Preoperative Chemoradiotherapy for Resectable Gastric Cancer

作者：Trevor Leong, Bernard Mark Smithers, Michael Michael, Karin M. Haustermans, Rebecca K.S. Wong, Val Gebski, Rachel L. O’Connell, John Raymond Zalcberg, Alex Boussioutas, Michael P. N. Findlay, David J. Willis, Alisha Moore, William K. Murray, Florian Lordick, Chris J. O’Callaghan, Carol Jane Swallow, Gail Elizabeth Darling, Danielle Miller, Andrew H. Strickland, Moishe Liberman, Laurent Mineur, John Simes · 发表于：New England Journal of Medicine · 年份：2024 · DOI：10.1056/nejmoa2405195 · 被引用次数：122 · 研究领域：Gastric Cancer Management and Outcomes、Gastrointestinal Tumor Research and Treatment、Esophageal Cancer Research and Treatment

BACKGROUND: In Western countries, the current standard of care for resectable gastric cancer is perioperative chemotherapy. Preoperative chemoradiotherapy has been considered, but data are limited regarding this treatment as compared with perioperative chemotherapy alone. METHODS: We conducted an international, phase 3 trial in which patients with resectable adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to receive preoperative chemoradiotherapy plus perioperative chemotherapy or perioperative chemotherapy alone (control). In both groups, patients received either epirubicin, cisplatin, and fluorouracil or fluorouracil, leucovorin, oxaliplatin, and docetaxel both before and after surgery; the preoperative-chemoradiotherapy group also received chemoradiotherapy (45 Gy in 25 fractions of radiation, plus fluorouracil infusion). The primary end point was overall survival, and secondary end points included progression-free survival, pathological complete response, toxic effects, and quality of life. RESULTS: A total of 574 patients underwent randomization at 70 sites in Australasia, Canada, and Europe: 286 to the preoperative-chemoradiotherapy group and 288 to the perioperative-chemotherapy group. A higher percentage of patients in the preoperative-chemoradiotherapy group than in the perioperative-chemotherapy group had a pathological complete response (17% vs. 8%) and greater tumor downstaging after resection. At a median follow-up of 67 months, ...