Postoperative (adjuvant) chemoradiation therapy

A prospective, multi-institution, phase III trial (SWOG-9008 [NCT01197118]) evaluated postoperative combined chemoradiation therapy compared with surgery alone in 559 patients with completely resected stage IB to stage IV (M0) adenocarcinoma of the stomach and gastroesophageal junction. Investigators reported a significant survival benefit for patients who received adjuvant combined-modality therapy.[3][Level of evidence A1]

A prospective, multi-institution, phase III trial (SWOG-9008 [NCT01197118]) evaluated postoperative combined chemoradiation therapy compared with surgery alone in 559 patients with completely resected stage IB to stage IV (M0) adenocarcinoma of the stomach and gastroesophageal junction. Investigators reported a significant survival benefit for patients who received adjuvant combined-modality therapy.[3][Level of evidence A1]

With more than 10 years of follow-up, median survival was 35 months for the adjuvant chemoradiation therapy arm and 27 months for the surgery-alone arm (P = .0046).

A prospective, multi-institution, phase III trial (SWOG-9008 [NCT01197118]) evaluated postoperative combined chemoradiation therapy compared with surgery alone in 559 patients with completely resected stage IB to stage IV (M0) adenocarcinoma of the stomach and gastroesophageal junction. Investigators reported a significant survival benefit for patients who received adjuvant combined-modality therapy.[3][Level of evidence A1]

Median relapse-free survival was 27 months in the chemoradiation arm compared with 19 months in the surgery-alone arm (P < .001). Improvement was primarily seen for locoregional recurrence risk (improvement from 47% for surgery vs. 29% for chemoradiation).[3] However, only 36 patients in the trial had stage IB tumors (18 patients in each arm).[9]

Attempts to evaluate the role of more intensive chemotherapy regimens in combination with radiation in the Cancer and Leukemia Group B study (CALGB-80101 [NCT00052910]) demonstrated no survival benefit. The 546 patients who had undergone curative resection of stage IB to stage IV (M0) gastric or gastroesophageal junction adenocarcinoma received postoperative 5-FU with leucovorin before and after radiation or postoperative ECF before and after combined radiation therapy.[10]

Attempts to evaluate the role of more intensive chemotherapy regimens in combination with radiation in the Cancer and Leukemia Group B study (CALGB-80101 [NCT00052910]) demonstrated no survival benefit. The 546 patients who had undergone curative resection of stage IB to stage IV (M0) gastric or gastroesophageal junction adenocarcinoma received postoperative 5-FU with leucovorin before and after radiation or postoperative ECF before and after combined radiation therapy.[10]

The 5-year OS rate was 44% in both arms.

In a phase III Dutch trial (CRITICS [NCT00407186]), 788 patients with stage IB to stage IVA gastric/gastroesophageal junction adenocarcinoma received preoperative chemotherapy and surgery, and then were randomly assigned to receive postoperative chemotherapy or chemoradiotherapy.[11] Adjuvant chemoradiation did not improve survival in those who received neoadjuvant chemotherapy.

In a phase III Dutch trial (CRITICS [NCT00407186]), 788 patients with stage IB to stage IVA gastric/gastroesophageal junction adenocarcinoma received preoperative chemotherapy and surgery, and then were randomly assigned to receive postoperative chemotherapy or chemoradiotherapy.[11] Adjuvant chemoradiation did not improve survival in those who received neoadjuvant chemotherapy.

Median OS was 43 months in the chemotherapy arm and 37 months in the chemoradiotherapy group (95% CI, 0.84–1.22; P = .90).