Chemoradiotherapy Vs Pure Chemotherapy For Local Progressive Gastric Cancer Following D2 Lymph Node Dissection:A Comparison Of Effectiveness

Objective: To compare the therapeutic effects and adverse reaction of concurrent chemoradiotherapy with pure chemotherapy for local progressive gastric cancer following D2 lymph node dissection.Methods: 79 patients with advanced gastric cancer who underwent R0 gastric resection and D2 lymph node dissection were randomly divided into two groups(experimental group and control group). After radical gastrectomy, the experimental group(n=40) patients received radiotherapy concurrent with capecitabine chemotherapy,and then followed by 4 cycles of XELOX chemotherapy; however the control group(n=39) only received 6 cycles of XELOX chemotherapy. The local-regional recurrence rate,3-year disease-free survival rates,3-year overall survival rates and toxicity were evaluated after the treatment.Result: Locoregional recurrence rate in the experimental group was significantly lower than that of the control group( 40.0% vs 64.1%, P=0.032). The 3-year disease-free survival rates and 3-year overall survival rates of the experimental group were higher than those in the control group, however, no statistical difference was observed in the two groups(P>0.05). The incidences of hematological and gastrointestinal toxicity in the experimental group were higher than those in the control group. Subgroup analysis of positive pathologic lymph nodes patients, there was a statistically significant difference in 3-year overall survival rates and disease-free survival(DFS) between the two groups. The 3-year overall survival rates in the experimental group was higher than the control group( 45.2%[14/31] vs 18.5%[5/27], P=0.049). The median disease-free survival(m DFS) was 26 months and 19 months, respectively(P=0.024). Multivariate analysis showed that lymph node metastasis and ECOG score were important prognostic factors which influenced survival time.Conclusion: The addition of concurrent chemoradiotherapy to chemotherapy can significantly reduce locoregional recurrence after curative resection and D2 lymph node dissection in gastric cancer patients.In patients with lymph node–positive gastric cancer, postoperative concurrent chemoradiotherapy have a trend to improve their survival. The main adverse reactions of the concurrent are hematological and gastrointestinal toxicities.