Gastric cancer has a poor survival rate. The Journal of the American Medical Association published a report from the Global Advanced/Adjuvant Stomach Tumor Research International Collaboration (GASTRIC) Group showing that chemotherapy can benefit patients. In the early stages of disease, surgery has the potential to remove the cancer completely. Unfortunately, 50 to 90 percent of these patients die of disease relapse.
The researchers identified 17 trials covering 3,838 patients who had surgical treatment for gastric cancer. Approximately half had surgery only, while the other half had surgery plus chemotherapy. Chemotherapy agents included mitomycin C, uracil plus tegafur, fluorouracil or ftorafur, cytosine arabinoside, doxorubicin, epirubicin, semustine, cisplatin, leucovorin, and methotrexate with leucovorin. There was no clear advantage to any particular agent. However, the median overall survival time increased from 4.9 years in the surgery only group to 7.8 years in the surgery plus chemotherapy group.
Radiation is often added to chemotherapy after surgery. Reference two reports that intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3D CRT) are both well tolerated, and provide comparable benefits. The IMRT method was better at protecting the liver and kidneys from radiation. Two-year survival rates were 51 percent for 3D CRT, and 65 percent for IMRT.
Surgical options include partial or complete removal of the stomach. According to Reference four, Japanese surgeons typically perform an extensive removal of lymph nodes. Japan has one of the world's highest rates of gastric cancer, and patients there have the best rates of long-term survival. The favorable outcomes are attributed to both earlier diagnosis and greater clinical experience. Western studies of their technique have not yet produced improved results.
Patients need nutritional therapy after surgery, and may need to eat at least 5 or 6 small meals per day. Complete removal of the stomach requires more lifestyle changes than partial removal.
Research continues into new treatment options. I found 811 clinical trials for gastric cancer currently listed at http://clinicaltrials.gov/.
References:
1. The GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, “Benefits of adjuvant chemotherapy for resectable gastric cancer: A meta-analysis”, JAMA. 2010; 303(17): 1729-37.
2. Minn AY et al, “Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer”, Cancer. 2010 Aug 15; 116(16): 3943-52.
3. Orditura M et al, “Chemoradiotherapy as adjuvant treatment of gastric cancer”, Annals of Oncology 2007; 18(Supplement 6): vi133-35.
4. Mackay S et al, “Management of gastric cancer”, Australian Family Physician 2006; 35(4): 208-12.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.