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5-Fluorouracil, Leucovorin, External Radiotherapy as Adjuvant Therapy

Abstract: 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 plus postoperative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction. METHODS: A total of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy or surgery alone. The adjuvant treatment consisted 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 completion 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 months, as compared with 36 months in the chemoradiotherapy group; the hazard ratio for death was 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.005). 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 occurred in 32 percent. CONCLUSIONS: Postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.

References

Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med; 345(10):725-30 2001  UI: 11547741.

Regimen

5 - FU....... 425 mg / M2 IV bolus days 1 - 5
Leucovorin....... 20 mg / M2 IV bolus days 1 - 5

above is given for 1 cycle postoperatively, followed by

5 - FU....... 425 mg / M2 IV bolus days 1 - 4,38 - 40
Leucovorin....... 20 mg / M2 IV bolus days 1 - 4,38 - 40

above is given concurrently with XRT to 4500 cGy in 180 cGy fractions
chemotherapy is given on first 4 and last 3 days of radiotherapy

5 - FU....... 425 mg / M2 IV bolus days 1 - 5
Leucovorin....... 20 mg / M2 IV bolus days 1 - 5

above portion of regimen is repeated every 28 days for 2 cycles post - concurrent therapy


     
  Summary Adjuvant chemoradiotherapy in advanced gastric cancer
  Hazard ratio for death 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.005).
  Bazard ratio for relapse 1.52 (95 percent confidence interval, 1.23 to 1.86; P<0.001).
  Median Overall Survival 36 months vs. 27 months in favor of the chemoradiotherapy group
  Toxicity 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 occurred in 32 percent.
     
Article reviewed by:

Dr. Tamer Fouad, M.D.

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