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Gastric cancer debate adjuvant chemoradiotherapy

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Describes the benefit associated with added radiotherapy to systemic adjuvant treatment in gastric cancer

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Gastric cancer debate adjuvant chemoradiotherapy

  1. 1. Gastric Cancer Debate: Adjuvant Chemo-radiotherapy Mohamed Abdulla M.D. Prof. of Clinical Oncology Cairo University Intercontinental City Stars Hotel and Tower Wednesday, 28/10/2015
  2. 2. 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:
  3. 3. 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]
  4. 4. Recurrence After Surgery: Wong et al. J Gastrointest Oncol 2015;6(1):89-107
  5. 5. Can we go better? Advanced Disease R0 – D2 Resection Neoadjuvant Perioperative Adjuvant Postoperative 40 - 65%  LR Radiation Therapy Schirren et al. Ther Adv Med Oncol.2015, Vol. 7(1) 39–48
  6. 6. Intergroup 0116 Adjuvant Trial: 556 Patients (T1-4 N0-1) Surgery (D1 or Less) Observation CRT S = 27 ms S + CRT = 36 ms P = 0.005 S = 19 ms S + CRT = 30 ms P < 0.001 Macdonald et al. N Engl J Med, Vol. 345, No. 10 · September 6, 2001
  7. 7. Updated Analysis of SOWG – Directed Intergroup 01116 Trial Smalley et al. J Clin Oncol. 2012 30:2327-2333.
  8. 8. ARTIST Trial: 458 Patients Non-Metastatic Gastric Cancer D2 Resection XP X 6 XP/XRT/XP Lee at al. J Clin Oncol. 2012 30:268-273
  9. 9. ARTIST Trial: 7 – Year Updated Analysis: Park et al. J Clin Oncol. 2015.33:3130-3136 XP XRT P LR 13% 7% 0.0033 DFS (LNs +) 72% 76% 0.004 Postoperative Radiation Therapy: • Positive LNs. • Intestinal (Non Diffuse) histopathology.
  10. 10. Who Benefits of Adjuvant Radiation Therapy?
  11. 11. Who Benefits of Adjuvant Radiation Therapy? OAS DFS Ohri et al. Int J Radiation Oncol Biol Phys, Vol. 86, No. 2, pp. 330e335, 2013
  12. 12. 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
  13. 13. 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
  14. 14. 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).
  15. 15. 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
  16. 16. 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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