New retrospective data are suggesting that there may be a role for chemoradiation therapy for select patients who have undergone curative-intent resection for gastric cancer.
Researchers at Johns Hopkins University used the multi-institutional U.S. Gastric Cancer Collaborative database and analyzed outcomes of 505 patients with gastric cancer treated between 2000 and 2012. They found that chemoradiation resulted in a mean survival of 46.7 months compared with only 20.9 months among those patients who received perioperative chemotherapy.1
“This is just one piece of evidence,” said study co-author Timothy Pawlik, MD, MPH, PhD, who is a professor of surgery at the Johns Hopkins University School of Medicine in Baltimore, MD. “We don’t have good prospective data and this suggests it warrants further consideration.”
Dr. Pawlik said the use of chemoradiation in patients with resectable gastric adenocarcinoma cancer remains controversial. A phase III trial out of Greece comparing chemoradiation to chemotherapy alone found no survival benefit from chemoradiation. However, the study included fewer than 150 patients.2
Dr. Pawlik and his colleagues analyzed the effect of perioperative therapy on survival with the use of propensity-score matching of clinicopathologic factors among patients who received chemotherapy alone versus perioperative chemoradiation.
In this investigation, the median age was 62 years and 58.2% of patients were male. The majority of patients had a T3 (38.7%) or T4 (36.8%) lesion. A total of 73.4% had lymph node metastasis. Among the 505 patients, 42% (221 patients) received chemotherapy alone and 58% (294 patients) received chemoradiation. Dr. Pawlik said patients who received chemoradiation tended to be younger with lymph node metastasis.
The researchers found that 46.9% of patients who received chemoradiation had survived after 5 years compared to 24.9% of patients who received chemotherapy alone.
Chemoradiation was found to improve patients’ recurrence-free survival to a median of 35.6 months compared with 16.6 months for patients who received chemotherapy alone. Dr. Pawlik said the addition of radiation appeared to significantly improve survival rates among patients with gastric cancer who had lymph node involvement in the immediate region of the stomach.