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Postoperative Intraperitoneal 5-Fluoro-2′-Deoxyuridine Added to Chemoradiation in Patients Curatively Resected (R0) for Locally Advanced Gastric and Gastroesophageal Junction Adenocarcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Chemoradiation after surgery for locally advanced gastric cancer improves overall and relapse-free survival compared with observation. However, locoregional recurrences remain high. Accordingly, we instituted this pilot/feasibility study, including intraperitoneal 5-fluoro-2′-deoxyuridine (IP FUDR) as part of the treatment.

Methods

Gastric/gastroesophageal junction adenocarcinoma stage Ib–IV (M0) patients who underwent R0 resection were eligible and had IP catheters inserted at time of surgery. IP FUDR (3 g/dose/day) was given during study days 1–3 and 15–17 before combined 5-fluorouracil, leucovorin, and external beam radiation (45 Gy). Endpoints included toxicity, completion rate, locoregional recurrence, and survival.

Results

Twenty-eight patients (22 men) were enrolled from 2002–2006 at two institutions; their median age was 59.5 years. After R0 resection, a median 22 (range, 8–102) lymph nodes were examined, and 22 patients had positive nodes. AJCC stages were IB (n = 8), II (n = 10), IIIA (n = 5), IIIB (n = 1), and IV (n = 4). Full-dose IP FUDR and chemoradiation treatment was completed in 20 and 25 patients, respectively. At nearly 4-year median follow-up, 11 patients were disease-free, 5 were alive with disease, 7 were dead of disease, and 1 was dead from other cause; 4 have been lost to follow-up. Recurrences were local in one, intra-abdominal in six, distant in two, multiple sites in two, and unknown in one. The median relapse-free survival is 65.3 months, and the median overall survival has not yet been reached.

Conclusions

IP FUDR before chemoradiation after R0 gastric cancer resection is well tolerated without compromising completion of postoperative adjuvant treatment. Larger randomized trials studying IP FUDR as part of gastric cancer multidisciplinary treatment are needed to prove efficacy in reducing regional recurrence and improving survival.

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Acknowledgment

This study was supported by an FDA Orphan Products grant # FD-R-2150-04.

Disclosure

No relevant commercial interest to disclose.

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Authors and Affiliations

  1. Division of Medical Oncology, New York University Cancer Center, NYU Medical Center, New York, NY, USA

    Deirdre J. Cohen, Richard Y. Chang, Milan Potmesil, Theresa Ryan, Minerva Utate & Franco Muggia

  2. Division of Surgical Oncology, New York University Cancer Center, NYU Medical Center, New York, NY, USA

    Elliot Newman & Leon H. Pachter

  3. Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA

    Syma Iqbal

  4. Division of Radiation Oncology, New York University Cancer Center, NYU Medical Center, New York, NY, USA

    Bernadine Donahue & Anurag Chandra

  5. Division of Biostatistics, New York University Medical Center, NYU School of Medicine, New York, NY, USA

    Mengling Liu

  6. Division of Surgical Oncology, Tisch Cancer Institute, Mount Sinai Medical Center, New York, NY, USA

    Spiros Hiotis

  7. Division of Medical Oncology, Yale Cancer Center, Yale Medical Center, New Haven, CT, USA

    Howard Hochster

Authors
  1. Deirdre J. Cohen
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  2. Elliot Newman
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Correspondence to Deirdre J. Cohen.

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Cohen, D.J., Newman, E., Iqbal, S. et al. Postoperative Intraperitoneal 5-Fluoro-2′-Deoxyuridine Added to Chemoradiation in Patients Curatively Resected (R0) for Locally Advanced Gastric and Gastroesophageal Junction Adenocarcinoma. Ann Surg Oncol 19, 478–485 (2012). https://doi.org/10.1245/s10434-011-1940-8

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  • DOI: https://doi.org/10.1245/s10434-011-1940-8

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