Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer

Gastric & Breast Cancer
DOI: 10.2122/gbc.2002.0009


Effectiveness of Adjuvant Chemoradiotherapy in Patients with Gastric Cancer Treated with Less Extensive Surgery

Worldwide, gastric cancer despite declining incidence remains one of the most common malignancies and a leading cause of cancer death. Although in the USA only 22,700 new cases are expected in 2001 real case-mortality remains high indicating little progress in the treatment of diagnosed gastric cancer. However, hopes for an improved patient outcome provides a most recent report from USA.[1] This large, carefully monitored, randomized trial is clinically important because up until now there was no credible evidence for the effectiveness of adjuvant treatment after gastric resection for cancer.[2-4]

In this multi-institutional trial, 556 patients after resection for adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy or surgery alone. The adjuvant treatment consisted of fluorouracil plus leucovorin followed by 4500 cGy of radiation. Chemoradiotherapy improved significantly the median overall survival by 9 months. The hazard ratio for death was 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.005). Three patients (1%) died from toxic effects of the chemoradiotherapy; grade 3 and grade 4 toxic effects occurred in 41% and 32% of the patients in the chemoradiotherapy group respectively. Macdonald and his colleagues concluded that 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.

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Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

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last update: 22 May 2003