Canadian Association of General Surgeons and American College of Surgeons Evidence-Based Reviews in Surgery. 25.: Perioperative chemotherapy and surgery versus surgery alone for resectable gastric cancer

• Published in: Canadian Journal of Surgery 2008-08, Vol.51 (4), p.302-304
• Main Authors: Henteleff, Harry, MD, Malthaner, Richard, MD, Barnett, Carlton, MD, for the Members of the Evidence Based Reviews in Surgery Group, McKenzie, M.E
• Format: Article
• Language: English
• Subjects: Cancer; Care and treatment; Chemotherapy; Evidence-based medicine; Evidence-Based Surgery; Patient outcomes; Stomach cancer; Surgeons; Surgery; Systematic review
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1016/S0008-428X(08)50080-4

Question: Does perioperative adjuvant therapy improve the outcome of operable gastric cancer? Design: Multicentre randomized controlled trial. Setting: Forty-five centres in the United Kingdom as well as centres in the Netherlands, Germany, Brazil, Singapore and New Zealand. Patients: Five hundred and three patients with histologically proven adenocarcinoma of the stomach, esophogastric junction or lower esophagus were randomized to perioperative chemotherapy plus surgery (n = 250 patients) or surgery alone (n = 253 patients). Interventions: Patients who were assigned to the perioperative chemotherapy and surgery group received 3 doses of chemotherapy (epirubicin, cisplatin and fluorouracil) preoperatively, followed by surgery 3-6 weeks after the third dose, and then 3 doses of postoperative chemotherapy beginning 6-12 weeks after surgery. Patients assigned to surgery alone were scheduled to have surgery within 6 weeks of randomization. The main outcome measure was overall survival. Secondary outcomes were progression-free survival, assessments of downstaging, the surgeon's assessment of whether the surgery was curative and quality of life. Results: Rates of postoperative complications were similar in both groups (46% v. 45%, respectively), as were the numbers of deaths within 30 days of surgery. The resected tumours were significantly smaller and less advanced in the group that received perioperative chemotherapy. With a mean follow-up of 4 years, 144 (60%) of the patients in the perioperative chemotherapy group and 170 (67%) of the patients in the surgery group died. The likelihood of overall survival was higher in the perioperative chemotherapy group (hazard ratio [HR] for death 0.75, 95% confidence interval [CI] 0.60-0.93; p = 0.009; 5-year survival rate 36% v. 23%), as was the likelihood of progression-free survival (HR for progression 0.66; 95% CI 0.53-0.81; p < 0.001). Conclusion: Compared with the group receiving surgery alone, overall survival improved in the group receiving perioperative chemotherapy, as did progressionfree survival among patients with resectable adenocarcinoma of the stomach, esophogastric junction or lower esophagus.