Adjuvant chemotherapy with 5-FU or regimens including oral fluoropyrimidine for curable gastric cancer

Abstract

tration of 45-Gy radiotherapy and fi ve courses of chemotherapy consisting of 5-fl uorouracil (5-FU) and leucovorin. Postoperative adjuvant chemoradiotherapy (CRT) showed a statistically signifi cant improvement of relapse-free survival (RFS) and overall survival (OS) for patients with gastric cancer undergoing curative surgery, compared with surgery alone as control. The 3-year OS after CRT was 50%, while that of the surgeryalone group was 41% (hazard ratio [HR], 1.35; 95% confi dence interval [CI], 1.09-1.66; P = 0.005). The chemotherapy used in this study, 5-FU and leucovorin, was a slightly-out-of-date regimen, but the low toxicity and high compliance of this treatment could have been the key to this successful study.The study had two major weak points. First, only 10% of patients underwent D2 dissection in spite of the recommendation of D2 dissection in the protocol, suggesting that poor local control by surgery was salvaged by radiotherapy. Secondly, 35 % of the irradiation plans had major or minor deviations, most of which could be revised before actual treatment by the central quality controller. The eventual rate of major deviation was 6.5%. This happened in the United States, where the standard level of radiotherapy seems to be much higher than that in most other countries, including Japan. This fact should be taken into consideration when this treatment is adopted in other countries.After this result came out, the standard treatment after potentially curative surgery for node-positive patients in the United States has been postoperative CRT. At present, we cannot see any United States clinical phase III trial of adjuvant treatment for potentially curable gastric cancer in the registry of the NCI (http:// www.clinicaltrial.gov.) MAGIC trial [3]Cunningham et al. [3] reported the results of the MAGIC trial, which was performed to evaluate the effi cacy of

Adjuvant Chemoradiotherapy in Patients With Stage III or IV Radically Resected Gastric Cancer

“…Finally, perioperative CT is under investigation, and the excellent Japanese results with S-1, to our knowledge, have not been reproduced in the West. 8,29 The role of RT alone as adjuvant treatment was reported in a randomized trial 30 in which 145 patients received surgery alone, 138 were administered postoperative CT, and 153 were given postoperative RT. No survival differences were reported, but RT offered an advantage in terms of reduction in local recurrence (27% with surgery alone vs 10% with surgery and RT).…”

Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center

“…For these patients, only one prospective non-randomized study demonstrated a gain of survival with adjuvant chemoradiotherapy [8]. The interpretation of this finding is limited by the retrospective analysis of the study and by conflicting results in the surgical group [9]. …”