Surgery plus RT works best for metastatic gastric cancer

Patients with metastatic gastric cancer face a grim prognosis, but those who undergo surgery followed by radiation therapy (RT) may have the best chance of longer survival, according to a study published online January 29 in Cancer.

The current standard of care for metastatic gastric cancer is systemic chemotherapy. Survival outcomes from peer-reviewed clinical trials have shown median survival ranging from eight to 14 months.

Few studies have analyzed whether radiotherapy would benefit these patients, according to Dr. Ravi Shridhar, PhD, a radiation oncologist at Moffitt Cancer Center in Tampa, FL, and colleagues.

They accessed data from the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with stage IV gastric cancer between 2004 and 2008. The 5,072 patients identified were divided into four groups: those who only had surgery, those who only had radiation therapy, those who had surgery and radiation therapy, and those who did not have either treatment.

Patients who had surgery and radiation therapy survived the longest, a median 16 months, and had the highest two-year survival rate, at 31.7%. Patients who only had surgery survived a median of 10 months and had an 18.2% two-year survival rate.

Radiation therapy by itself was no better than no treatment at all in terms of survival. Patients in these two groups survived for eight and seven months, respectively, and had two-year survival rates of 8.9% and 8.2%.

Building upon this study, prospective trials should be conducted to assess the role and sequence of surgery and radiation therapy for patients with metastatic gastric cancer, the authors concluded.

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