Intensity-modulated radiotherapy combined with chemotherapy for the treatment of gastric cancer patients after standard D1/D2 surgery.

The purpose of the current study is to evaluate the efficacy and complications of concurrent chemoradiotherapy (CCRT) for the treatment of gastric cancer patients after D1/D2 surgery. Sixty-eight untreated gastric cancer patients (T3/T4 and/or N+) were enrolled. After surgery, they were randomized into two groups: the CCRT group and the single chemotherapy group. Radiotherapy patients were treated according to the Intergroup 0116 guidelines. The chemotherapy consisted of continuously administered 5-fluorouracil (5-FU) and tetrahydrofolic acid (LV). The CCRT began 28 days after the first cycle of chemotherapy, and chemotherapy was given within the first four and last three days during the CCRT period, at a radiation dosage of 45 Gy/25 f, i.e., 1.8 Gy 5 times per week. Two cycles of the same chemotherapy were administrated 1 month after the radiotherapy. Five cycles of 5-FU and LV were applied to CG. One-, two-, and three-year survival rates were 85.9, 73.4, and 67.7%, respectively, in the CCRT group and 68.0, 50.0, and 44.1%, in the single chemotherapy group (P < 0.05). The corresponding disease-free survival rates were 73.5, 64.7, and 55.8% in the CCRT group and 61.8, 38.2, and 29.4% in the single chemotherapy group (P < 0.05). The major side effects were gastrointestinal reactions and neutrocytopenia. In both the CCRT and single chemotherapy groups, the incidence of these side effects was 73.5% (25/34) and 44.1% (15/34) (P < 0.05) for Grade I and Grade II anorexia, 82.35% (28/34) and 73.5% (25/34) (P > 0.05) for nausea and vomiting, and 70.6% (24/34) and 44.1% (15/34) (P < 0.05) for neutrocytopenia, respectively. The other indices showed no significant differences. Our findings indicate that CCRT can increase the one-, two-, and three-year total survival rates, as well as the disease-free survival rates of gastric cancer patients (T3/T4 and/or N+) who have been initially treated with surgery. The major adverse reactions were Grade I and Grade II nausea and vomiting, as well as myelosuppression. CCRT is well tolerated.