Capecitabine with concurrent radiation is as effective as concurrent 5-fluorouracil (5-FU) with radiation or fluoropyrimidine-based chemotherapy alone when used as adjuvant treatment in patients with gastric cancers, according to a study published online Aug. 7 in the World Journal of Gastroenterology.
The outcome of large T3-T4 gastric tumors and those with lymph node involvement remains poor after surgical resection, and optimal adjuvant therapy after surgical resection has not yet been determined, noted Chee Kian Tham, MD, of the department of medical oncology at the National Cancer Center Singapore, and colleagues.
Adjuvant treatment strategies include fluoropyrimidine-based chemotherapy with or without radiation, but due to easier administration, capecitabine has largely replaced continuous-infusion 5-FU. However, no randomized phase III trial directly compared these options.
The authors sought to analyze the outcome of patients who received concurrent capecitabine and radiation compared to the established concurrent 5-FU with radiation and fluoropyrimidine-based chemotherapy alone as adjuvant treatment in gastric cancers.
The researchers reviewed the data for all patients presenting with gastric cancers (108 patients, with an average age of 60) who had received adjuvant treatment at the cancer center between 1996 and 2006. Recurrence-free survival and overall survival of the patients— 64.8 percent of whom had advanced stage III and IV disease with no distant metastasis— who received radiation were compared with those who had 5-FU and radiation or chemotherapy alone as adjuvant therapy for gastric cancers, and average follow-up was 23 months, they explained.
Of the 108 patients, four did not undergo D2 gastrectomy (two in the radiation group and two in the chemotherapy-only group) and 21 patients had positive surgical resection margins. The radiation cohort was comprised of 33 patients; 52 patients underwent 5-FU and radiation and 23 received chemotherapy alone. For the patients in the chemotherapy-only group, all had fluoropyrimidine-based therapy, with added cisplatin in seven patients and epirubicin in two patients.
Tham and colleagues found that the average recurrence-free survival was longer for the radiation group (52 months) compared to the 5-FU and radiation group (35 months) and chemotherapy-only group (25 months). However, patients in the radiation group presented similar average overall survival (53 months) as the 5-FU and radiation (54 months) and the chemotherapy-only groups (44 months).
“Our study showed that capecitabine with concurrent radiation was as effective as 5-FU and radiation and fluoropyrimidine-based chemotherapy when given as adjuvant treatment for locally advanced gastric cancer,” wrote the authors.
The findings of the study provides the basis for a further prospective study in evaluating the role of radiation with concurrent capecitabine alone as adjuvant therapy in resected gastric cancers, concluded Tham and colleagues.