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

John S. Macdonald, Stephen R. Smalley, Jacqueline Benedetti, Scott A Hundahl, Norman C. Estes, Grant N. Stemmermann, Daniel G. Haller, Jaffer A. Ajani, Leonard L. Gunderson, J. Milburn Jessup, James A. Martenson

Research output: Contribution to journalArticle

2626 Citations (Scopus)

Abstract

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 radio-therapy, 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.

Original languageEnglish (US)
Pages (from-to)725-730
Number of pages6
JournalNew England Journal of Medicine
Volume345
Issue number10
DOIs
StatePublished - Sep 6 2001
Externally publishedYes

Fingerprint

Esophagogastric Junction
Chemoradiotherapy
Stomach
Adenocarcinoma
Leucovorin
Poisons
Fluorouracil
Adjuvant Chemoradiotherapy
Confidence Intervals
Recurrence
Survival
Body Surface Area
Radio
Radiotherapy
Radiation
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. / Macdonald, John S.; Smalley, Stephen R.; Benedetti, Jacqueline; Hundahl, Scott A; Estes, Norman C.; Stemmermann, Grant N.; Haller, Daniel G.; Ajani, Jaffer A.; Gunderson, Leonard L.; Milburn Jessup, J.; Martenson, James A.

In: New England Journal of Medicine, Vol. 345, No. 10, 06.09.2001, p. 725-730.

Research output: Contribution to journalArticle

Macdonald, JS, Smalley, SR, Benedetti, J, Hundahl, SA, Estes, NC, Stemmermann, GN, Haller, DG, Ajani, JA, Gunderson, LL, Milburn Jessup, J & Martenson, JA 2001, 'Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction', New England Journal of Medicine, vol. 345, no. 10, pp. 725-730. https://doi.org/10.1056/NEJMoa010187
Macdonald, John S. ; Smalley, Stephen R. ; Benedetti, Jacqueline ; Hundahl, Scott A ; Estes, Norman C. ; Stemmermann, Grant N. ; Haller, Daniel G. ; Ajani, Jaffer A. ; Gunderson, Leonard L. ; Milburn Jessup, J. ; Martenson, James A. / Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. In: New England Journal of Medicine. 2001 ; Vol. 345, No. 10. pp. 725-730.
@article{1fb6ef7b2d334802a34eaf5700b282b3,
title = "Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction",
abstract = "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 radio-therapy, 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.",
author = "Macdonald, {John S.} and Smalley, {Stephen R.} and Jacqueline Benedetti and Hundahl, {Scott A} and Estes, {Norman C.} and Stemmermann, {Grant N.} and Haller, {Daniel G.} and Ajani, {Jaffer A.} and Gunderson, {Leonard L.} and {Milburn Jessup}, J. and Martenson, {James A.}",
year = "2001",
month = "9",
day = "6",
doi = "10.1056/NEJMoa010187",
language = "English (US)",
volume = "345",
pages = "725--730",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "10",

}

TY - JOUR

T1 - Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction

AU - Macdonald, John S.

AU - Smalley, Stephen R.

AU - Benedetti, Jacqueline

AU - Hundahl, Scott A

AU - Estes, Norman C.

AU - Stemmermann, Grant N.

AU - Haller, Daniel G.

AU - Ajani, Jaffer A.

AU - Gunderson, Leonard L.

AU - Milburn Jessup, J.

AU - Martenson, James A.

PY - 2001/9/6

Y1 - 2001/9/6

N2 - 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 radio-therapy, 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.

AB - 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 radio-therapy, 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.

UR - http://www.scopus.com/inward/record.url?scp=0035818048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035818048&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa010187

DO - 10.1056/NEJMoa010187

M3 - Article

C2 - 11547741

AN - SCOPUS:0035818048

VL - 345

SP - 725

EP - 730

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 10

ER -