Abstract
BackgroundAlthough several studies have been carried out to determine the best treatment for gastric carcinoma, the data on survival rate still remain inconclusive.ObjectiveTo evaluate the effects of postoperative radio-chemotherapy on overall and disease-free survival.Data SourcesMEDLINE and CANCERLIT searches of reference lists (for the period 1970 to 2016) were supplemented with hand search of reference lists.Study selectionThe present work includes randomized controlled trials comparing postoperative radio-chemotherapy to postoperative chemotherapy or to surgery alone in patients with resected gastric carcinoma without evidence of metastatic disease. Ten randomized controlled trials were analyzed in total: four compared postoperative radiochemotherapy to surgery alone (708 patients), and six compared postoperative radiochemotherapy to postoperative chemotherapy (1020 patients).Data extractionAccording to “intention to treat” method, three independent observers have extracted from each trial, the data on patients, intervention, and outcomes. These data were subsequently combined using DerSimonian and Laird methods.ResultsPostoperative radiochemotherapy significantly increases 3-year and 5-year overall survival and 3-year and 5-year disease free survival rate compared to postoperative chemotherapy (RR 0.89; 95%CI 0.81-0.97 and RR 0.82; 95%CI 0.71–0.95) or surgery alone (RR 0.83; 95% CI 0.77-0.91 and RR 0.80; 95% CI 0.65–0.98).ConclusionsIn patients with resected gastric cancer, postoperative radiochemotherapy obtains: 1) an increase in overall survival, 2) an increase in disease free survival, and 3) a gain in 5 year disease free survival independent of surgical procedure.
Highlights
Gastric carcinoma continues to represent an enigmatic and heterogeneous disease [1] for its management
Postoperative radiochemotherapy significantly increases 3-year and 5-year overall survival and 3-year and 5-year disease free survival rate compared to postoperative chemotherapy (RR 0.89; 95%confidence interval (CI) 0.81-0.97 and relative risk (RR) 0.82; 95%CI 0.71– 0.95) or surgery alone (RR 0.83; 95% CI 0.77-0.91 and RR 0.80; 95% CI 0.65–0.98)
The main clinical question of this study is to investigate whether postoperative radiochemotherapy is more efficacious than postoperative chemotherapy or only surgery for increasing the outcome in resected gastric cancer patients
Summary
Gastric carcinoma continues to represent an enigmatic and heterogeneous disease [1] for its management. In 2007, a pooled analysis [3] of randomized clinical trials, including the Gastric Surgical Adjuvant Trial (INT0116) [4], showed that radiotherapy (RT) significantly increases 3-year and 5-year overall survival:even though the improvement is relatively limited it still is clinically important. Performed along with adjuvant studies, the MAGIC trial demonstrate the advantage of preoperative chemotherapy, becoming the standard of treatment. [5] improvements in surgical technique showed an important role of lymphadenectomy to tumor stage accurately and to increase long-term survival. Several studies have evaluated the impact of “super-extended” lymphadenectomy (D3 resection) on recurrences, suggesting that it does not decrease locoregional recurrences [7]. Several studies have been carried out to determine the best treatment for gastric carcinoma, the data on survival rate still remain inconclusive
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