Efficacy and safety of XELOX combined with neoadjuvant radiotherapy verus neoadjuvant chemotherapy in locally advanced gastric cancer

Abstract

Abstract Objective The work aimed to compare the efficacy and safety of XELOX regimen combined with neoadjuvant radiotherapy (CRT) and neoadjuvant chemotherapy (CT) in locally advanced gastric cancer. Methods The clinical data of patients with locally advanced gastric cancer were retrospectively included. They underwent radical gastrectomy with D2 lymph node dissection in our center from January 2019 to December 2020. We compared the postoperative pathology, adverse reactions and DFS and OS after XELOX regimen combined with CRT and RT. Inverse probability weighting was used as the statistical method to deal with confounding factors. Results 369 people (90.2%) were included in the CT group and 40 people (9.8%) were in the CRT group. The negative conversion rate was 38.1% in tumor marker CEA-positive patients in the CRT group after neoadjuvant therapy. It was significantly higher than 11.8% of the CT group (P < 0.001). The rate of PCR in the RT group was 15.8%, which was significantly higher than that of the CT group (4.7%) (P = 0.017). The ypN0 rate was significantly higher the CRT group (60.3%) than that in the CT group (39.8%) (P = 0.024). The CRT group was 100%, and the CT group was 96.5% (P = 0.001) after the R0 resection rate was weighted by inverse probability. No statistically significant difference existed in nerve invasion, vascular tumor embolus, and peritoneal invasion between the two groups. The median follow-up time of the whole group was 25.1 months. The DFS and OS of the CRT group were significantly higher than those of the CT group (P < 0.001) after weighting by IPTW. No significant difference existed between the CRT group and the CT group in adverse reactions, postoperative complications and average hospitalization time. Conclusion XELOX regimen combined with CRT had good downstaging effects. It showed better short-term pathological curative effects and survival benefits after surgery compared with CT. The surgical safety was equivalent between the two groups.