A Retrospective Study of Survival and Patterns of Failure in Gastric Cancer after Adjuvant Chemoradiation

Background: Even after curative resection, 38-94% of gastric cancer patients develop locoregional recurrence denoting the importance of adjuvant therapy and its refinement. The aim of this study was to assess survival and pattern of failure and factors affecting them in non-metastatic gastric cancer. Patients and Methods: Medical records of 43 non-metastatic gastric cancer patients, who received adjuvant concurrent chemoradiotherapy of 5-FU/Leucovorin after curative resection, were analyzed. Results: After a median follow-up of 45 months (6-81 months), the 4-year Overall survival (OAS) and disease free survival (DFS) rates were 51.3% and 46.4% respectively. Multivariate analysis for OAS revealed that stage is the only significant prognostic factor (HR: 4.25; 95% CI: 1.83-9.86). Patterns of recurrence were iIsolated locoregional recurrence (LRR), isolated hematogenous and mixed recurrences seen in 6 patients (14.0%), 11 patients (25.6%) and 5 patients (11.6%) respectively. Conclusion: Postoperative chemoradiation was promising, with acceptable toxicity, decreasing locoregional failure with less pronounced benefit on peritoneal and distant failure, suggesting the need for more effective systemic chemotherapy for adjuvant treatment especially for locally advanced gastric cancer (pT3 and PT4), which predicts worse OAS.