Capecitabine-cisplatin versus 5-fluorouracil/leucovorin in combination with radiotherapy for adjuvant therapy of lymph node positive locally advanced gastric cancer
Bala Basak Oven Ustaalioglu1, Ahmet Bilici2, Metin Tilki3, Ali Surmelioglu3, Burçak Erkol1, Metin Figen4, Serab Uyar4
1 Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
2 Department of Medical Oncology, Medipol University, Istanbul, Turkey
3 Department of General Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
4 Department of Radiation Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
Bala Basak Oven Ustaalioglu,
Selimiye Mahallesi, Şair Nesimi Sokak, Kardeşler Apartment, No: 1, Daire: 4, 34668 Uskudar, Istanbul
Source of Support: None, Conflict of Interest: None
Aim of the Study: Although surgery is considered to be curative treatment, recurrence rates are high in gastric cancer. Adjuvant 5-fluorouracil (5-FU) based chemoradiotherapy has been shown to improve the prognosis. We compared tolerability and efficacy of the two different chemotherapy regimens; 5-FU/leucovorin (LV) versus cisplatin with capecitabine (XP) combined with radiotherapy (RT) in the adjuvant therapy of the lymph node positive locally advanced gastric cancer.
Materials and Methods: Totally, 104 patients who underwent curative surgery with lymph node resection were evaluated, respectively. Patients were stratified two group based on the adjuvant chemoradiotherapy regimen. Group 1 (n = 46) received XP followed capecitabine with RT (XRT) then XP. Group 2 (n = 58) received 5-FU/LV combined with RT postoperatively. Two groups were compared based on clinicopathological parameters. Factors related with disease-free survival (DFS) and overall survival (OS) were analyzed.
Results: Totally, 32 patients had recurrent disease, and there was no difference between two groups. While peritoneal metastasis was more common in XP arm, distant metastasis was commonly seen in 5-FU/LV arm. There was no significant difference between two groups in regard of Grade 3/4 toxicitis; hematologic toxicities were more in 5-FU/LV group than XP arm. In addition, dose modification because of toxicities were more frequent in 5-FU/LV arm (P = 0.003). For all groups, lymph node dissection type was related with DFS, surgical margin and recurrence were important for OS.
Conclusion: XP-XRT regimen is well tolerated with lower toxicity compared the standard 5-FU/LV-RT. Although there is no difference with respect to outcome, patients with XP arm without the necessity of intravenous catheter admitted hospital less frequent than bolus5-FU/LV arm.