Dohoon Lim, Samsung Medical Center, South Korea

Biography

1990 M.D., Medical College, Seoul National Univeristy
1995-1999 Resident, Dept. of Radiation Oncology, Samsung Medical Center
2001-present Professor, Dept. of Radiation Oncology, College of Medicine, Sungkyunkwan University

Summary of presentation

The Adjuvant chemoRadioTherapy In Stomach Tumors (ARTIST) trial was the first study to invetigate the role of postoperative chemoradiotherapy in patients with curatively resected gastric cancer with D2 lymph node dissection. The ARTIST I trial designed to compare postoperative treatment with capecitabine plus cisplatin (XP) versus XP plus radiotherapy with capacitabine (XP/XRT/XP). Of 458 patients, 228 were randomly assigned to the XP arm and 230 to the XP/XRT/XP arm. Overall, the addition of XRT to XP chemotherapy did not significantly prolong disease-free survival (DFS; p=0.0862). However, in the subgroup of patients with pathologic lymph node metastasis at the time of surgery (n=396), XP/XRT/XP arm patients experienced superior DFS and the statistical significance was retained at multivariate analysis (p=0.0471).

A subsequent trial (ARTIST II) compared two adjuvant chemotherapy regimens (oral S-1 alone vs S-1 plus oxaliplatin; SOX) and chemoradiotherapy (SOX plus chemoradiotheapy) in patients with D2-resected, stage II or III, node-positive gastric cancer. A total of 546 patients were recruited with 182, 181, and 183 patients in the S-1, SOX, and SOXRT arms, respectively. After median follow-up period of 47 months, the estimated 3-year DFS rates were 64.8%, 74.3%, and 72.8T in the S-1, SOX, and SOXRT arms, respectively. In patients with curatively D2-resected stage II/III, node-positive gastric cancer, adjuvant SOX or SOXRT was effective in prolonging DFS, when compared with S-1 monotherapy. However, the addition of radiotherapy to SOX did not significantly reduce the rate of recurrence after D2 gastrectomy.