Toxicity and outcomes of adjuvant chemoradiotherapy in patients with resected gastric adenocarcinoma
Bibliographic record
Abstract
4157 Background: The Intergroup 0116 study showed a survival benefit with adjuvant chemoradiotherapy (CRT) for resected gastric cancer using conventional 2D planning, but with significant toxicity. In an attempt to reduce toxicity, CRT with a 5 field conformal technique has been used since October 2000 at Princess Margaret Hospital. Outcomes are reported. Methods: Patients with resected gastric or gastro esophageal junction (GEJ) adenocarcinoma, PS ≤2, stage 1B to IV (M0), were treated using 5 cycles of 5FU/leucovorin chemotherapy and 45Gy/25 fractions concurrent with cycle 2 and 3 as per the Intergroup 0116 study. Retrospective analysis on the 1st 50 patients is reported. Acute toxicity was scored using CTC v3.0. Results: Patient characteristics: mean age 54.5 years (21.6 -74.8); M: F 62%: 38%; Site: stomach 92%, GEJ 8%. Surgery: total 16%, subtotal 22%, partial distal 40%, other 22%; RO: R1 resection 98%: 2%. UICC stage IB 20%, II 34%, IIIA 36%, IIIB 2%, IV (M0) 8%. Toxicity grade 3 and 4: upper GI 36%, lower GI 2%, hematological 38%, all types 52%. One patient died of neutropenic sepsis. 60% of patients completed CRT. 38% did not complete chemotherapy, 36% required delays in chemotherapy, 30% required dose reductions; 16% required reductions and delays. 10% did not complete radiotherapy. Median follow up was 27.5 months (4.5- 49.5). Eighteen (36%) patients have relapsed (5 locoregional relapse (LR), 8 LR and distant disease, 5 distant disease alone). Fifteen patients (30%) have died of recurrent disease. Median time from diagnosis to 1st relapse was 15.9 months (5.9–34) and diagnosis to death was 20.0 months (6.9–37.9). Overall and progression free survival was 86% and 84% at 1 year. Median survival has not been reached. Conclusions: Despite use of conformal radiotherapy techniques, adjuvant CRT for gastric cancer has significant toxicity. Early results are comparable to the Intergroup 0116 study. We are currently conducting a phase I/II trial using a modified chemotherapy protocol of infusional 5FU and cisplatin in an attempt to reduce toxicity. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".