What's the Best Treatment Modality for Resectable Stomach Cancer?

By Reuters Staff

December 29, 2021

NEW YORK (Reuters Health) - For resectable gastric cancer, neoadjuvant chemoradiation may be better than other treatment modalities for achieving pathologic complete response (pCR) and treatment with any chemotherapy may provide the biggest survival benefit, according to a new analysis.

"Treatment of resectable gastric cancer uses a multimodal approach, including surgical treatment and chemotherapy with or without radiation therapy, and the optimal treatment strategy and timing of each of these modalities is unknown," researchers note in JAMA Network Open.

To investigate, Dr. Jun Gong with Cedars-Sinai Medical Center, in Los Angeles, and colleagues used the National Cancer Database to do a comparative effectiveness analysis of various neoadjuvant and adjuvant treatment modalities in more than 3,000 patients with resectable gastric cancer.

They created nine treatment groups: neoadjuvant chemoradiation (nCRT) only, neoadjuvant chemotherapy only, adjuvant chemotherapy (aCT) only, adjuvant chemoradiation (aCRT) only, neoadjuvant chemotherapy and adjuvant radiation, chemotherapy with timing unknown (CTTU), chemoradiation therapy with timing unknown, radiation therapy with timing unknown (RTTU), and no perioperative therapy (NT).

In multivariable analyses, nCRT had the highest pCR rate (odds ratio, 59.6; P<0.001) compared with NT, followed by RTTU (OR, 30.0; P=0.004).

CTTU was associated with the greatest reduction in overall risk of death compared with NT (hazard ratio, 0.41; P< 0.001), followed by nCRT (HR, 0.48; P<0.001).

Median overall survival was greatest among patients treated with CTTU (53.9 months), followed by nCRT (39.1 months) and aCT (36.1 months).

Two-year overall-survival rates were 65.6% for CTTU, 63.6% for nCRT, and 59.7% for aCT.

The researchers say that, to their knowledge, this study is the first to compare the effectiveness of the various treatment modalities for resectable gastric cancer by using a modality-by-modality approach.

The findings point to the "importance of chemotherapy (including neoadjuvant and adjuvant therapy) as the standard of treatment in the multimodal approach" for these patients based on the association of chemotherapy with increased overall survival, they say.

The study had no specific funding.

SOURCE: https://bit.ly/3ILPtTx JAMA Network Open, online December 10, 2021.

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