1 / 16

Bruce Minsky

What is the optimal sequence of therapies for stage II-III adenocarcinoma of the proximal stomach? - Chemoradiation followed by surgery. Bruce Minsky. INT 0116 Adjuvant Gastric Trial. • T3 and/or N1-2 (85%) • 20% GEJ • 54% D 0. 5-FU/LV x 4 + 45 Gy. Surgery alone. CMT SURGERY

bela
Download Presentation

Bruce Minsky

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What is the optimal sequence of therapies for stage II-III adenocarcinoma of the proximal stomach? - Chemoradiation followed by surgery Bruce Minsky

  2. INT 0116 Adjuvant Gastric Trial • T3 and/or N1-2 (85%) • 20% GEJ • 54% D0 5-FU/LV x 4 + 45 Gy Surgery alone CMTSURGERY 3-Year Survival (%) 40 30** Local Failure (%) 19 29

  3. INT 0116 – 10.3 Yr Median F/U Smalley et al JCO 2012

  4. Postop RT Fields

  5. Acute Toxicity – INT 0116 % Toxicity 33 Gr 3-4 Diarrhea 54 Gr 3-4 Neutropenia 1 Death • 65% Completed all therapy • 17% Stopped for toxicity

  6. Postop S1 (ACTS-GC) · 1059 pts, Stage II/III · D2 resection S1 Wks 1-4, q 6 weeks x 1 yr · Gr 3+ toxicity < 5% % 5-Yr % LR SurvivalFailureHR Surgery only 61 8 0.669 Postop S1 72 13 0.572 Sasaco et al JCO 2011

  7. Upper GI Adenocarcinomas • Overlap of GE Junction and Gastric (Siewert II and III) • 20% GE junction in INT 0116 • Preop CMT for GE junction

  8. Adjuvant Preop RT Zhang IJROBP 1998 370 pts, clinically resectable disease % 5-Yr % Failure %R0 SurvivalLocalLN Surgery 62 20 47 55 40 Gy 80* 30* 33 31

  9. Phase III Preop CT +/- CMT for GE Junction Adeno · 119/126 eligible pts T3-4Nx GE junction (Siewert I-III) FU/LV/CDDP X 2.5 FU/LV/CDDP VP-16/CDDP X 2.5 30 Gy (2 Gy/d) Surgery Surgery Stahl et al JCO 2009

  10. Phase III Preop CT +/- CMT for GE Junction Adeno Induction Induction ChemotherapyChemoRTP # Entered 49 45 % R0 Resection 70 72 - % Mortality 4 10 - % pCR 2 16 0.03 3-Yr Survival 28 47 0.07 % 3-Yr Local Fail 41 24 0.06

  11. Preop CMT for Gastric RTOG 9904 • 43 pts • EUS T2-3 and/or N1-2, lap negative • 5FU/LV/CDDP x 2 then 45 Gy/5FU/Paclitaxel • 36 had surgery (7 POD), 50% D2 • 26% pCR • 21% Gr 4 toxicity • 23 M median survival JCO 2006

  12. CROSS Study Group Surgery ∙ 368 pts ∙ 75% Adeno ∙ T1N1 or ∙ T2-3N0-1 Preop paclitaxel/carboplat Concurrent 41.4 Gy (1.8 Gy/d) ∙ pCR: 29% (adeno: 23% vs. 49% SCC), 4% mortality R0% 5-Yr S Preop` 92 59 Surg 69 48 p<0.003 p=0.001 Van Hagen NEJM 2012

  13. CROSS I + II Trials 422 Pts, 374 underwent surgery 75% adeno F/U: 45 M median, 24 M min #%LR%PS%DF Preop 34 14 35 p<0.001 p<0.001 p=0.025 Surg 14 4 29 5% LR (1% isolated) in the RT field Oppedijk et al, JCO 2014

  14. SCOPE1: CMT+ Cetuximab 50Gy/CDDP/Cape 50 Gy/CDDP/Cape + Cetuximab ∙ 258 Pts, Stage I-III ∙ (97% stage II,III) ∙ 25% Adeno ∙ Stopped early – met futility % 2-Yr Median % Gr 3+ CetuximabSurvivalSurvivalNon-heme Toxicity Yes 41 22 m 79 No 56 25 m 63

  15. RTOG 1010

  16. Conclusions • Postop CMT increases survival • Overlap between GE junction and gastric • Preop CMT improves survival (CROSS) • Preop RT fields are smaller (no postop bed)

More Related