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
The results of a 10-year study of a three-prongedtreatment (surgical resection followed by chemotherapy and radiotherapy) foradenocarcinoma of the stomach showed that patients who underwent both surgicalresection and postoperative chemoradiotherapy had a significantly improvedsurvival rate. Past studies found that chemoradiotherapy alone after surgery didnot increase survival. More extensive surgery has also been investigated and hasfailed to improve outcome. However, the three-pronged approach produced asignificant 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 wasexperimental, all radiation oncologists treating patients in this study wererequired to get his approval of the radiation planned for each patient prior totherapy.
"The most promising news is that this approach leads to significantimprovement in both disease-free and overall survival among thesepatients," said Dr. Smalley. "This research changes the standardprotocol for the treatment of most patients with completely resected stomachcancer."
Survival and Relapse Rate Improve
The study enrolled 556 patients following curative surgery. Participants werethen randomized to receive no further treatment or both chemotherapy andradiotherapy. Survival was substantially higher in the group that receivedchemoradiotherapy after surgery. The median survival rate in the surgery-onlygroup was 27 months. Among patients who underwent both chemotherapy andradiotherapy, the median survival was 36 months and the relapse-free period wasalso higher. "The median time in which patients had no relapse was 30months in the chemoradiotherapy group, compared to 19 months in the surgery-onlygroup," said Dr. Smiley.
However, the results of this study, reported in the New England Journal ofMedicine (345:725-730, 2001), apply only to patients in whom all visible signsof cancer can be removed surgically. The authors of the study emphasized thatproper nutrition is also a significant part of treatment.