Gastric cancer: adding preoperative radiation may do more harm than good

  • Tian S & al.
  • Cancer
  • 18 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Adding preoperative radiotherapy to perioperative chemotherapy (POC) was associated with worse survival in patients with resectable stage IB-IIIC gastric or gastroesophageal junction (GEJ) cancer.

Why this matters

  • Findings suggest that POC (neoadjuvant + adjuvant chemotherapy) should remain the standard of care, pending results of the Neo-AEGIS and TOPGEAR randomized studies.

Study design

  • Retrospective propensity score matching (PSM) analysis of 1048 patients with stage IB-IIIC (excluding T2N0) adenocarcinoma of the stomach (30.9%) or GEJ (69.1%) retrieved from the National Cancer Database.
  • Funding: Winship Cancer Institute of Emory University; NCI.

Key results

  • All received POC; 46.8% also received preoperative radiotherapy.
  • Median follow-up, 25.8 months.
  • Adding preoperative radiation to POC yielded a greater rate of pathologic complete response (13.1% vs 8.2%; P=.039).
  • POC alone was tied to better survival in unmatched groups (HR, 0.83; P=.043).
  • In PSM analysis, POC alone was tied to a 30% reduced mortality risk (median OS, 45.1 vs 31.4 months: HR=0.70, P=.016).
    • 2-year OS: 72.9% vs 62.5%. 
    • 5-year OS: 40.7% vs 33.1%.
  • In subgroup analyses, survival benefit favoring POC failed to meet statistical significance in PSM gastric cancer (HR, 0.41; P=.07) and GEJ (HR, 0.77; P=.08).

Limitations

  • Retrospective analysis.