PMID- 32208351
OWN - NLM
STAT- MEDLINE
DCOM- 20201123
LR  - 20201123
IS  - 1879-0852 (Electronic)
IS  - 0959-8049 (Linking)
VI  - 130
DP  - 2020 May
TI  - Older versus younger adults with gastric cancer receiving perioperative 
      treatment: Results from the CRITICS trial.
PG  - 146-154
LID - S0959-8049(20)30057-5 [pii]
LID - 10.1016/j.ejca.2020.02.008 [doi]
AB  - AIM: To evaluate treatment-related toxicity, treatment compliance, surgical 
      complications and event-free survival (EFS) in older (>/=70 years) versus younger 
      (<70 years) adults who underwent perioperative treatment for gastric cancer. 
      METHODS: In the CRITICS trial, 788 patients with resectable gastric cancer were 
      randomised before start of any treatment and received preoperative chemotherapy 
      (3 cycles of epirubicin, cisplatin or oxaliplatin and capecitabine), followed by 
      surgery, followed by either postoperative chemotherapy or chemoradiotherapy 
      (45Gy + cisplatin + capecitabine). RESULTS: 172 (22%) patients were older adults. 
      During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger 
      adults experienced severe toxicity (p < 0.001); older adults received 
      significantly lower relative dose intensities (RDIs) for all chemotherapeutic 
      drugs. Equal proportions of older versus younger adults underwent curative 
      surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications 
      and postoperative mortality. Postoperative therapy after curative surgery started 
      in 87 (64%) older adults versus 391 (78%) younger adults (p < 0.001). Incidence 
      of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults 
      versus 113 (59%) in younger adults (p = 0.541); older adults received 
      significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates 
      for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) 
      for younger adults (p = 0.703), with comparable chemotherapy RDIs and 
      radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger 
      adults. CONCLUSION: Perioperative treatment compliance, especially in the 
      postoperative phase, was poorer in older adults compared with younger adults. As 
      comparable proportions of patients underwent curative surgery, future studies 
      should focus on neo-adjuvant treatment. TRIAL REGISTRATION: ClinicalTrials.gov 
      identifier: NCT00407186. EudraCT number: 2006-00413032.
CI  - Copyright (c) 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
FAU - Slagter, Astrid E
AU  - Slagter AE
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
FAU - Tudela, Benjamin
AU  - Tudela B
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands; Department of Radiation Oncology, Universidad de Valparaiso, 
      Valparaiso, Chile.
FAU - van Amelsfoort, Romy M
AU  - van Amelsfoort RM
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
FAU - Sikorska, Karolina
AU  - Sikorska K
AD  - Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
FAU - van Sandick, Johanna W
AU  - van Sandick JW
AD  - Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
FAU - van de Velde, Cornelis J H
AU  - van de Velde CJH
AD  - Department of Surgical Oncology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - van Grieken, Nicole C T
AU  - van Grieken NCT
AD  - Department of Pathology, Amsterdam University Medical Centers, Location VUmc, 
      Amsterdam, the Netherlands.
FAU - Lind, Pehr
AU  - Lind P
AD  - Department of Oncology, Stockholm Soder Hospital, Stockholm, Sweden; Karolinska 
      Institutet, Stockholm, Sweden.
FAU - Nordsmark, Marianne
AU  - Nordsmark M
AD  - Department of Medical Oncology, Aarhus University, Aarhus, Denmark.
FAU - Putter, Hein
AU  - Putter H
AD  - Department of Biometrics, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Hulshof, Maarten C C M
AU  - Hulshof MCCM
AD  - Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University 
      Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
FAU - van Laarhoven, Hanneke W M
AU  - van Laarhoven HWM
AD  - Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University 
      Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Grootscholten, Cecile
AU  - Grootscholten C
AD  - Department of Gastrointestinal Oncology/Medical Oncology, Netherlands Cancer 
      Institute, Amsterdam, the Netherlands.
FAU - Braak, Jeffrey P B M
AU  - Braak JPBM
AD  - Department of Surgical Oncology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Meershoek-Klein Kranenbarg, Elma
AU  - Meershoek-Klein Kranenbarg E
AD  - Department of Surgical Oncology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Jansen, Edwin P M
AU  - Jansen EPM
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands.
FAU - Cats, Annemieke
AU  - Cats A
AD  - Department of Gastrointestinal Oncology/Medical Oncology, Netherlands Cancer 
      Institute, Amsterdam, the Netherlands.
FAU - Verheij, Marcel
AU  - Verheij M
AD  - Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the 
      Netherlands; Department of Radiation Oncology, Radboud University Medical Center, 
      Nijmegen, the Netherlands. Electronic address: Marcel.Verheij@radboudumc.nl.
LA  - eng
SI  - ClinicalTrials.gov/NCT00407186
PT  - Clinical Trial, Phase III
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20200321
PL  - England
TA  - Eur J Cancer
JT  - European journal of cancer (Oxford, England : 1990)
JID - 9005373
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Perioperative Care/*methods
MH  - Stomach Neoplasms/surgery/*therapy
OTO - NOTNLM
OT  - Chemoradiotherapy
OT  - Chemotherapy
OT  - Older adults
OT  - Resectable gastric cancer
COIS- Conflicts of interest statement N.C.T. van Grieken reported receiving grants from 
      the Dutch Cancer Society and The Netherlands Organisation for Health Research and 
      Development, and serving on an advisory board for Bristol-Myers Squibb and Merck 
      Sharp & Dohme. H.W.M. van Laarhoven reported receiving grants/medication support 
      from Bayer, BMS, Celgene, Janssen, Lilly, Nordic Pharma, Philips, Roche, Servier, 
      and serving on an advisory board for BMS, Lilly, MSD, Nordic Pharma, Novartis, 
      Servier E.P.M. Jansen, A. Cats and M. Verheij reported receiving grants from the 
      Dutch Cancer Society, the Dutch Colorectal Cancer Group and Hoffmann La Roche. 
      All remaining authors have declared no conflicts of interest.
EDAT- 2020/03/26 06:00
MHDA- 2020/11/24 06:00
CRDT- 2020/03/26 06:00
PHST- 2019/11/19 00:00 [received]
PHST- 2020/02/06 00:00 [revised]
PHST- 2020/02/08 00:00 [accepted]
PHST- 2020/03/26 06:00 [pubmed]
PHST- 2020/11/24 06:00 [medline]
PHST- 2020/03/26 06:00 [entrez]
AID - S0959-8049(20)30057-5 [pii]
AID - 10.1016/j.ejca.2020.02.008 [doi]
PST - ppublish
SO  - Eur J Cancer. 2020 May;130:146-154. doi: 10.1016/j.ejca.2020.02.008. Epub 2020 
      Mar 21.