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Does chemoradiotherapy after intended curative surgery increase survival of gastric cancer patients?
  1. A Cuschieri
  1. Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK;

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Chemoradiotherapy after intended curative surgery for gastric cancer prolonged survival in patients with an adenocarcinoma of the stomach or gastro-oesophageal junction

The randomised controlled trial reported by MacDonald et al documents an impressive increase in overall survival with postoperative chemoradiotherapy compared with surgical resection of gastric cancer alone (36 months v 27 months). Of equal importance is the finding of a significant reduction in the hazard ratio for relapse (1.52, 95% CI 1.23–1.86; p<0.001). Although not the first randomised controlled trial to document a survival benefit from postoperative adjuvant therapy,1 it is the first to demonstrate a substantial survival advantage due to reduction of locally recurrent disease from postoperative adjuvant orthodox chemoradiation (425 mg fluorouracil/m2 plus 20 mg leucovorin/m2 for five days, followed by 45 000 cGy of radiation over a five week period) and brings hope to a depressing cancer with an unfavourable prognosis unless diagnosed at the T1 stage. Thus this North American randomised controlled trial merits close scrutiny.

The trial has adequate power …

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