Adjuvant Chemotherapy and Radiation: A New Standard of Care for Gastric Cancer
Results from a large clinical trial recently reported in the New England Journal of Medicine, confirm previous reports that adjuvant therapy, (treatment with chemotherapy and radiation following surgery) significantly improves survival for patients with gastric cancer and should become the standard of care for this disease.
The stomach is the primary organ of digestion. It receives food from the esophagus and is located in the upper abdomen. Gastric cancer (stomach cancer) is characterized by the presence of cancer cells in the tissues of the stomach. It is currently the second leading cause of cancer death worldwide.
Surgery remains an essential treatment component for gastric cancer. Recently, results from a previous pivotal clinical trial indicated a marked improvement in the outcome of patients treated with adjuvant therapy consisting of chemotherapy plus radiation, as compared to surgery alone. These findings prompted researchers to evaluate this issue further, in order to define optimal treatment regimens for patients with this disease.
The concept behind the use of adjuvant therapy arises from the fact that current detection methods are not able to find or measure small amounts of cancer cells that may be left behind following surgery. These cancer cells are responsible for cancer recurrences. Chemotherapy is a systemic treatment, meaning its effects reach the entire body. This property enables chemotherapy to potentially kill undetectable cancer cells remaining in patients following surgery. In addition, radiation is able to kill cancer cells within the treated area, which may help decrease the rate of a local cancer recurrence.
A recent multi-institutional clinical trial was conducted to further evaluate adjuvant therapy consisting of chemotherapy and radiation in over 500 patients with gastric cancer. All patients in this trial underwent surgery to remove their cancer, with no evidence of cancer remaining following the surgical procedure. Half of the patients then received adjuvant combination chemotherapy consisting of 5-fluorouracil and leucovorin plus radiation, while the other half of patients were treated with surgery alone (control group). Three years following therapy, 50% of patients treated with surgery followed by adjuvant chemotherapy and radiation survived, compared with only 41% of patients in the control group. Three years following treatment, 48% of patients treated with adjuvant therapy survived without a cancer recurrence, compared to only 31% who received surgery alone. The average duration of survival following treatment was 27 months in the control group, compared with 36 months for patients receiving adjuvant therapy.
Results from this trial are consistent with previous studies, indicating that the use of adjuvant therapy should become standard of care for patients with gastric cancer that has not spread to distant sites in the body. Future clinical trials evaluating different combinations and doses of adjuvant therapies are warranted to establish optimal treatment regimens for patients with gastric cancer. Patients with this disease may wish to speak with their physician about the risks and benefits of adjuvant therapy or the participation in a clinical trial further evaluating this issue. Two sources of information include comprehensive, easy-to-use listing services provided by the National Cancer Institute ( cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. ( New England Journal of Medicine, Vol 345, No 10, pp 725-730, 2001)
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