Can Perioperative Chemotherapy for Advanced Gastric Cancer Be Recommended on the Basis of Current Research? A Critical Analysis
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(Bauer Katrin) - Kempten Clinic Department of General, Visceral, Vascular, Thoracic and Pediatric Surgery
(Porzsolt Franz) - Ulm University Clinic Working Group Healthcare Research
(Henne-Bruns Doris) - Ulm University Clinic Department of General and Visceral Surgery
Abstract
Purpose: According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to im-proved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major stud-ies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric cancer can be recommended on the basis of their findings.
Materials and Methods: We analyzed the validity of the three most important studies (MAGIC, ACCORD, and EORTC) using a standard-ized questionnaire. Each study was evaluated for the study design, patient selection, randomization, changes in protocol, participating clinics, preoperative staging, chemotherapy, homogeneity of subjects, surgical quality, analysis of the results, and recruitment period.
Results: All three studies had serious shortcomings with respect to patient selection, homogeneity of subjects, changes in protocol, surgi-cal quality, and analysis of the results. The protocols of the MAGIC and ACCORD-studies were changed during the study period because of insufficient recruitment, such that carcinomas of the lower esophagus and the stomach were examined collectively. In neither the MAGIC study nor the ACCORD study did patients undergo adequate lymphadenectomy, and only about half of the patients in the che-motherapy group could undergo the treatment specified in the protocol. The EORTC study had insufficient statistical power.
Conclusions: We concluded that none of the three studies was sufficiently robust to justify an unrestrained recommendation for periop-erative chemotherapy in cases of advanced gastric cancer.
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Perioperative chemotherapy, Lower esophageal cancer, Stomach neoplasms, Cancer of the esophagogastric junction
KMID :
0914820140140010039
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