By Anthony J. Brown, MD
WESTPORT, CT (Reuters Health) – Postoperative chemoradiotherapy improves the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction, according to a report published in the September 6th issue of The New England Journal of Medicine.
Dr. John S. MacDonald, from St. Vincent's Comprehensive Cancer Center in New York, and colleagues assessed the outcomes of 556 patients with cancer of the stomach or gastroesophageal junction who were randomized to undergo surgery alone or surgery plus postoperative chemoradiotherapy. The chemoradiotherapy regimen included fluorouracil, leucovorin, and 4500 cGy of radiation therapy.
The median survival of patients who did and did not receive chemoradiotherapy was 36 and 27 months, respectively (p = 0.005). The median relapse-free survival periods for these groups was 30 and 19 months, the authors note (p < 0.001). Three deaths were attributed to toxic effects of the chemoradiotherapy. Grade 3 and 4 toxic effects occurred in 41% and 32% of adjuvant therapy patients, respectively.
"A number of studies have investigated the use of various postoperative chemotherapy regimens and have, in general, shown minimally significant benefit from this form of therapy," Dr. MacDonald told Reuters Health. "In contrast, our study combined postoperative chemotherapy with radiotherapy and we found a statistically significant improvement in both disease-free survival and overall survival," he stated.
"When you resect a cancer, it is important to understand the pattern of relapse," Dr. MacDonald noted. "With gastric cancer, about 80% to 90% of patients who relapse have some component of local relapse," he explained. "Therefore, it makes sense to look at treatment modalities that control local relapse."
"I think that adding external beam radiation for local relapse control to chemotherapy for systemic control is what really made the difference in our study," Dr. MacDonald said.
The chemotherapy agents used in the current study were state of the art in 1991 when the trial began, Dr. MacDonald pointed out. "A future area of investigation might be to compare the outcomes of patients treated with the adjuvant therapy described in this paper with those of patients treated with the newer 21st century chemotherapy agents," he said. The benefits of preoperative adjuvant therapy also require further study, he added.