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Impact of Treatment Sequencing on Survival for Patients with Locally Advanced Gastric Cancer

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

Abstract

Background

Data are limited concerning the survival outcomes of locally advanced gastric cancer patients according to the multimodality therapy (MMT) administered.

Methods

Single institution, retrospective analysis of 235 patients with locally advanced gastric cancer from 2001 to 2015. All patients met criteria for curative-intent surgery and chemotherapy ± radiation therapy. Treatment regimens were: (1) surgery first with adjuvant chemoradiation therapy (S + Adj); (2) perioperative chemotherapy + surgery (Periop); and (3) total neoadjuvant therapy followed by surgery (TNT + S).

Results

One hundred twenty-eight (60.0%) patients received S + Adj, 69 (26.8%) Periop, and 38 (13.2%) TNT + S. Of the 235 patients, 222 (94.5%) received surgery. All intended therapy was received by 81.6% of TNT + S, 44.5% of S + Adj, and 42.0% of Periop patients. MMT was significantly more likely to be completed by TNT + S patients (HR 6.67, p < 0.001). At a median follow-up of 37 months, survival rates on an intention-to-treat basis with TNT + S, Periop, and S + Adj were 52.6%, 59.4%, and 45.3%, respectively. Regimen and completion of MMT significantly affected overall mortality risk. Compared with Periop, TNT + S had similar mortality risk (hazard ratio [HR] 1.28, p = 0.421), whereas S + Adj had increased mortality risk (HR 1.64, p = 0.027).

Conclusions

The choice of treatment sequencing has a major impact on completion rates of multimodal therapy in patients with locally advanced gastric cancer. Less than 50% of patients treated with upfront surgery or perioperative chemotherapy receive all intended therapies. TNT has higher intended therapy completion rates and comparable survival compared with perioperative therapy in our data. Further prospective investigations of TNT are warranted.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Selena S. Li BS, Christina L. Costantino MD & John T. Mullen MD, FACS

  2. Harvard Medical School, Boston, MA, USA

    Selena S. Li BS, Samuel J. Klempner MD, Christina L. Costantino MD, Aparna Parikh MD, Jeffrey W. Clark MD, Jennifer Y. Wo MD, Theodore S. Hong MD & John T. Mullen MD, FACS

  3. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Samuel J. Klempner MD, Aparna Parikh MD & Jeffrey W. Clark MD

  4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA

    Jennifer Y. Wo MD & Theodore S. Hong MD

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  1. Selena S. Li BS
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  2. Samuel J. Klempner MD
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  3. Christina L. Costantino MD
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Correspondence to John T. Mullen MD, FACS.

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Disclosures

Aparna Parikh—Advisory Board Participant Natera, Puretech. Institution Research funding, Guardant, Array, BMS, Eli Lilly Consulting Eli Lilly. Theodore Hong—Consulting- Novocure, Synthetic Biologics, Merck. Clinical trial support- Tesaro, BMS, Astra-Zeneca, IntraOp, Ipsen, Taiho

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Li, S.S., Klempner, S.J., Costantino, C.L. et al. Impact of Treatment Sequencing on Survival for Patients with Locally Advanced Gastric Cancer. Ann Surg Oncol 28, 2856–2865 (2021). https://doi.org/10.1245/s10434-020-09248-1

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  • DOI: https://doi.org/10.1245/s10434-020-09248-1

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