ASCO GI: Adjuvant Chemoradiation Underutilized Following Gastric Resection

January 19, 2007

ORLANDO -- About half the patients with resectable stomach cancer who would benefit from adjuvant chemoradiation do not get it, researchers reported here today.

ORLANDO, Jan. 19 -- About half of the patients with resectable stomach cancer who would benefit from adjuvant chemoradiation do not get it, researchers reported here today.

This is so despite the fact that the utilization of chemoradiation following stomach cancer surgery has more than doubled in the six years since results of the Intergroup 0116 demonstrated a survival benefit for 5FU (5 fluorouracil) plus Wellcovorin (leucovorin) followed by radiation, said Ulrich Guller, M.D., of the University of Toronto.

Prior to the presentation of the Intergroup 0116 findings in 2000 at the annual meeting of the American Society of Clinical Oncology, about 15% of patients underwent postoperative chemoradiation Dr. Guller said at a gastrointestinal cancer symposium Immediately after the 2000 report, the percentage of stomach cancer patients getting chemoradiation therapy jumped to 30%.

When the Intergroup 0116 study was subsequently published in the New England Journal of Medicine, the number getting chemoradiation again increased, this time to about 37%. But by 2003, the percentage had fallen back to about 30.4%.

The chemoradiation rate was determined by an analysis of data on 9,528 patients identified through review of the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database.

The patients were divided into two groups for comparison-those who had surgery from 1996 through April 2000 (before the results of Intergroup 0116 were reported) and those who underwent surgery from May 2000 through December 2003, after the results were reported.

William Blackstock, M.D., of North Carolina Baptist Hospital in Winston-Salem said it is difficult to cite an optimum chemoradiation rate, "but I think it should be more than 30% and I would like to think that it should be around half to two-thirds of patients who undergo resection." Dr. Blackstock, who was not involved in the study, moderated a press conference where the data were presented.

Robert Mayer, M.D., of Harvard and the Dana-Farber Cancer Institute in Boston, commented that the standard of care is the Intergroup 0116 regimen, or the MAGIC chemotherapy regimen (pre-and postoperative Ellence (epirubicin), Platinol (cisplatin), and 5-FU fluorouracil), or enrollment in a clinical trial, because "everyone needs to be on something."

Dr. Blackstock took a narrower view, arguing that not everyone was a candidate for chemoradiation. "Many people are just too sick or frail to tolerate adjuvant therapy after surgery," he said.

In his presentation, Dr. Guller said 46% of patients younger than age 60 received chemoradiation versus 13% of those 75 or older (P