What is the role of chemoradiotherapy in the treatment of gastric cancer?

Updated: Feb 23, 2021
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

A postoperative chemoradiation study was prompted in part by the patterns of local failure often preceding systemic spread. A randomized phase III study performed in the United States, Intergroup 0116, demonstrated a survival benefit associated with postoperative chemoradiotherapy compared with surgery alone (en bloc resection). [6]

In Intergroup 0116, patients with T3 and/or N+ adenocarcinoma of the stomach or gastroesophageal junction were randomized to receive a bolus of 5-fluorouracil (5-FU) and leucovorin (LV) and radiotherapy or observation. Patients who received the adjuvant chemoradiotherapy demonstrated improved disease-free survival (from 32% to 49%) and improved overall survival rates (from 41% to 52%) compared to those who were merely observed. This regimen is considered the standard of care in the United States.

The phase III CALGB 80101 study found that in patients who had undergone curative resection of gastric or gastroesophageal junction adenocarcinoma, postoperative chemoradiotherapy with epirubicin, cisplatin, and infusional 5-FU before and after radiotherapy did not improve survival compared with standard 5-FU and LV before and after radiotherapy. With a median follow-up duration of 6.5 years, 5-year overall survival rates were 44% in both treatment arms. [50]


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