical and morphological assessment of response showed that significant regression of both primary tumor and regional metastases was in the majority of patients (prominent regression (>50%) was in 3 cases; partial regression (<50%) – in 7 cases; stabilization – in 3 cases). It was shown that after neoadjuvant chemoradiotherapy the rate of regional lymph node involvement decreased, the findings are consisted with literature data. Preoperative treatment do not complicate performance of surgery including combined operations, particularly reconstructive step. In this study the absence of complications and deaths was considered to be associated with optimization of all components of neoadjuvant therapy, proven surgical technique and postoperative management of patients. Thus, the obtained results and literature data show neoadjuvant prolonged chemoradiotherapy with D2 gastrectomy in patients with gastric cancer to be reasonable and promising treatment. The developed method of preoperative treatment is feasible, causes prominent therapeutic response of primary tumor and regional lymph nodes and does not worse short-term outcomes for following surgical treatmentа. The main prognostic factors were morphological tumor regression including negative regional lymph nodes, the stage after chemoradiotherapy and the surgical radicality (R0). Multicenter randomized studies to prove these findings are necessary.

KEY WORDS: gastric cancer, chemoradiotherapy, D2 gastrectomy, XELOX, daily dose fractionation, neoadjuvant treatment.

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