Gastric cancer recurrence after resection and adjuvant chemoradiation

Objectives Surgery remains the primary therapy for locally advanced gastric cancer, but locoregional recurrence (LRR) has been documented in up to 68.6 % of patients with surgery alone. Peri- or post-operative adjuvant treatment improves survival. The objective of this study is to examine rates and patterns of recurrence following resection and adjuvant chemoradiation. Methods We reviewed consecutive patients undergoing adjuvant chemoradiation (45 Gy/25 with 5-FU-based chemotherapy) for resected gastric adenocarcinoma (Stages Ib-IV) at the Princess Margaret Cancer Centre between January 1, 2000, and November 30, 2009. Site of first disease recurrence, overall survival (OS) and relapse-free rates (RFR) was determined. Results Among 197 patients identified, median age was 58.4 (range 21.6–79.5) years and median follow-up 28.7 (range 4.0–99.4) months. The majority were male (62.9 %), with stage II (33.0 %) or III (39.6 %) disease. Three-year OS and RFR were 66.7 and 57.7 % respectively; 71 patients relapsed. Isolated LRR was seen in 14 (7.1 %), while 48 (24.4 %) had isolated distant and 9 (4.6 %) had both LRR and distant relapses. In multivariate analysis, only T-category is a significant predictor for RFR ( p = 0.009), whilst age ( p = 0.03), T-category ( p = 0.001), N-category ( p = 0.02) and type of surgery ( p = 0.046) were significant predictors for OS. Conclusions Isolated LRR in this study was uncommon. The predominant pattern was distant failure. This is in keeping with other studies that have observed lower rates of LRR with adjuvant chemoradiation after curative resection of gastric cancer.