Global trial ends 20-year debate over gastro-esophageal cancer treatment

Medical Xpress / Peter MacCallum Cancer Centre / New England Journal of Medicine ^ | Sept. 16, 2024 | Trevor Leong et al

[ConservativeMind]

Cancer patients could avoid unnecessary radiation therapy as a result of an international clinical trial, led by Prof Trevor Leong. The TOPGEAR study demonstrated that radiotherapy does not improve survival outcomes for patients with operable gastric and gastro-esophageal junction cancer when compared to chemotherapy alone.

More than 2,500 Australians are diagnosed with stomach cancer each year and the study investigated whether adding radiotherapy to the treatment approach of surgery plus chemotherapy would improve outcomes for patients.

All trial participants had chemotherapy before and after surgery—the "standard of care" in most countries—while some were randomized to also have radiotherapy before surgery.

Prof Leong says there has been a 20-year debate over the role of radiotherapy in treating these cancers, after earlier studies suggested a benefit of radiotherapy after surgery.

"Our results now demonstrate that even when delivered optimally as preoperative therapy, radiotherapy does not improve survival outcomes compared to chemotherapy alone," says Professor Leong.

"The TOPGEAR trial results have the potential to be practice changing as some centers around the world, particularly in the U.S., currently employ preoperative radiotherapy as standard treatment for gastric cancer.

TOPGEAR started at Peter Mac in 2009 and opened to patients internationally from 2014 with 70 sites across 15 countries taking part.

Preoperative radiotherapy was seen to improve the rate of pathological complete response—meaning the cancer became undetectable—in trial participants, at 17% compared to 8% for the chemotherapy plus surgery approach.

However, at follow-up some five years later (median 67 months), there was no significant difference between these groups in progression-free and overall survival.

"While the increase in pathological complete response is interesting and may warrant further investigation, in the longer term radiotherapy did not meaningfully improve cancer control or extend lives," Professor Leong says.

[ConservativeMind]

It appears the radiation for stomach cancer doesn’t lead to a better long-term outcome over just chemo.

I’d take the chemo.

[ConservativeMind]

The “Take Charge Of Your Health” Ping List
This high volume ping list is for health articles and studies which describe something you or your doctor, when informed, may be able to immediately implement for your benefit.

Email me to get on either the “Common/Top Issues” (20 - 25% fewer pings) or “Everything” list.

[Chode]

i did chemo and radiation at the same time, i’d be hard pressed to say which one was more evil...

[grobdriver]

Bookmark.

[trebb]

Same here - but mine was in lower 3 inches of esophagus from long-term acid reflux - and I didn’t want the surgery where they remove the whole esophagus and then use most of your stomach to “form a new one”.

So far, so good - clean PET Scans for last 9 months - with a gastro guy going in and taking biopsies and doing ablations to help remove any possible recurrence areas.

[Wuli]

I have a brother (esophogeal cancer) who recently had both chemo and radiation and they have yet to decide if surgery will also be used.

[Chode]

stay well

[trebb]

Thanks