Dr. Stephen R. Smalley of the Radiation Oncology Center of Olathe, Kansas, and colleagues randomized 559 patients with primary gastric cancer at or beyond T3 and/or node-positive cancer to observation or chemoradiotherapy following r0 resection. Patients received fluorouracil and leucovorin before, during, and after radiotherapy.
The team previously reported the benefits of adjuvant therapy at a median of four years. Their latest report, published online May 14 in the Journal of Clinical Oncology, extends the median follow-up to more than 10 years.
The adjuvant group continued to show a benefit in overall survival (hazard ratio, 1.32) and relapse-free survival (hazard ratio, 1.51). There were substantial reductions in rates of regional relapse (22% vs. 39%) and relapse in general (52% vs. 76%).
Hazard ratios, the researchers point out, "remain virtually unchanged from our initial report."
There was no significant difference in rates of second malignancies.
The authors say the findings "continue to demonstrate dramatic benefit for patients who received adjuvant radiochemotherapy."
"Many issues regarding optimization of radiochemotherapy remain, including optimal timing of radiation with respect to surgery," they note.
An editorial by Dr. Charles S. Fuchs of the Dana-Farber Cancer Institute, Boston, and colleagues observes that the latest report "highlights the durable benefit of postoperative fluorouracil-based chemoradiotherapy."
They write, "The authors conclude that the observed benefits appear to outweigh a possible increased risk of second malignancy. In light of the documented survival benefits after 10 years of follow-up, this conclusion seems reasonable."
Neither Dr. Smalley nor Dr. Fuchs responded to requests for comments.
J Clin Oncol 2012.
Last Updated: 2012-06-20 14:00:28 -0400 (Reuters Health)
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