Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.

Background: Surgical resection of adenocarcinoma of the stomach is curative in less than 40 percent of cases. We investigated the effect of surgery pl us postoperative (adjuvant) chemoradiotherapy on the survival of patients w ith resectable adenocarcinoma of the stomach or gastroesophageal junction. Methods: A total of 556 patients with resected adenocarcinoma of the stomac h or gastroesophageal junction were randomly assigned to surgery plus posto perative chemoradiotherapy or surgery alone. The adjuvant treatment consist ed of 425 mg of fluorouracil per square meter of body-surface area per day, plus 20 mg of leucovorin per square meter per day, for five days, followed by 4500 cGy of radiation at 180 cGy per day, given five days per week for five weeks, with modified doses of fluorouracil and leucovorin on the first four and the last three days of radiotherapy. One month after the completi on of radiotherapy, two five-day cycles of fluorouracil (425 mg per square meter per day) plus leucovorin (20 mg per square meter per day) were given one month apart. Results: The median overall survival in the surgery-only group was 27 month s, as compared with 36 months in the chemoradiotherapy group; the hazard ra tio for death was 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.0 05). The hazard ratio for relapse was 1.52 (95 percent confidence interval, 1.23 to 1.86; P<0.001). Three patients (1 percent) died from toxic effects of the chemoradiotherapy; grade 3 toxic effects occurred in 41 percent of the patients in the chemoradiotherapy group, and grade 4 toxic effects occu rred in 32 percent. Conclusions: Postoperative chemoradiotherapy should be considered for all p atients at high risk for recurrence of adenocarcinoma of the stomach or gas troesophageal junction who have undergone curative resection.