Adjuvant therapy after curative resection with D2 lymphadenectomy for gastric cancer: results of a prospective clinical trial

Rytis Markelis, Žilvinas Endzinas, Mindaugas Kiudelis, Saulius Grižas, Juozas Pundzius, Žilvinas Saladžinskas, Elona Juozaitytė¹, Arturas Inčiūra¹, Darius Pranys², Almantas Maleckas

Department of Surgery, ¹Department of Oncology, ²Department of Pathological Anatomy, Kaunas University of Medicine, Lithuania

Key words: stomach cancer; curative resection; D2 lymphadenectomy; concomitant chemoradiation; chemotherapy.

Summary. Objective. Adjuvant chemoradiation for gastric cancer is used more frequently, but there is no general opinion about the effect of this treatment. The aim of this study was to compare adjuvant chemoradiation with adjuvant chemotherapy after radical operation for stomach cancer.

Material and methods. A total of 133 patients were included in this prospective study. Sixty-three patients after curative gastrectomy and D2 lymphadenectomy for gastric cancer were assigned to the chemoradiotherapy group and 70 to the chemotherapy group.

The groups were identical by age, sex, and cancer stages. Toxicity was evaluated by the WHO scale, and survival was evaluated by the Kaplan-Meier method.

Results. Grade III and IV toxicity was found more frequently in the chemoradiation group than in the chemotherapy group (44.4% and 7.1%, respectively; P<0.0001). Treatment was not finished in 27% of patients in the chemoradiation group and 11.4% in the chemotherapy group (P=0.03). Overall survival was better in the chemotherapy group as compared with the chemoradiation group (P=0.039). Median survival for patients with stage III and IV cancer was 41 months in the chemotherapy group and 18 months in the chemoradiation group (P=0.085). Survival of patients with stage IIIA cancer in the chemotherapy group was significantly better (P=0.005).

Conclusions. Median survival is shorter in the adjuvant chemoradiation group after curative gastrectomy for gastric cancer as compared with the adjuvant chemotherapy group. Adjuvant chemoradiation is more toxic and should be recommended only for patients with advanced-stage cancer.

Correspondence to R. Markelis, Department of Surgery, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: rytism@medi.lt

Received 5 May 2009, accepted 5 June 2009