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Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer

DC FieldValueLanguage
dc.contributor.author금기창-
dc.contributor.author금웅섭-
dc.contributor.author김미선-
dc.contributor.author라선영-
dc.contributor.author이용찬-
dc.contributor.author형우진-
dc.date.accessioned2016-02-04T11:04:09Z-
dc.date.available2016-02-04T11:04:09Z-
dc.date.issued2015-
dc.identifier.issn1007-9327-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/139593-
dc.description.abstractAIM: To investigate the efficacy of neoadjuvant chemoradiotherapy (NACRT) for resectability of locally advanced gastric cancer (LAGC). METHODS: Between November 2007 and January 2014, 29 patients with LAGC (clinically T3 with distal esophagus invasion/T4 or bulky regional node metastasis) that were treated with NACRT followed by D2 gastrectomy were included in this study. Resectability was evaluated with radiologic and endoscopic exams before and after NACRT. Using three-dimensional conformal radiotherapy, patients received 45 Gy, with a daily dose of 1.8 Gy. The entire tumor extent and the regional metastatic lymph nodes were included in the gross tumor volume. Patients presenting with a resectable tumor after NACRT received a total or subtotal gastrectomy with D2 dissection. The pathologic tumor response was evaluated using Japanese Gastric Cancer Association histologic evaluation criteria. Postoperative morbidity was evaluated using the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0. Overall survival (OS) and progression-free survival (PFS) rates were estimated using a Kaplan-Meier analysis and compared using the log-rank test. RESULTS: All patients were assessed as unresectable cases. Twenty-four patients (24/29; 82.8%) showed LAGC on positron emission tomography-computed tomography (CT) and contrast-enhanced CT, whereas four patients (4/29; 13.8%) with vague invasion or abutment to an adjacent organ underwent diagnostic laparoscopy. One patient (1/29; 3.4%), initially assessed as a resectable case, underwent an "open and closure" after the tumor was found to be unresectable. Abutment to an adjacent organ (34.5%) was the most common reason for NACRT. The clinical response rate one month after NACRT was 44.8%. After NACRT, 69% (20/29) of patients had a resectable tumor. Of the 20 patients with a resectable tumor, 18 patients (62.1%) underwent a D2 gastrectomy. The R0 resection rate was 94.4% and two patients (2/18; 11.1%) showed a complete response. The median follow-up duration was 13.5 mo. The one-year OS and PFS rates were 72.4 and 48.9%, respectively. The one-year OS, PFS, local failure-free survival, and distant metastasis-free survival were higher in patients with a resectable tumor after NACRT (P < 0.001, P < 0.001, P < 0.001, and P = 0.078, respectively). No grade 3-4 late treatment-related toxicities or postoperative mortalities were observed. CONCLUSION: NACRT with D2 gastrectomy showed a high rate of R0 resection and promising local control, which may increase the R0 resection opportunity resulting in survival benefit.-
dc.description.statementOfResponsibilityopen-
dc.format.extent2711~2718-
dc.relation.isPartOfWORLD JOURNAL OF GASTROENTEROLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.subject.MESHAdult-
dc.subject.MESHAged-
dc.subject.MESHChemoradiotherapy/adverse effects-
dc.subject.MESHChemoradiotherapy/methods*-
dc.subject.MESHChemoradiotherapy/mortality-
dc.subject.MESHDisease Progression-
dc.subject.MESHDisease-Free Survival-
dc.subject.MESHFemale-
dc.subject.MESHGastrectomy/methods*-
dc.subject.MESHHumans-
dc.subject.MESHKaplan-Meier Estimate-
dc.subject.MESHLymphatic Metastasis-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHMultimodal Imaging-
dc.subject.MESHNeoadjuvant Therapy/adverse effects-
dc.subject.MESHNeoadjuvant Therapy/methods*-
dc.subject.MESHNeoadjuvant Therapy/mortality-
dc.subject.MESHNeoplasm Invasiveness-
dc.subject.MESHNeoplasm Recurrence, Local-
dc.subject.MESHPositron-Emission Tomography-
dc.subject.MESHRadiation Dosage-
dc.subject.MESHRadiotherapy, Conformal*/adverse effects-
dc.subject.MESHRadiotherapy, Conformal*/mortality-
dc.subject.MESHRetrospective Studies-
dc.subject.MESHRisk Factors-
dc.subject.MESHStomach Neoplasms/drug therapy*-
dc.subject.MESHStomach Neoplasms/mortality-
dc.subject.MESHStomach Neoplasms/pathology-
dc.subject.MESHStomach Neoplasms/surgery*-
dc.subject.MESHTime Factors-
dc.subject.MESHTomography, X-Ray Computed-
dc.subject.MESHTreatment Outcome-
dc.subject.MESHTumor Burden-
dc.titleNeoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학)-
dc.contributor.googleauthorMi Sun Kim-
dc.contributor.googleauthorJoon Seok Lim-
dc.contributor.googleauthorWoo Jin Hyung-
dc.contributor.googleauthorYong Chan Lee-
dc.contributor.googleauthorSun Young Rha-
dc.contributor.googleauthorKi Chang Keum-
dc.contributor.googleauthorWoong Sub Koom-
dc.identifier.doi10.3748/wjg.v21.i9.2711-
dc.admin.authorfalse-
dc.admin.mappingfalse-
dc.contributor.localIdA00272-
dc.contributor.localIdA00273-
dc.contributor.localIdA00444-
dc.contributor.localIdA02988-
dc.contributor.localIdA04382-
dc.contributor.localIdA01316-
dc.relation.journalcodeJ02795-
dc.identifier.eissn2219-2840-
dc.identifier.pmid25759540-
dc.subject.keywordAdvanced gastric cancer-
dc.subject.keywordCombined modality therapy-
dc.subject.keywordD2 gastrectomy-
dc.subject.keywordNeoadjuvant chemoradiotherapy-
dc.subject.keywordTreatment outcome-
dc.contributor.alternativeNameKeum, Ki Chang-
dc.contributor.alternativeNameKoom, Woong Sub-
dc.contributor.alternativeNameKim, Mi Sun-
dc.contributor.alternativeNameRha, Sun Young-
dc.contributor.alternativeNameLee, Yong Chan-
dc.contributor.alternativeNameHyung, Woo Jin-
dc.contributor.affiliatedAuthorKeum, Ki Chang-
dc.contributor.affiliatedAuthorKoom, Woong Sub-
dc.contributor.affiliatedAuthorKim, Mi Sun-
dc.contributor.affiliatedAuthorLee, Yong Chan-
dc.contributor.affiliatedAuthorHyung, Woo Jin-
dc.contributor.affiliatedAuthorRha, Sun Young-
dc.rights.accessRightsfree-
dc.citation.volume21-
dc.citation.number9-
dc.citation.startPage2711-
dc.citation.endPage2718-
dc.identifier.bibliographicCitationWORLD JOURNAL OF GASTROENTEROLOGY, Vol.21(9) : 2711-2718, 2015-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers

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