Postoperative intraperitoneal 5-fluoro-2′-deoxyuridine added to chemoradiation in patients curatively resected (R0) for locally advanced gastric and gastroesophageal junction adenocarcinoma

Deirdre J. Cohen, Elliot Newman, Syma Iqbal, Richard Y. Chang, Milan Potmesil, Theresa Ryan, Bernadine Donahue, Anurag Chandra, Mengling Liu, Minerva Utate, Spiros Hiotis, Leon H. Pachter, Howard Hochster, Franco Muggia

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Purpose: Chemoradiation after surgery for locally advanced gastric cancer improves overall and relapse-free survival compared with observation. However, locoregional recurrences remain high. Accordingly, we instituted this pilot/feasibility study, including intraperitoneal 5-fluoro-2′- deoxyuridine (IP FUDR) as part of the treatment. Methods: Gastric/ gastroesophageal junction adenocarcinoma stage Ib-IV (M0) patients who underwent R 0 resection were eligible and had IP catheters inserted at time of surgery. IP FUDR (3 g/dose/day) was given during study days 1-3 and 15-17 before combined 5-fluorouracil, leucovorin, and external beam radiation (45 Gy). Endpoints included toxicity, completion rate, locoregional recurrence, and survival. Results: Twenty-eight patients (22 men) were enrolled from 2002-2006 at two institutions; their median age was 59.5 years. After R 0 resection, a median 22 (range, 8-102) lymph nodes were examined, and 22 patients had positive nodes. AJCC stages were IB (n = 8), II (n = 10), IIIA (n = 5), IIIB (n = 1), and IV (n = 4). Full-dose IP FUDR and chemoradiation treatment was completed in 20 and 25 patients, respectively. At nearly 4-year median follow-up, 11 patients were disease-free, 5 were alive with disease, 7 were dead of disease, and 1 was dead from other cause; 4 have been lost to follow-up. Recurrences were local in one, intra-abdominal in six, distant in two, multiple sites in two, and unknown in one. The median relapse-free survival is 65.3 months, and the median overall survival has not yet been reached. Conclusions: IP FUDR before chemoradiation after R 0 gastric cancer resection is well tolerated without compromising completion of postoperative adjuvant treatment. Larger randomized trials studying IP FUDR as part of gastric cancer multidisciplinary treatment are needed to prove efficacy in reducing regional recurrence and improving survival.

Original languageEnglish (US)
Pages (from-to)478-485
Number of pages8
JournalAnnals of Surgical Oncology
Volume19
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Oncology
  • Surgery

Fingerprint

Dive into the research topics of 'Postoperative intraperitoneal 5-fluoro-2′-deoxyuridine added to chemoradiation in patients curatively resected (R0) for locally advanced gastric and gastroesophageal junction adenocarcinoma'. Together they form a unique fingerprint.

Cite this