[Adjuvant chemotherapy followed by conformal chemoradiotherapy in gastric carcinoma]. / Chimiothérapie adjuvante suivie d'une chimioradiothérapie conformationnelle dans les cancers de l'estomac.

ABSTRACT

PURPOSE: Analysis of the feasibility and results of adjuvant chemotherapy followed by conformal chemoradiotherapy after surgery for gastric carcinoma. PATIENTS AND METHODS: Twenty-six patients (R0 or R1) were treated postoperatively by three cycles of 5-fluorouracil (5-FU) and cisplatin, followed by a concomitant association of LV5FU2 chemotherapy with a conformal radiotherapy of 45 Gy. RESULTS: The tumor was classified pT3-T4 in 77% of the patients and 92.5% had a nodal involvement (pN1 54%; pN2 31%). FEASIBILITY (1) Adjuvant chemotherapy nausea/vomiting grade II/III 12 patients (48%); neutropenia grade III/IV two patients; completed in all patients, except one. (2) Chemoradiotherapy nausea/vomiting grade II/III 10 patients; diarrhea grade II/3 two patients; oesophagitis grade II/III two patients; myocardial infarction/pulmonary embolism two patients. All patients except one received the planned dose of 45Gy. Radiotherapy was interrupted in six cases, with a median duration of 14 days. Survival with a median follow-up of 30 months, 65% of the patients were alive without disease; median survival was 32 months. CONCLUSION: This postoperative schedule was judged feasible. It allowed the deliverance of a more intensified chemotherapy than the classical schedule. Its clinical benefit must be evaluated in a phase III trial.