Gastric Cancer Debate:Adjuvant Chemo-radiotherapyMohamed Abdulla M.D.Prof. of Clinical OncologyCairo University
Intercontinental City Stars Hotel and TowerWednesday, 28/10/2015
Member of Advisory Board, Consultant, and Speaker for:• Amgen, Astellas, AstraZeneca, Hoffman la Roche, Janssen
Cilag, Merck Serono, Novartis, Pfizer• The content of this presentation does not relate to any product
of a commercial interest
Speaker Disclosures:
Basic Facts:• Decreasing incidence over past decades.• 2nd – 3rd cause of cancer related deaths.• Surgical resection is the cornerstone in curative
management loco-regional failures (40 – 65%).• The 10 – Year OAS for all stages is only around 20%.• Wide Ethnic & Geographic variations between Asian
and other countries.
Landry et al. Patterns of failure following curative resection of gastric cancer. Int J Ra- diat Oncol Biol Phys 1990;191:1357-62. Jemal etal. Cancer Statistics, 2010. CA Cancer J Clin 2010. [Epub ahead of print]
Recurrence After Surgery:
Wong et al. J Gastrointest Oncol 2015;6(1):89-107
Can we go better?
Advanced Disease
R0 – D2Resection
NeoadjuvantPerioperative
AdjuvantPostoperative
40 - 65% LR
Radiation Therapy
Schirren et al. Ther Adv Med Oncol.2015, Vol. 7(1) 39–48
Intergroup 0116 Adjuvant Trial:
556 Patients(T1-4 N0-1)
Surgery (D1 or Less)
Observation
CRT
S = 27 msS + CRT = 36 msP = 0.005
S = 19 msS + CRT = 30 msP < 0.001
Macdonald et al. N Engl J Med, Vol. 345, No. 10 · September 6, 2001
Updated Analysis of SOWG – Directed Intergroup 01116 Trial
Smalley et al. J Clin Oncol. 2012 30:2327-2333.
ARTIST Trial:458 Patients
Non-Metastatic Gastric Cancer
D2 ResectionXP X 6
XP/XRT/XP
Lee at al. J Clin Oncol. 2012 30:268-273
ARTIST Trial: 7 – Year Updated Analysis:
Park et al. J Clin Oncol. 2015.33:3130-3136
XP XRT PLR 13% 7% 0.0033
DFS (LNs +) 72% 76% 0.004
Postoperative Radiation Therapy:• Positive LNs.• Intestinal (Non Diffuse) histopathology.
Who Benefits of Adjuvant Radiation Therapy?
Who Benefits of Adjuvant Radiation Therapy?
OAS DFS
Ohri et al. Int J Radiation Oncol Biol Phys, Vol. 86, No. 2, pp. 330e335, 2013
Who Benefits of Adjuvant Radiation Therapy?
Ohri et al. Int J Radiation Oncol Biol Phys, Vol. 86, No. 2, pp. 330e335, 2013
OAS By Nodal Dissection
20% in OAS & DFS
Who Benefits of Adjuvant Radiation Therapy?
Ohri et al. Int J Radiation Oncol Biol Phys, Vol. 86, No. 2, pp. 330e335, 2013
Radiation Therapy Incomplete Nodal Dissection
Intestinal Type
Positive Nodal Disease
Multi-Modal Treatment of GC:
Schirren et al. Ther Adv Med Oncol.2015, Vol. 7(1) 39–48
Multimodal Treatment is Superior to Single Modality (Surgery).
Geographic Practice Variations:
Schirren et al. Ther Adv Med Oncol.2015, Vol. 7(1) 39–48
USA European Japanese
Adjuvant CRT Neoadjuvant CT Adjuvant CT
Int. 0116 MAGIC D2 Resection S1 Adjuvant
Take Home Message:
• Clinical trials are crucial.• Radiation therapy is appealing in
improving local control and DFS among patients with LNs +ve.
• Postoperative CRT would be preferred for non-cardia lesions.
• 5-Fu/LV/RT according to Int. 0116 is preferred.
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