Chemoradiotherapy or Chemotherapy Compared with Surgery in Patients with Gastric Cancer

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Despite the phase I/II studies that have indicated that chemoradiotherapy could be beneficial, there has not yet been a statistically significant indication that preoperative radiotherapy with chemotherapy is beneficial to patients with gastric cancer.

Research recently published in the European Journal of Surgical Oncology summarized a literature review that aimed to compare survival and postoperative mortality and morbidity data in randomized clinical studies between patients who received preoperative chemoradiotherapy or chemotherapy versus surgery alone, or preoperative chemoradiotherapy versus chemotherapy for gastric and/or gastro-oesophageal junction (GOJ) cancer.

The researchers determined the hazard ratios for overall mortality and extracted the individual patient data from the principal investigators of each study or the study’s meta-analysis. Researchers also examined postoperative morbidity and mortality incidence of each study.

The researchers found 18 studies that matched the criteria they were searching and found that data was available from 14 studies. The hazard ratios in relation to the overall survival according to the meta-analysis was 0.75 (95% CI 0.65, 0.86, P<0.001) for preoperative chemoradiotherapy and 0.83 (95% CI 0.67, 1.01, P=0.065) for preoperative chemotherapy when compared with surgery alone. When preoperative chemoradiotherapy was compared directly to chemotherapy, the researchers found a hazard ratio of 0.71 (95% CI 0.45, 1.12, P=0.146). 

There was no significant statistical difference between the risk for postoperative morbidity or mortality in preoperative treatments and surgery alone or preoperative chemoradiotherapy and chemotherapy.

However, there was a significant survival benefit for preoperative chemoradiotherapy for gastric cancer when compared with surgery alone and a trend towards improved survival after the addition of radiotherapy when comparing preoperative chemotherapy and chemoradiotherapy.

Chemo First May Be Better in Rectal Cancer
No statistically significant indication that preoperative radiotherapy is beneficial to patients with gastric cancer.
Kumagai K, et al. - In this study, a systematic literature search was performed to capture survival and postoperative morbidity and mortality data in randomised clinical studies comparing preoperative (chemo)radiotherapy or chemotherapy versus surgery alone, or preoperative chemoradiotherapy versus chemotherapy for gastric and/or gastro-oesophageal junction (GOJ) cancer.
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