Surgery plus radiation boosts survival in metastatic gastric cancer

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Although persons with metastatic gastric cancer have poor survival, a recent study published by the journal Cancer indicated that those who have both surgery and radiation live longer than do those who undergo just one or neither of those treatments.

Ravi Shridhar, MD, PhD, of the radiation oncology department at H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida, and colleagues identified 5,072 patients with stage IV gastric cancer from the Surveillance, Epidemiology, and End Results (SEER) database. Analyzing data from 2004 to 2008, the investigators found surgery and/or radiation to be associated with increased survival, with the greatest benefits seen in persons undergoing both treatments.

Median survival and 2-year survival were as follows:

  • 16 months and 31.7%, respectively, among patients who underwent both surgery and radiation therapy
  • 10 months and 18.2%, respectively, among patients who underwent surgery only
  • 8 months and 8.9%, respectively, among patients who underwent radiation only
  • 7 months and 8.2%, respectively, among patients who underwent neither surgery nor radiation.

“This was the first SEER database study to suggest a survival benefit for patients undergoing both surgery and radiation in the management of metastatic gastric cancer,” noted Shridhar in a statement from Moffitt. “Even in the metastatic setting, patients undergoing surgery had better survival if they received radiation therapy and had more than 15 lymph nodes removed.”

Nevertheless, noted the authors, these findings should not be used to make general recommendations about surgery and radiation for patients with metastatic gastric cancer. Rather, the information should be used to form the basis for conducting clinical trials to assess the roles of surgery and radiation in patients who have responded to systemic chemotherapy, the current standard of care for metastatic gastric cancer.

“If the patient has not responded to chemotherapy, surgery and radiation will likely hold no benefit,” explained Shridhar in the Moffitt statement.

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