Gastric cancer is a global health issue as the world's fifth most common malignancy and third leading cause of cancer mortality, respectively. Preoperative radiation therapy may improve overall survival (OS) but is seldom used. There is precedent for preoperative chemoradiation, as it is the standard of care for esophageal and gastroesophageal junction tumors. However, reluctance of physicians to prescribe preoperative radiation therapy in gastric cancer may be due to the large treatment fields necessary to account for stomach motion. Adaptive radiation therapy may permit decreased field sizes and more accurate dose delivery. In traditional CT based radiation delivery the same radiation plan is delivered each day without assessment of inter-fraction or intra-fraction motion. Adaptive radiation therapy permits the physician to contour the unique anatomy daily to generate a new plan to account for day to day organ motion. Real-time MR imaging is also used during the treatment so that radiation is only delivered when the tumor is within the pre-specified target area. Thus, adaptive radiation therapy may overcome traditional barriers of radiation delivery in gastric cancer and improve oncologic outcomes.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
4
Radiation must be livered with adaptive planning and MR gating or CBCT breath hold treatment.
The recommendations are CAPOX, FOLFOX, or FLT.
Washington University School of Medicine
St Louis, Missouri, United States
Complete Pathologic Response (pCR - Primary and Nodal) Rate
pCR: no pathological signs of cancer
Time frame: At the time of surgery (approximately 4.5 months)
Number of Participants With Local Control
Local control calculated from start of radiation.
Time frame: At 1 year post radiation
Number of Grade 3 or Greater Toxicity as Defined by CTCAE Version 5.0
Time frame: From baseline through 12 months after surgery/definitive end of treatment (estimated to be 16.5 months)
Overall Survival
-Overall survival from start of radiation.
Time frame: At 1 year post radiation
Number of Participants With Disease-free Survival
-Disease free means no locoregional and distant recurrence
Time frame: At 1 year post radiation
Number of Patients Able to Complete a Full Course of Total Neoadjuvant Chemotherapy
Time frame: Through completion of neoadjuvant chemotherapy (estimated to be 4.5 months)
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