Radiotherapy and Lymph Node Staging Vital in Management of Gastric Cancer
Recent findings from a study Dr. Robert E. Roses and colleagues from the University Of Pennsylvania Perelman School Of Medicine, Philadelphia revealed that a proper management of gastric cancer requires a proper lymph node staging as it is vital. They also reported that even if lymph node staging is not enough, radiotherapy seems to improve the outcome of gastric cancer in patients.
The researchers conducted their study based on the National Data Cancer Database (NCDB) data on 3,008 patients who had gastrectomy done for them due to gastric adenocarcinoma. The analysis of the NCDB on these patients was to draw a comparison between the impact of chemotherapy as a monotherapy on survival in patients and impact of adjuvant chemoradiotherapy (CRT) on survival in patients. Their study revealed that usage of chemotherapy alone increased the mortality by 29% compared to usage of CRT on gastric cancer patients. Among the risks affecting the mortality rate in gastric cancer patients include inadequate lymph node staging, lymph node positivity, and increasing pathologic stage. 669 chemotherapy-alone patients had 28.9 months median overall survival while 1869 CRT patients had 36.1 months of median overall survival. Additionally, chemotherapy-alone patients had 74.9% 1-year overall survival and 31.9% 5-year overall survival while CRT patients had 83.9% 1-year overall survival and 40.2% 5-year overall survival. Patients with node-positive disease receiving the least lymph node staging seem to have greater survival benefit of CRT.
The researchers concluded that the study data has shown supportive evidence that adjuvant CRT should be the standard approach in the United States. They then concluded that to improve survival in node-positive and surgically under staged patients, the usage of radiotherapy in the treatment plan is vital. Dr. Daniele Marrelli, from the University of Siena's Unit of Surgical Oncology, Siena, Italy, voiced out that an extended lymphadenectomy is important in gastric cancer treatment and should not be left out. Dr. Daniele Marrelli added that the survival curves shown by this study revealed that the removal of 30 or more lymph nodes yields the best long-term results.