Adjuvant chemoradiation in XXXX : long-term outcomes and prognostic factors from a single institution.

@entity1 @entity137 @entity3136 @entity5 @entity4434 @entity356 @entity1349
BACKGROUND: Adjuvant chemoradiotherapy (CRT) improves relapse-free ( @entity4434 ) and @entity1349 ( @entity1349 ) in @entity1 with resected @entity356 . However, difficulties in standardizing an optimal surgical approach and a perceived higher @entity137 compared with the perioperative approach have limited its widespread application in Europe. The aim of our study was to assess @entity137 and long-term outcomes of adjuvant CRT at our institution. METHODS: A retrospective review (September 2001-January 2012) was completed of @entity1 with resected @entity356 who received adjuvant CRT (Macdonald regimen). Adverse events and completion rates, @entity4434 and @entity1349 were estimated. Univariate and multivariate analyses of prognostic factors for @entity1349 were performed. RESULTS: Eighty-seven @entity1 were included. Most had diffuse (52%) and locally advanced @entity5 (stage III-IV; 66.7%). D2 lymphadenectomy was performed in 80.5%. The most frequent grade 3-4 @entity137 were gastrointestinal (28%) and @entity3136 (20%), with 78.2% completing treatment. With a median follow-up of 115 months, 58.5% had relapsed, most of them distantly. Median @entity4434 and @entity1349 were 9 and 24 months, respectively. Univariate analysis showed that performance status, stage and lymph node burden were significant factors for @entity1349 . In the multivariate study, only stage and lymph node burden remained as independent @entity1349 predictors. CONCLUSIONS: Our implementation of the Macdonald regimen achieved worse outcomes than those reported in the INT-0116 trial. The rate of distant relapse remains unacceptably high. Higher rate of positive lymph nodes and of diffuse @entity5 could explain some differences. The use of perioperative chemotherapy, especially in @entity1 with a poorer prognosis, might improve these results.
