Surgery is the mainstay of treatment for stomach and esophageal cancer.
In the United States, some patients may receive postoperative chemotherapy and radiation.
This is as a result of a study, which showed a survival benefit compared to surgery alone in patients with adenocarcinoma of the stomach, and of the junction between the stomach and esophagus.
For patients with advanced cancer of the stomach or lower esophagus that can't be removed by surgery, benefit has been shown with epirubicin, cisplatin, and 5-fluorouracil, a combination called ECF.
The National Cancer Institute wanted to find out whether the combination regime given both before and after surgery (known as perioperative chemotherapy), would extend the lives of patients with operable disease.
The study was conducted under the leadership of Dr David Cunningham in the United Kingdom.
|5 years after diagnosis, 36 % of patients receiving chemotherapy survived versus 23 % who had surgery|
|National Cancer Institute|
The researchers included a total of 503 patients with adenocarcinoma of the stomach or lower esophagus that could be removed by surgery.
The patients were randomly assigned to be treated with surgery alone or surgery plus combination chemotherapy both before and after the operation.
The researchers reported that 5 years after diagnosis, 36 % of the patients who got chemotherapy were still alive.
The research team noted that 23 % of those who got surgery survived 5 years after diagnosis.
In addition, the researchers noted that cancer progressed in fewer patients treated with chemotherapy than surgery alone.
Dr Cunningham concludes, “This is the first trial to show that perioperative chemotherapy improves survival in patients with this disease.”
“This approach should be considered one of the standard treatment options for patients with operable cancer of the stomach and lower esophagus.”
Dr Robert Mayer of the Dana-Farber Cancer Institute in Boston commenting on the study's findings at the American Society of Clinical Oncology meeting.
Dr Mayer adds,“The best results in the treatment of advanced stomach cancer have been achieved with regimens involving cisplatin, 5-FU, and either docetaxel or epirubicin.”
“No single chemotherapy regimen for advanced stomach cancer has yet been shown to be superior to the other options.”
“The results of the current study validate the concept of perioperative chemotherapy."