Gastric Cancer OS Better With Perioperative Chemotherapy Than Postoperative Chemoradiotherapy

Patients with operable gastric or gastro-oesophageal cancer derive a survival advantage from perioperative chemotherapy versus postoperative chemoradiotherapy

medwireNews: Perioperative chemotherapy is associated with longer overall survival (OS) than postoperative chemoradiotherapy (CRT) among patients with resectable adenocarcinoma of the stomach or gastro-oesophageal junction, shows a database analysis published in Cancer. 

Although the addition of either regimen has been shown to improve survival over surgery alone, the modalities have not been directly compared in a randomised setting to date causing debate as to the best approach, explain Jimmy Efird, from the University of Newcastle in New South Wales, Australia, and colleagues. 

They add that perioperative chemotherapy is encouraged in European centres following the results of the MAGIC trial, whereas postoperative CRT is favoured in the USA on the basis of the Intergroup 0116 trial. 

The current analysis relied on the US National Cancer Database to identify 5058 patients who underwent resection for stage II or III gastric cancer between 2004 and 2013. Of these, 11% received perioperative chemotherapy, that is, treatment with multi-agent chemotherapy before and after surgery, while the remaining 89% received postoperative CRT. 

After adjusting for confounding variables, including demographic factors, treatment regimen, comorbidity and tumour size and grade, individuals who received perioperative chemotherapy had a significant survival advantage over those given postoperative CRT, with a hazard ratio (HR) of 0.58. 

The 3- and 5-year actuarial OS rates for patients in the perioperative chemotherapy group were 62% and 44%, respectively, which were significantly higher than the corresponding 52% and 38% rates in the postoperative CRT group. 

The survival gain was maintained when participants were stratified by clinical stage, such that the HRs for perioperative chemotherapy versus postoperative CRT were 0.79 for those with stage II disease and 0.49 for stage III patients. 

The researchers note that the benefit was more pronounced for patients with lymph node-positive disease than for those who were classed as node-negative, with respective HRs of 0.52 and 0.90. 

And they write: “Because the greatest benefit was noted among patients with clinically lymph node-positive disease, perhaps more aggressive therapy before surgery in an attempt to convert patients with lymph node-positive to lymph node-negative status is a consideration.” 

However, Jimmy Efird and team urge caution when interpreting the findings “in the context of patients who are unable to withstand more aggressive therapies, or if their condition in other ways differentially dictates their treatment.” 

They add that “individualized recommendations must include the consideration of various factors that predict quality of life during and after treatment.” 

Reference  

Fitzgerald TL, Efird JT, Bellamy N, et al. Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: A survival analysis of 5058 patients. Cancer; Advance online publication 6 April 2017. doi: 10.1002/cncr.30692 

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