Efficacy and toxicity of capecitabine combined with intensity-modulated radiotherapy after D1/D2 lymph node dissection in patients with gastric cancer

Table 1 Clinical target volume for elective nodal regions according to the Japanese Gastric Cancer Association guidelines

Tumor location	CTV for elective nodal regions
Upper 1/3rd or gastroesophageal junction	110, 1-3, 7, 9-11
Middle 1/3rd	1-3, 5-13, 141, 16a
Lower 1/3rd	3, 5-9, 11p, 12-13, 141, 16a

¹No. 14 was included in the clinical target volume (CTV) only when the surface or parenchyma of the pancreas was involved by the tumor. 110: Paraesophageal lymph nodes (LNs) in the lower thorax; 1: Right paracardial LNs; 2: Left paracardial LNs; 3: LNs along the lesser curvature; 5: Suprapyloric LNs; 6: Infrapyloric LNs; 7: LNs along the left gastric artery; 8: LNs along the common hepatic artery; 9: LNs around the celiac artery; 10: LNs at the splenic hilum; 11: LNs along the splenic artery (11p: LNs along the proximal splenic artery); 12: LNs in the hepatoduodenal ligament; 13: LNs on the posterior surface of the pancreatic head; 14: LNs along the root of the mesentery; 16a: LNs around the abdominal aorta (above the level of the inferior border of the left renal vein). CTV: Clinical target volume.

Table 2 Patient characteristics

Characteristic	n	%
Age in yr, median (range)	53 (24-71)
Men	28	70.0
Tumor size in cm, median (range)	5.0 (2-20)
Location of primary tumor
Upper 1/3rd of stomach	8	20
Middle 1/3rd of stomach	8	20
Lower 1/3rd of stomach	14	35
≥ 2 sites involved	10	25
Surgery type
Partial gastrectomy	36	90
Total gastrectomy	4	10
Positive LNs, median (range)	7 (1-26)
LNs resected, median (range)	24 (15-56)
LN ratio, median (range)	0.27 (0-0.86)
Extent of dissection
D1	18	45
D2	22	55
Lauren type
Intestinal type	12	30
Diffuse type	16	40
Mixed type	12	30
Tumor differentiation
Good	1	2.5
Moderate	8	20
Poor	31	77.5
Lymphatic/vascular invasion
Absent	16	40
Present	24	60
Perineural invasion
Absent	30	75
Present	10	25
Signet ring cells
Absent	29	72.5
Present	11	27.5
Tumor deposit
Absent	34	85
Present	6	15
Stage (AJCC 7th)
IIa	2	5
IIb	6	15
IIIa	11	27.5
IIIb	11	27.5
IIIc	10	25
Stage (AJCC 6th)
Ib	2	5
II	14	35
IIIa	10	25
IIIb	2	5
IV	12	30

AJCC: American Joint Committee on Cancer; LN: Lymph node.

Table 3 Overall toxicities at the recommended dose, n = 40

Toxicity	Grade 1-2, n (%)	Grade 3-4, n (%)
Nausea	22 (45)	3 (7.5)
Vomiting	15 (37.5)	4 (10)
Anorexia	27 (67.5)	2 (5)
Esophagitis	6 (15)	3 (7.5)
Diarrhea	5 (12.5)	0
Abdominal pain	1 (2.5)	1 (2.5)
Gastritis	9 (22.5)	2 (5)
Fatigue	21 (52.5)	1 (2.5)
Weight loss	8 (20)	0
HFS	14 (35)	0
Leukopenia	27 (67.5)	5 (12.5)
Neutropenia	7 (17.5)	1 (2.5)
Anemia	3 (7.5)	0
Thrombocytopenia	17 (42.5)	3 (7.5)
ALT/AST	2 (5)	0

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HFS: Hand foot syndrome.

Table 4 Survival outcomes

Time	DFS (95%CI)	OS (95%CI)	LRFS (95%CI)	DMFS (95%CI)
3 yr	66.2 (58.6-73.8)	75 (68.2-81.8)	80.8 (74.2-88.6)	72.4 (64.9-79.9)
5 yr	55.2 (47.1-63.3)	58.9 (51.0-66.8)	80.8 (74.2-88.6)	60.4 (52.1-68.7)
7 yr1	52.3 (44.1-60.5)	48.2 (39.5-56.9)	80.8 (74.2-88.6)	57.2 (48.8-65.6)

¹Estimated survival. CI: Confidence interval; DFS: Disease-free survival; DMFS: Distant metastasis-free survival; LRFS: Locoregional recurrence-free survival; OS: Overall survival.