BACKGROUND: Both chemoradiotherapy and chemotherapy are used in postoperative adjuvant therapy for resected gastric cancer. However, it is controversial whether chemoradiotherapy or chemotherapy is the optimal strategy for patients with gastric cancer after D2 lymphadenectomy. The present meta-analysis aims to provide more evidence on the relative benefits of adjuvant therapies in this setting. METHODS: We conducted a systematic review of randomized controlled trials, extracted time-to-event data using Tierney methods (when not reported), and performed meta-analysis to obtain the relative hazards of adjuvant chemoradiotherapy to chemotherapy on efficacy and toxicities. RESULTS: A total of 895 patients from 3 randomized controlled trials were identified for this meta-analysis. All patients were from Asian countries. Our results showed that postoperative chemoradiotherapy significantly improved locoregional recurrence-free survival [LRRFS: hazard ratio (HR) = 0.53, 95% CI = 0.32-0.87, p = 0.01] and disease-free survival (DFS: HR = 0.72, 95% CI = 0.59-0.89, p = 0.002); however, the improvement of distant metastasis recurrence-free survival (DMRFS: HR = 0.86; 95% CI = 0.66-1.11, p = 0.25) and overall survival (OS: HR = 0.79, 95% CI = 0.61-1.03, p = 0.08) were non-significant. The main grade 3 or 4 toxicities were equivalent between the two groups. CONCLUSION: In non-selected Asian patients with resected gastric cancer who underwent D2 lymphadenectomy, postoperative chemoradiotherapy improved LRRFS and DFS but might not improve OS compared to postoperative chemotherapy.
BACKGROUND: Both chemoradiotherapy and chemotherapy are used in postoperative adjuvant therapy for resected gastric cancer. However, it is controversial whether chemoradiotherapy or chemotherapy is the optimal strategy for patients with gastric cancer after D2 lymphadenectomy. The present meta-analysis aims to provide more evidence on the relative benefits of adjuvant therapies in this setting. METHODS: We conducted a systematic review of randomized controlled trials, extracted time-to-event data using Tierney methods (when not reported), and performed meta-analysis to obtain the relative hazards of adjuvant chemoradiotherapy to chemotherapy on efficacy and toxicities. RESULTS: A total of 895 patients from 3 randomized controlled trials were identified for this meta-analysis. All patients were from Asian countries. Our results showed that postoperative chemoradiotherapy significantly improved locoregional recurrence-free survival [LRRFS: hazard ratio (HR) = 0.53, 95% CI = 0.32-0.87, p = 0.01] and disease-free survival (DFS: HR = 0.72, 95% CI = 0.59-0.89, p = 0.002); however, the improvement of distant metastasis recurrence-free survival (DMRFS: HR = 0.86; 95% CI = 0.66-1.11, p = 0.25) and overall survival (OS: HR = 0.79, 95% CI = 0.61-1.03, p = 0.08) were non-significant. The main grade 3 or 4 toxicities were equivalent between the two groups. CONCLUSION: In non-selected Asian patients with resected gastric cancer who underwent D2 lymphadenectomy, postoperative chemoradiotherapy improved LRRFS and DFS but might not improve OS compared to postoperative chemotherapy.
Authors: H H Hartgrink; C J H van de Velde; H Putter; J J Bonenkamp; E Klein Kranenbarg; I Songun; K Welvaart; J H J M van Krieken; S Meijer; J T M Plukker; P J van Elk; H Obertop; D J Gouma; J J B van Lanschot; C W Taat; P W de Graaf; M F von Meyenfeldt; H Tilanus; M Sasako Journal: J Clin Oncol Date: 2004-04-13 Impact factor: 44.544
Authors: Wilson L Costa; Felipe J F Coimbra; Ricardo C Fogaroli; Héber S C Ribeiro; Alessandro L Diniz; Maria Dirlei F L Begnami; Celso A L Mello; Marcelo F Fanelli; Milton J B Silva; José Humberto Fregnani; André L Montagnini Journal: Radiat Oncol Date: 2012-10-15 Impact factor: 3.481
Authors: Xuguang Chen; Jennifer R Eads; John B Ammori; Aryavarta M Kumar; Tithi Biswas; Jennifer A Dorth Journal: Curr Oncol Rep Date: 2015-04 Impact factor: 5.945