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Adjuvant chemotherapy, radiotherapy feasible for resected gastric cancer
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Chemotherapy with a FOLFOX-4 regimen combined with concomitant radiotherapy was found to be effective in patients with resected high-risk gastric cancer in a pilot study.
The researchers noted that the role and timing of chemotherapy and radiotherapy is controversial in these patients. In the United States, the two are recommended postoperatively, but in Europe, the use of chemotherapy and radiotherapy are not considered the standard of care.
In this study, 29 patients with gastric cancer who had undergone potentially curative surgery received combined adjuvant FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin; eight cycles) and concomitant radiotherapy (45 Gy in 25 daily fractions) begun after two weeks of chemotherapy. The FOLFOX-4 regimen was reduced 25% during the radiotherapy period.
The DFS rate after one, two and three years was 79%, 35% and 35%, respectively. The OS rate at those time points was 85%, 62.6% and 50.1%, respectively. These rates “were shown to be substantially better than those observed in untreated patients,” the researchers wrote.
The treatment was generally well tolerated, with gastrointestinal adverse effects as the most common problems. There were 10 grade-3 or -4 adverse gastrointestinal effects, and six grade-3 or -4 hematologic adverse effects.
In an accompanying comment in the journal, Lorenzo Ferri, MD, PhD, and David Mulder, MD, wrote that the results of the study “demonstrate the feasibility of aggressive chemotherapy-radiotherapy after potentially curative surgery for locally advanced gastric carcinoma. …These data demand an expanded patient study group.” They also noted that the results of several ongoing trials will shed further light on the optimal use of chemotherapy and radiotherapy in these patients.
For more information:
- Orditura M. Arch Surg. 2010;145:233-238.