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Preoperative Chemoradiotherapy for Resectable Gastric Cancer
Trevor Leong1, B Mark Smithers1, Michael Michael1
1From the Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne (T.L., M.M., W.K.M.), the School of Public Health, Monash University (J.Z.), the Department of Medical Oncology, Alfred Health (J.Z.), Central Clinical School, Alfred Centre (A.B.), and Monash Medical Centre (A.S.), Melbourne, VIC, Princess Alexandra Hospital, University of Queensland, Brisbane (B.M.S.), and Cancer Care Services, Sunshine Coast University Hospital, Birtinya, QLD (D.W.), National Health and Medical Research Council Clinical Trials Centre, University of Sydney (V.G., R.L.O., J.S.), and Chris O'Brien Lifehouse (D.M.), Sydney, and the Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, NSW (A.M.) - all in Australia; the Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium (K.H.); Princess Margaret Hospital (R.W.) and Mount Sinai Hospital (C.S.), Toronto, the Canadian Cancer Trials Group, Queen's University, Kingston, ON (C.O.), Nova Scotia Health Central Zone, Halifax (G.D.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.) - all in Canada; the Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (M.F.); University Cancer Center Leipzig and Comprehensive Cancer Center Central Germany Leipzig-Jena, University Medicine Leipzig, Leipzig, Germany (F.L.); and Sainte Catherine Institut du Cancer Avignon-Provence, Avignon, France (L.M.).
Adding preoperative chemoradiotherapy to perioperative chemotherapy did not improve overall survival for gastric cancer patients. Standard perioperative chemotherapy alone remains the comparable treatment for resectable gastric and gastroesophageal junction adenocarcinoma.
Area of Science:
- Oncology
- Gastrointestinal Surgery
- Radiation Oncology
Background:
- The standard treatment for resectable gastric cancer in Western countries is perioperative chemotherapy.
- Preoperative chemoradiotherapy is an alternative, but comparative data are limited.
Purpose of the Study:
- To compare the efficacy of preoperative chemoradiotherapy plus perioperative chemotherapy versus perioperative chemotherapy alone for resectable gastric and gastroesophageal junction adenocarcinoma.
Main Methods:
- An international, phase 3 randomized trial involving 574 patients.
- Patients received either preoperative chemoradiotherapy plus perioperative chemotherapy or perioperative chemotherapy alone.
- Chemotherapy regimens included epirubicin, cisplatin, and fluorouracil or fluorouracil, leucovorin, oxaliplatin, and docetaxel. Preoperative chemoradiotherapy involved 45 Gy radiation in 25 fractions with fluorouracil infusion.
Main Results:
- A higher pathological complete response rate (17% vs. 8%) and greater tumor downstaging were observed in the preoperative chemoradiotherapy group.
- No significant differences in overall survival (median 46 vs. 49 months) or progression-free survival (median 31 vs. 32 months) were found between the groups.
- Treatment-related toxic effects were similar in both groups.
Conclusions:
- The addition of preoperative chemoradiotherapy to perioperative chemotherapy does not enhance overall survival for patients with resectable gastric and gastroesophageal junction adenocarcinoma.
- Perioperative chemotherapy alone demonstrates comparable survival outcomes to the combined approach.
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