Preoperative Concurrent Chemoradiotherapy Versus Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: Phase...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Locally advanced gastric cancer (LAGC) requires effective neoadjuvant treatment strategies to improve surgical outcomes.
• Comparing neoadjuvant chemotherapy (NACT) with neoadjuvant chemoradiotherapy (NACRT) is crucial for optimizing treatment protocols.

Purpose of the Study:

• To compare the efficacy and safety of NACRT versus NACT in patients with LAGC.
• To evaluate the impact of these neoadjuvant strategies on R0 resection rates, pathological response, and survival.

Main Methods:

• A single-center, randomized phase II trial was conducted.
• Patients with LAGC received either NACT or NACRT, followed by gastrectomy and adjuvant chemotherapy.
• The primary endpoint was the R0 resection rate, with secondary endpoints including pathological response and survival rates.

Main Results:

• R0 resection rates were similar between NACT (73.0%) and NACRT (73.7%).
• NACRT demonstrated a significantly higher major pathological response rate (37.9%) compared to NACT (17.9%).
• The 5-year overall survival rate was higher in the NACRT group (61.9%) versus the NACT group (50.1%), with longer median progression-free survival in the NACRT arm.

Conclusions:

• S-1-based NACRT did not improve the R0 resection rate for LAGC compared to NACT.
• NACRT showed superior tumor regression and improved survival outcomes without increasing postoperative complications.
• NACRT represents a viable neoadjuvant option for LAGC, offering better tumor response and survival benefits.