A team from the USA investigated the effect of surgery plus postoperative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction.
Surgical resection alone has been found to be curative in less than 40% of cases.
A total of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy, or surgery alone.
The adjuvant treatment consisted of 425 mg of fluorouracil per square meter of body-surface area per day, plus 20 mg of leucovorin per square meter per day, for 5 days.
This was followed by 4500 cGy of radiation at 180 cGy per day, given 5 days per week for 5 weeks.
|Median overall survival after treatment:|
Surgery plus chemoradiotherapy: 36 months
|New England Journal of Medicine|
Modified doses of fluorouracil and leucovorin were given on the first 4 and the last 3 days of radiotherapy.
One month after the completion of radiotherapy, two 5-day cycles of fluorouracil (425 mg per square meter per day) plus leucovorin (20 mg per square meter per day) were given one month apart.
The median overall survival in the surgery-only group was 27 months, as compared with 36 months in the chemoradiotherapy group. The hazard ratios for death and relapse were 1.35 and 1.52, respectively.
Three patients (1%) died from toxic effects of the chemoradiotherapy. Grade 3 toxic effects occurred in 41% of the patients in the chemoradiotherapy group, and Grade 4 toxic effects occurred in 32%.
Dr John S. Macdonald, of the St. Vincent's Comprehensive Cancer Center, New York, concluded on behalf of the group, "Postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection."