Adjuvant Radiochemotherapy Demonstrates Benefit in Gastric Cancer
Adjuvant radiochemotherapy provides strong and persistent benefit in patients who have undergone curative gastric resection, according to the long-term results of a study published in the Journal of Clinical Oncology.
Gastric cancer refers to cancer of the stomach. Though gastric cancer has a relatively low incidence in the United States, it is the second leading cause of cancer death worldwide. The incidence of gastric cancer is quite high in Asian countries such as Korea, China, Taiwan, and Japan. Treatment of gastric cancer typically involves surgical removal of the cancer followed by the use of chemotherapy with or without radiation therapy.
In 2001, the Intergroup 0116 study demonstrated the benefit of adjuvant radiochemotherapy (RCT) after curative gastric cancer resection. Now, with a more than 10-year median follow-up, the researchers present an update that includes data on failure patterns and second malignancies.
The randomized phase III study included 559 patients—282 patients were assigned to RCT and 277 were assigned to observation. All patients had a moderate risk for locoregional failure and had primaries of T3 or greater and/or node-positive gastric cancer.
The results of the update indicate that after more than 10 years of median follow-up, overall survival rates and relapse-free survival rates improved with postoperative RCT. Overall and locoregional relapse rates were substantially lower in patients who received RCT. The treatment showed strong benefit in most subsets, except patients with diffuse histology who did not exhibit a significant treatment effect. There were secondary malignancies in 21 patients in the RCT group and 8 in the observation group.
The researchers concluded that adjuvant RCT provides a strong and persistent benefit. Despite the toxicities, the regimen appears acceptable and they suggest that it should remain a standard therapy for patients who undergo curative gastric resection.
 Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed Intergroup Study 0116: A phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. Journal of Clinical Oncology. 2012; 30(19): 2327-2333.
 Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. New England Journal of Medicine. 2001; 345: 725-730.
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