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Neo-adjuvant treatment of gastric cancer: radio-chemo-therapy

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Neo-adjuvant treatment of gastric cancer: radio-chemo-therapy

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    1. (Neo-)adjuvant treatment of gastric cancer: radio-chemo-therapy? Tom Boterberg Department of Radiation Oncology University Hospital Gent

    2. Criteria for adjuvant therapy Complete resection, no metastases High risk of relapse due to (occult) residual disease Treatment should increase disease-free period and/or cure rate Acceptable toxicity

    4. Postoperative chemotherapy?

    5. Any role for adjuvant R(CT)?

    6. Is radiotherapy used optimally?

    7. What is the target volume?

    8. Anatomical challenges

    9. Modern radiotherapy

    10. Adjuvant radiochemotherapy I Macdonald et al., NEJM 2001 556 pts gastric carcinoma + GE junction Surgery versus surgery + RCT 5-FU > 45 Gy + 5-FU > 5-FU OS: 27 months vs 36 months Time to relapse: 19 vs 30 months Major problem: extent of surgery

    11. Intergroup Study INT-0116 Results

    12. Survival data

    13. Adjuvant radiochemotherapy II Kim et al., IJROBP 2005 990 pts D2-resected gastric cancer Observational study (not randomized) 5-FU > 45 Gy + 5-FU > 5-FU OS: 63 vs 95 months Relapse-free survival: 53 vs 76 months Selected from 3447 pts (no stage I)

    14. Survival according to stage

    15. Survival data

    16. Is there a role for radiotherapy in gastric cancer? Probably there is, but...

    17. With care and consideration How to select patients (II-III?) Use modern radiotherapy techniques Addition of chemotherapy may make the difference What is the optimal timing?

    18. Preoperative radiochemotherapy

    19. Future role for radio(chemo)therapy? Postoperative radiochemotherapy: a new standard? Is the chemotherapy satisfactory? Combination with recent biologicals with potential radiosensitising effect? What about docetaxel, CPT-11, oxaliplatin? Preliminary data in advanced disease Biological or immunological molecules? Timing of radio-chemotherapy?

    20. MAGIC Trial ASCO 2005 UK 1994-2002 503 patients Resectable gastric (74%), oesophago-gastric junction (11%) or distal oesophagus (15%) adenocarcinoma Epirubicin, cisplatin, 5-FU (ECF) Surg. vs 3 x ECF + Surgery + 3 x ECF

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