The results of a 10-year study of a three-pronged treatment (surgical resection followed by chemotherapy and radiotherapy) for adenocarcinoma of the stomach showed that patients who underwent both surgical resection and postoperative chemoradiotherapy had a significantly improved survival rate. Past studies found that chemoradiotherapy alone after surgery did not increase survival. More extensive surgery has also been investigated and has failed to improve outcome. However, the three-pronged approach produced a significant decrease in relapse and increase in survival rates.
Stephen R. Smalley, MD, of Therapeutic Radiologists Inc, in Kansas City, originally developed the study in 1987. Because the radiotherapy was experimental, all radiation oncologists treating patients in this study were required to get his approval of the radiation planned for each patient prior to therapy.
"The most promising news is that this approach leads to significant improvement in both disease-free and overall survival among these patients," said Dr. Smalley. "This research changes the standard protocol for the treatment of most patients with completely resected stomach cancer."
Survival and Relapse Rate Improve
The study enrolled 556 patients following curative surgery. Participants were then randomized to receive no further treatment or both chemotherapy and radiotherapy. Survival was substantially higher in the group that received chemoradiotherapy after surgery. The median survival rate in the surgery-only group was 27 months. Among patients who underwent both chemotherapy and radiotherapy, the median survival was 36 months and the relapse-free period was also higher. "The median time in which patients had no relapse was 30 months in the chemoradiotherapy group, compared to 19 months in the surgery-only group," said Dr. Smiley.
However, the results of this study, reported in the New England Journal of Medicine (345:725-730, 2001), apply only to patients in whom all visible signs of cancer can be removed surgically. The authors of the study emphasized that proper nutrition is also a significant part of treatment.