Is it the end of chemoradiotherapy for resectable GC?

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Takeaway

  • Preoperative chemotherapy, surgery, and postoperative chemoradiotherapy does not improve OS compared with perioperative chemotherapy and surgery in patients with resectable gastric cancer (GC).

Why this matters

  • Preoperative chemotherapy, surgery, and postoperative chemoradiotherapy is the standard treatment for resectable GC in the United States, based on findings from a 2001 study, while perioperative chemotherapy and surgery is the preferred treatment in Europe, based on results of a 2006 study.
  • The authors of an accompanying commentary suggest that these new findings point to a limited role for chemoradiotherapy in resectable GC.

Study design

  • Open-label, randomized, phase 3, multicenter, international CRITICS trial.
  • 788 patients with resectable GC received perioperative chemotherapy (chemotherapy group; n=393) or preoperative chemotherapy with postoperative chemoradiotherapy (chemoradiotherapy group; n=395).
  • Funding: Dutch Cancer Society and others.

Key results

  • 95% of chemotherapy group and 93% of chemoradiotherapy group underwent surgery.
  • 233 patients initiated postoperative chemotherapy and 245 patients initiated postoperative chemoradiotherapy, respectively.
  • 43 months median OS in chemotherapy group vs 37 months in chemoradiotherapy group (HR, 1.01; 95% CI, 0.84-1.22).
  • Overall, 98% of patients reported adverse events (AEs) during preoperative therapy.
  • Postoperative AEs similar between groups.

Limitations

  • Some patients had no postoperative treatment.