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Adjuvant Therapy for Gastric Adenocarcinoma

Treatment of gastric cancer can be difficult, with surgical resection curing less than one half of patients. Macdonald and colleagues present data from a large randomized trial comparing surgical resection with subsequent chemo- and radiotherapy, and surgery alone.

Trial candidates had adenocarcinoma of the stomach or gastroesophageal junction that was shown by clear margins to be completely resected at the time of surgery. From 1991 to 1998, 556 patients were enrolled in the trial. The risk of relapse was high, with metastases to regional nodes present in 85 percent of patients.

Patients randomized to adjuvant therapy were given postoperative fluorouracil for five days, followed by a five-week regimen of radiotherapy and two more cycles of fluorouracil over the next two months. Adjuvant therapy was completed in 64 percent of patients. The most common reason for not completing adjuvant therapy was withdrawal related to side effects (17 percent), chiefly leukopenia and gastrointestinal toxicity. Adjuvant therapy was lethal in three patients (1 percent).

The median length of follow-up was five years. Patients who were given both surgery and adjuvant therapy survived an average of 36 months, while the surgery-alone group survived approximately 27 months. This difference was statistically significant. Three-year survival rates were 50 percent for surgery with chemo- and radiotherapy versus 41 percent for surgery alone. Survival was not altered by gender, race, location of primary tumor, or extent of surgical resection.

The authors conclude that postoperative chemo- and radiotherapy, compared with surgical resection alone, can extend the survival of patients with gastric cancer in those who are able to complete adjuvant therapy.

BILL ZEPF, M.D.

Macdonald JS, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med September 6, 2001;345:725-30.