Reflections on adjuvant treatment of gastric cancer

Figures & data

Table 1 Definition of “R” and “D”. R refers to the type of resection carried out. D refers to the extent of the lymph node dissection

R0	Curative resection without residual disease
R1	Resection with curative intention but with microscopic residual disease
R2	Palliative resection with macroscopic residual disease
D1	Resection of tumor and adjacent nodes only
D2	Resection including coeliac and perigastric nodes up to >3 cm of the primary T

Table 2 Survival at 5 years by stage and location of tumor

Stage	Overall	Antrum/pylorus	Cardia/fundus
IA	78%	81%	64%
IB	58%	65%	42%
II	34%	38%	24%
IIIA	20%	23%	13%
IIIB	8%	6%	6%
IV	7%	9%	6%

Table 3 Distribution of gastric cancer relapses

Local	Peritoneal	Distant	Ref.
23%	54%	54%	Schwarz et al 2002
42%–48%	21%–52%	25%–46%	Marrelli et al 2002
29%	72%	18%	Macdonald et al 2001
38%–93%	30%–43%	49%	Gunderson et al 2002

Table 4 Adjuvant chemotherapy studies with positive results

Study	Treatment	No. p	Sup %	p	Criticism
GITSG 1982	MeCCNU + 5FU	71		<0.03	Not reproduced in
	Control	71			VASOG y ECOG
Neri et al 2001	Epi + 5FU/LV	69	30	<0.01	?
	Control	68	13
Grau et al 1998	MMC	45	44	0.004	Small number of cases.
	MMC + tegafur	40	67		11 years conscription.
					No control group
Hagiwara et al 1992	IP carbon-absorbed	24	69		Small number of cases.
	cisplatin			<0.005	Australian study
	Control	25	27		negative.
Kim et al 1992	MMC + 5FU + AraC + OK432	74	45	<0.05	Small number of cases.
	Control	64	23		Not reproduced
Cirera et al 1999	MMC + tegafur	76	56	0.04	?
	Control	72	36

Abbreviations: FU, fluorouracil; LT, leucovorin; MMC, mitomycin.

Table 5 Studies of adjuvant radiochemotherapy

Study	Treatment	P	Sup %	p	Criticism
Lim et al 2004	5FU/LV + RT	291	58	-	Not comparative
	D2 Surgery
Park et al 2003	5FU/LV + RT	261	60	-	Not comparative
	D2 Surgery
Macdonald et al 2001	5FU/LV + RT	281	50%*		Low compliance with protocol
	Control		41%*		(64%)
INT-0116	D2 Surgery				17% abandoned due to toxicity
	10%		*3		35% revision of RT plan
	D1 Surgery		years		3 toxic deaths
	36%				Poor quality of surgery

Abbreviations: FU, fluorouracil; LT, leucovorin; RT, radiotherapy.

Table 6 Locoregional relapses according to treatment

Study	P No. rel/(Total no.)	Treatment	Locoregional relapses	Relapse* predictors	p*
Schwarz et al 2002	35/(73)	Surgery R0D2	23%	N3	0.005
			only local 6%	T3/T4	0.008
Cirera et al 1999	37/(76)	Surgery D2 + CT	26%	–	–
	50/(72)	Surgery D2	33%
Lim et al 2004	114/(291)	Surgery	19%	N3	<0.0001
		D2 + CT + RT	only local 7%	T3/T4	<0.0001
Park et al 2003	114/(261)	Surgery	29%	III/IV (M0)	<0.001
		D2 + CT + RT
Macdonald et al 2001	120(281)	10% D2 Surgery	19%
		+ CT + RT		–	**NS
(INT-0116)	177/(275)	10% D2 Surgery	29%**

Abbreviations: CT, chemotherapy; RT, radiotherapy.

SchwarzREZagala-NevarezKRecurrence patterns after radical gastrectomy for gastric cancer: Prognostic factors and implications for postoperative adjuvant therapyAnn Surg Oncol2002939440011986192

 PubMed Web of Science ®Google Scholar

MarrelliDRovielloFde ManzoniGDifferent patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal studyWorld J Surg2002261160512209247

 PubMed Web of Science ®Google Scholar

MacdonaldJSSnalleySRBenedettiJChemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junctionN Engl J Med20013457253011547741

 PubMed Web of Science ®Google Scholar

GundersonLLGastric cancer – patterns of relapse after surgical resectionSemin Radiat Oncol2002121506111979416

 PubMed Web of Science ®Google Scholar

[GITSG] The Gastrointestinal Tumor Study GroupControlled trial of adjuvant chemotherapy following curative resection for gastric cancerCancer1982491116227037156

 PubMed Web of Science ®Google Scholar

NeriBCiniGAndreoliFRandomized trial of adjuvant chemotherapy versus control after curative resection for gastric cancer: 5-year follow-upBr J Cancer2001848788011286464

 PubMed Web of Science ®Google Scholar

GrauJJEstapeJFusterJRandomized trial of adjuvant chemotherapy with mitomycin plus ftorafur versus mitomycin alone in resected locally advanced gastric cancerJ Clin Oncol1998161036399508188

 PubMed Web of Science ®Google Scholar

HagiwaraATakahashiTKojimaOProphylaxis with carbon-absorbed mitomycin against peritoneal recurrence of gastric cancerLancet1992339629631347336

 PubMed Web of Science ®Google Scholar

KimJPKwonJSungTResults of surgery on 6589 gastric cancer patients and inmunochemosurgery as the best treatment of advanced gastric cancerAnn Surg1992216269781417176

 PubMed Web of Science ®Google Scholar

CireraLlBalilABatiste-AlentornERandomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancerJ Clin Oncol19991738101510577853

 PubMed Web of Science ®Google Scholar

LimDHKimDYKangMKPatterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist’s viewBr J Cancer20049111715162146

 PubMed Web of Science ®Google Scholar

ParkSHKimDYHeoJSPostoperative chemoradiotherapy for gastric cancerAnn Oncol2003141373712954575

 PubMed Web of Science ®Google Scholar