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Chemotherapy Improves Survival for Stomach and Esophageal Cancer: Presented at ACS

By Crystal Phend

SAN FRANCISCO, CA -- October 19, 2005 -- Addition of chemotherapy before and after surgery in patients with stomach and esophageal cancer significantly improves overall survival and disease-free survival, according to data presented here at the annual meeting of the American College of Surgeons (ACS).

Surgery alone is currently the standard of care in countries such as the United Kingdom. However, the outcome is poor for patients with advanced disease, which is over three quarters of patients.

"There is a need to combine surgery with some other mode of treatment," said lead author and presenter William H. Allum, MD, Surgeon, Royal Marsden Hospital, Sutton, United Kingdom.

Dr. Allum presented the findings from a prospective, controlled, multicentre study on October 18^th. The study randomized 503 patients to receive surgery alone or with a 3-week course of preoperative chemotherapy and a 3-week course of postoperative chemotherapy.

The chemotherapy regimen was epirubicin 50 mg/m² IV bolus and cisplatin 60 mg/m² as a 4-hour infusion, both on day 1, and 5-fluorouracil 200 mg/m²/day continuous infusion during the 3 cycles.

Patient characteristics were similar between groups. In the whole study, 74% had gastric cancer, 11% had esophagogastric junctional cancer and 15% had lower esophageal cancer.

Surgeons decided on the type of resection and whether to do lymphadenectomy, although the researchers suggested removal of the majority of lymph nodes around the stomach.

Surgery was considered curative in a significantly higher proportion of patients in the chemotherapy group compared to the group receiving surgery alone (79% vs. 70%). Dr. Allum said this may have been due to a downstaging effect of adjuvant chemotherapy. The chemotherapy group had a maximum tumor diameter of 3 cm compared to 5 cm for the control group.

Pathological examination of tumors indicated that the chemotherapy group was less likely to have lymph node involvement, he said.

Overall survival, the main endpoint, was significantly higher at both 2 and 5 years of follow-up for the chemotherapy group, a 9% and 13% advantage, respectively.

Time to recurrence was significantly better for patients receiving chemotherapy plus surgery compared to surgery alone, Dr. Allum said.


[Presentation title: Perioperative Chemotherapy in Operable Gastric and Lower Esophageal Cancer: Final Results of a Randomized Controlled Trial. Papers Session I, GS42]

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