The following is a summary of “Preoperative Chemoradiotherapy for Resectable Gastric Cancer,” published in the September 2024 issue of Gastroenterology by Leong et al. 

In Western countries, the usual treatment for resectable gastric cancer is perioperative chemotherapy. 

Researchers conducted a retrospective study investigating preoperative chemoradiotherapy as an option to treat resectable gastric cancer. 

They randomly assigned patients with resectable adenocarcinoma of the stomach or gastroesophageal junction to preoperative chemoradiotherapy plus perioperative chemotherapy or just perioperative chemotherapy. The primary endpoint was overall survival (OS), and the study looked at progression-free survival (PFS), pathological complete response, toxic effects, and quality of life. 

The results showed that among 574 patients, 286 were in the preoperative-chemoradiotherapy group, and 288 were in the perioperative-chemotherapy group. The preoperative-chemoradiotherapy group had a higher pathological complete response rate (17% vs. 8%) and better tumor downstaging post-resection. After a median follow-up of 67 months, OS was 46 months for preoperative chemoradiotherapy and 49 months for perioperative chemotherapy (HR for death, 1.05; 95% CI: 0.83 – 1.31), with no significant differences in PFS (31 vs. 32 months). Treatment-related toxic effects were similar between the groups. 

Investigators concluded that adding preoperative chemoradiotherapy to perioperative chemotherapy did not boost overall survival compared to using perioperative chemotherapy alone for patients with resectable gastric and gastroesophageal junction adenocarcinoma.

Source: nejm.org/doi/full/10.1056/NEJMoa2405195