| |
|
Headlines:
|
 |
Back
to index
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.
|
|
|
|
Are you a doctor or a nurse?
Do you want to join the Doctors Lounge online medical community?
Participate in editorial activities (publish, peer review, edit) and
give a helping hand to the largest online community of patients.
Click on the link below to see the requirements:
Doctors Lounge Membership
Application |
|
| 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. |
| |
|
|
|
|
send
to a friend
printer
friendly version
