Surgery plus chemoradiation linked to improved survival rates for gastric cancer patients

Patients who receive chemotherapy and radiation after surgery for gastric cancer appear to have better survival rates than those who had surgery followed by only chemotherapy, according to results of a look-back study of more than 500 people by Johns Hopkins scientists.

The combination of post-operative chemotherapy and radiation, or chemoradiation, resulted in survival for an average of 46.7 months after treatment, compared to 20.9 months among those who received chemotherapy only after surgery. Five years after treatment, 46.9 percent of chemoradiation-plus-surgery patients were still living, while 24.9 percent of chemotherapy-plus-surgery patients survived.

Chemoradiation also improved patients’ recurrence-free survival, to an average of 35.6 months, compared with 16.6 months among those who received chemotherapy alone.

The addition of radiation especially improved survival rates among gastric cancer patients whose cancers had spread to lymph nodes in the immediate region of the stomach, says Timothy Pawlik, M.D., M.P.H., Ph.D., professor of surgery at the Johns Hopkins University School of Medicine and member of the Johns Hopkins Kimmel Cancer Center.

Pawlik says the role of radiation therapy in treating gastric cancer has been understudied, “but these data would suggest that radiation therapy would benefit patients, in particular those patients who had disease that has spread to lymph nodes.”

Although rates of gastric cancer have dropped in recent years in the United States, it is still the fourth most common cancer and the second-leading cause of cancer deaths worldwide.

The study results, described in the Annals of Surgical Oncology, is a so-called retrospective one, looking at the records of 505 gastric cancer patients treated between 2000 and 2012. Retrospective studies come with a certain amount of limitation and bias, Pawlik says, because researchers can only analyze how therapy was carried out and can’t control which patients received which treatments.

Pawlik and his colleagues attempted to remove some of that bias in their study with a statistical fix. Using information on the patients’ ages, tumor sizes and other factors collected from the multi-institutional U.S. Gastric Cancer Collaborative database, the researchers were able to build a score that measured how likely it would be for a patient to receive chemoradiation along with surgery. Within groups of patients with similar scores, they were able to compare the outcomes between those who did get chemoradiation and those who had chemotherapy only.

This “fancy matching” helps get rid of some but not all of the bias in a retrospective study, says Pawlik. “It is possible that patients who got radiation therapy were younger, healthier, and could more easily tolerate radiation therapy, which factored into longer survival.”

Chemoradiation therapy also has improved over the past decade, making it an important tool to consider when treating gastric cancer, says Joseph Herman, M.D., director of clinical research in the Department of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins. “Some patients will benefit more from chemoradiation, and these large studies can give us more insight into who these patients might be.”

Other researchers involved in the study include Aslam Ejaz, Gaya Spolverato and Yuhree Kim of the Johns Hopkins University School of Medicine; Malcolm H. Squires and Shishir K. Maithel of Emory University; George Poultsides and David J. Worhunskyof Stanford University; Ryan Fields and Linda X. Jin of Washington University in St. Louis; Mark Bloomston, Carl Schmidt and Neil Saunders of The Ohio State University; Sharon M. Weber, Alexandra W. Acher and Clifford S. Cho of the University of Wisconsin; and Konstantinos Votanopoulos and Douglas Swords of Wake Forest University.

Ejaz was supported in part by the Eleanor B. Pillsbury Foundation for Surgical Research

 

 

Interstitial lung disease is a significant risk factor for lung inflammation following stereotactic body radiation therapy for lung cancer

Pretreatment interstitial lung disease (ILD) is a significant risk factor for developing symptomatic and severe radiation pneumonitis in stage I non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT) alone.

ILD is a group of diseases that cause scarring and stiffing of the tissue and space around the air sacs in the lungs, which results in diminished gas exchange. The incidence of ILD among lung cancer patients is higher than in the general population as tobacco smoking is a common risk factor for both. Some lung cancer patients with ILD may not be considered good candidates for surgical therapy. SBRT uses sophisticated techniques to deliver a targeted and focused radiation dose to a tumor in order to stop the growth locally with limited damage to surrounding healthy tissue. SBRT is considered an acceptable therapy choice for early-stage NSCLC patients who are not good candidates for or decline surgery.

In order to determine the optimal treatment for early-stage lung cancer patients with ILD, researchers at Kyoto University in Japan examined the incidence of radiation pneumonitis and the clinical outcomes in 157 patients who underwent SBRT alone for stage I NSCLC.

Results published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), show that of the 157 patients who received SBRT for lung cancer therapy, 20 were identified as having pretreatment ILD. The presence of ILD was a significant risk factor for both symptomatic and severe radiation pneumonitis and the cumulative incidence of radiation pneumonitis increased significantly with worse ILD. Overall survival trended to be shorter in the ILD positive population but this was not statistically significant and may be accountable to the ILD itself. There were no differences in disease progression or local progression rates in patients with ILD versus those patients without.

“Our results suggest that the impact of ILD on radiation pneumonitis depends on the preexisting severity of the ILD findings and clinicians should be cautious when considering SBRT for those with significant ILD findings”, say the authors. “However, other than radiation pneumonitis, life-threatening complications after SBRT are rare. Thus, if the severity of ILD and the risk of radiation pneumonitis are carefully evaluated, SBRT is a curative-intent treatment option for those with early-stage NSCLC and pretreatment ILD.”

http://www.medicalnewstoday.com/releases/285268.php

 

Picture courtesy of www.nature.com