Results from a real-world study show the addition of chemotherapy and radiation to surgery is associated with an improvement in overall survival (OS) for patients with non-metastatic gastric adenocarcinoma (BMJ Open Gastroenterol. 2020;7[1]:e000483. doi:10.1136/bmjgast-2020-000483).
Afsaneh Barzi, MD, PhD, Department of Medical Oncology and Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, and colleagues conducted a comparative study evaluating the efficacy of various treatment strategies in patients with curative surgery gastric adenocarcinoma.
A total of 35,882 patients diagnosed with gastric adenocarcinoma in the National Cancer Database from 2004 to 2013 were identified and grouped according to their treatment: surgery alone (n = 15,184), chemoradiation in the neoadjuvant (n = 6000) or adjuvant setting (n = 7953), and perioperative chemotherapy (n = 3745) or adjuvant chemotherapy (n = 3000).
The primary end point was OS using Cox proportional hazard model and Kaplan-Meier curves.
“Compared with surgery alone, all adjunctive therapies resulted in an improvement in overall survival (OS)”, Dr Barzi and the team reported.
Neoadjuvant chemoradiation had an HR of 0.9 (95% CI: 0.67 to 0.75), preoperative chemotherapy had an HR of 0.73 (95% CI: 0.68 to 0.79), adjuvant chemoradiation had an HR of 0.71 (95% CI: 0.67 to 0.75), and adjuvant chemotherapy had an HR of 0.86 (95% CI: 0.8 to 0.93).
For distal gastric adenocarcinoma, adjuvant chemoradiation improved OS (HR 0.89; 95% CI: 0.796 to 0.996; P = .042). For patients with proximal gastric adenocarcinoma, neoadjuvant chemoradiation was inferior to perioperative chemotherapy (HR: 1.101; 95% CI: 1.006 to 1.204; P = .036)
“In this real-world population, addition of chemotherapy and radiation to surgery was associated with better OS. Radiation therapy may have a role in patients with distal [gastric adenocarcinoma],” concluded Dr Barzi and colleagues.
“Future research can elucidate patient, tumour, and treatment factors that necessitate the inclusion and sequence of radiation therapy in this population,” they added.—Marta Rybczynski
