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Chemoradiation Benefit Holds Up for Gastric Cancer: Presented at ASCO-GI

By Roberta Friedman, PhD

SAN FRANCISCO, CA -- January 23, 2004 -- Long term surveillance of patients who had chemotherapy and radiation after surgical removal of gastric cancer shows that the survival benefit of the adjuvant therapy holds up, with more than 6 years median follow up.

As reported at the first Annual Symposium on Gastrointestinal Cancers, sponsored jointly by the American Society of Clinical Oncology and other societies, results of a subgroup analysis from the Southwest Oncology Group study (SWOG) 9008 suggest that patients whose gastric adenocarcinoma is circumscribed have better outcomes than do those with diffuse pathology. But, said presenter Jack Macdonald, of Saint Vincent's Medical Center, New York, the difference did not achieve statistical significance.

"We feel the study is now mature enough to do some subset analysis," he said during his presentation of the data. The findings, he said, support a significant interaction between the adjuvant therapy with tumor stage (T-stage), node stage, and level of dissection. "T-stage [was] highly prognostic, as all of us know," he said.

Patients had stage Ib through IV adenocarcinoma, and were randomized after surgical removal of the tumor to receive chemotherapy plus radiation, or simply to post-operative follow up. A combination of 5-fluorouracil 425 mg/m² and leucovorin 20 mg/m² was given daily for 5 days. Radiation of 4500 cGy followed, at 180 cGY a day. Chemotherapy continued after the radiation therapy for 2 more cycles at monthly intervals.

Overall survival was a median of 35 months for adjuvant treatment and 26 months with surgery alone (P < .006).

Patients who had lymph nodes resected en bloc had better survival, Dr. Macdonald said. He cautioned that these relatively few patients - 54 of the 551 who had surgery in the trial - might have had a more favorable prognosis. The study was retrospective, he reminded the audience, and the surgeons had not been given a mandate to resect nodes.


[Study title: Postoperative combined radiation and chemotherapy improves disease-free survival (DFS) and overall survival (OS) in resected adenocarcinoma of the stomach and gastroesophageal junction: Update of the results of Intergroup Study INT-0116 (SWOG 0998). Abstract OP6]

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