Use of Adjuvant 5-Fluorouracil and Radiation Therapy After Gastric Cancer Resection Among the Elderly and Impact on Survival

Journal Article · Thu Apr 15 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.03.050· OSTI ID:21372205

Strauss, Joshua ^[1]; Hershman, Dawn L ^[1]; Buono, Donna ^[1]; McBride, Russell ^[2]; Clark-Garvey, Sean ^[1]; Woodhouse, Shermian A ^[3]; Abrams, Julian A ^[1]

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1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY (United States)
2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (United States)
3. Department of Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY (United States)

Purpose: In randomized trials patients with resected nonmetastatic gastric cancer who received adjuvant chemotherapy and radiotherapy (chemoRT) had better survival than those who did not. We investigated the effectiveness of adjuvant chemoRT after gastric cancer resection in an elderly general population and its effects by stage. Methods and Materials: We identified individuals in the Surveillance, Epidemiology, and End Results-Medicare database aged 65 years or older with Stage IB through Stage IV (M0) gastric cancer, from 1991 to 2002, who underwent gastric resection, using multivariate modeling to analyze predictors of chemoRT use and survival. Results: Among 1,993 patients who received combined chemoRT or no adjuvant therapy after resection, having a later year of diagnosis, having a more advanced stage, being younger, being white, being married, and having fewer comorbidities were associated with combined treatment. Among 1,476 patients aged less than 85 years who survived more than 4 months, the 313 who received combined treatment had a lower mortality rate (hazard ratio, 0.83; 95% confidence interval, 0.71-0.98) than the 1,163 who received surgery alone. Adjuvant therapy significantly reduced the mortality rate for Stages III and IV (M0), trended toward improved survival for Stage II, and showed no benefit for Stage IB. We observed trends toward improved survival in all age categories except 80 to 85 years. Conclusions: The association of combined adjuvant chemoRT with improved survival in an overall analysis of Stage IB through Stage IV (M0) resected gastric cancer is consistent with clinical trial results and suggests that, in an elderly population, adjuvant chemoradiotherapy is effective. However, our observational data suggest that adjuvant treatment may not be effective for Stage IB cancer, is possibly appropriate for Stage II, and shows significant survival benefits for Stages III and IV (M0) for those aged less than 80 years.

• OSTI ID: 21372205
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 76, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2009.03.050; PII: S0360-3016(09)00515-X; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
ELDERLY PEOPLE
FLUOROURACILS
MORTALITY
NEOPLASMS
RADIOTHERAPY
STOMACH
SURVIVAL CURVES
ADULTS
AGE GROUPS
AGED ADULTS
ANIMALS
ANTIMETABOLITES
AZINES
BODY
DIGESTIVE SYSTEM
DISEASES
DRUGS
GASTROINTESTINAL TRACT
HETEROCYCLIC COMPOUNDS
HUMAN POPULATIONS
HYDROXY COMPOUNDS
MAMMALS
MAN
MEDICINE
MINORITY GROUPS
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANIC FLUORINE COMPOUNDS
ORGANIC HALOGEN COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
ORGANS
POPULATIONS
PRIMATES
PYRIMIDINES
RADIOLOGY
THERAPY
URACILS
VERTEBRATES