Gastric Cancer Treatment (PDQ®)
Cancer Information Summaries « English « Health professionals « G
Stage III Gastric Cancer
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Standard treatment options:
- Radical surgery. Curative resection procedures are confined to patients who at the time of surgical exploration do not have extensive nodal involvement.
- Postoperative chemoradiation therapy. [1]
- Perioperative chemotherapy. [2]
All patients with tumors that can be resected should undergo surgery. As many as 15% of selected stage III patients can be cured by surgery alone, particularly if lymph node involvement is minimal (<7 lymph nodes).
Postoperative chemoradiation therapy may be considered for patients with stage III gastric cancer. A prospective multi-institution phase III trial ( INT-0116) evaluating postoperative combined chemoradiation therapy versus surgery alone in 556 patients with completely resected stage IB to stage IV (M0) adenocarcinoma of the stomach and gastroesophageal junction reported a significant survival benefit with adjuvant combined modality therapy. [1] [ Level of evidence: 1iiA] With a median follow-up of 5 years, median survival was 36 months for the adjuvant chemoradiation therapy group as compared to 27 months for the surgery-alone arm ( P=.005). Three-year overall survival (OS) and relapse-free survival rates were 50% and 48%, respectively, with adjuvant chemoradiation therapy versus 41% and 31%, respectively, for surgery alone ( P=.005). Because distant disease remains a significant concern, the aim of the current Cancer and Leukemia Group B study ( CALGB-80101) is to augment the postoperative chemoradiation regimen used in the INT-0116trial, for example, and the preoperative chemotherapy and chemoradiation therapy regimen used in the RTOG-9904trial, as another example.
Investigators in Europe evaluated the role of preoperative and postoperative chemotherapy without radiation therapy. [2] In the randomized phase III trial ( MRC-ST02), patients with stage II or higher adenocarcinoma of the stomach or of the lower third of the esophagus were assigned to receive three cycles of epirubicin, cisplatin, and continuous infusion 5-fluorouracil (ECF) before and after surgery or to receive surgery alone. Compared with the surgery group, the perioperative chemotherapy group had a significantly higher likelihood of progression-free survival (hazard ratio [HR] for progression, 0.66; 95% confidence interval [CI], 0.53 – 0.81; P<.001) and of OS (HR for death, 0.75; 95% CI, 0.60 – 0.93; P=.009). Five-year OS was 36.3%; 95% CI, 29 to 43 for the perioperative chemotherapy group and 23%; 95% CI, 16.6 to 29.4 for the surgery group. [2] [ Level of evidence: 1iiA]
Treatment options under clinical evaluation:
- Postoperative chemoradiation with ECF such as in the CALGB-80101trial. [3].
- Neoadjuvant chemoradiation therapy such as in the SWOG-S0425and RTOG-9904trials. [4]
All newly diagnosed patients with stage III gastric cancer should be considered candidates for clinical trials.
Current Clinical Trials
Check for U.S. clinical trials from NCI’s PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III gastric cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
Fuchs C, Tepper JE, Niedwiecki D, et al.: Postoperative adjuvant chemoradiation for gastric or gastroesophageal adenocarcinoma using epirubicin, cisplatin, and infusional (CI) 5-FU (ECF) before and after CI 5-FU and radiotherapy (RT): interim toxicity results from Intergroup trial CALGB 80101. [Abstract] American Society of Clinical Oncology 2006 Gastrointestinal Cancers Symposium, 26-28 January 2006, San Francisco, California. A-61, 2006.
This record was last updated on May 16th, 2008.
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PDQ (Physician Data Query) is a comprehensive cancer database published by the National Cancer Institute (NCI), which is part of the National Institutes of Health (NIH). It contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care, and complementary and alternative medicine; a registry of cancer clinical trials; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care.
The PDQ Cancer Information Summaries are peer reviewed and updated monthly by six editorial boards comprised of specialists in adult treatment, pediatric treatment, supportive care, screening and prevention, genetics, and complementary and alternative medicine. The Boards review current literature from more than 70 biomedical journals, evaluate its relevance, and synthesize it into clear summaries. Many of the summaries are also available in Spanish.
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