Iatrogenic Illness and Cancer
Note: The information on this website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up.
Hallissey MT, Dunn JA, Ward LC, Allum WH.
Lancet 1994 May 28;343(8909):1309-12.The results of this study show that adjuvant chemotherapy and adjuvant radiotherapy do not prolong survival in patients with cancer of the stomach. Four hundred thirty-six patients with gastric cancer were randomized to receive surgery alone, surgery followed by radiation, or surgery followed by chemotherapy. Five-year survival was 20% in patients who received surgery alone, 12% in those who received surgery with radiation, and 19% in those who received surgery plus chemotherapy. These data do not support the use of adjuvant therapies in the management of gastric cancer.
Pathological prognostic factors in the second British Stomach Cancer Group trial of adjuvant therapy in resectable gastric cancer.
Yu CC; et al.
J Cancer, 71(5):1106-10 1995 May.This study reports the results of a randomized controlled trial in which patients with gastric cancer were randomized to receive surgery alone, surgery followed by chemotherapy, or surgery followed by radiotherapy. No differences in survival were observed between the three groups, indicating that chemotherapy and radiotherapy are ineffective in the management of patients with gastric cancer.
Adjuvant therapy for gastric carcinoma: closing out the century.
Yao JC, Shimada K, Ajani JA.
Oncology (Huntingt) 1999 Nov;13(11):1485-94.This article highlights that the results of 40 years of research in the West failed to document a survival advantage in patients with gastric cancer treated with chemotherapy or radiotherapy in addition to surgery, compared to those treated with surgery alone.
Treatment of gastric cancer.
Wils J.
Curr Opin Oncol, 10(4):357-61 1998 Jul.This article emphasizes that the effects of chemotherapy in the treatment of patients with early and late stage gastric cancer have been largely disappointing.
A phase II study of 5-fluorouracil, leucovorin, and interferon-alpha in the treatment of patients with metastatic or recurrent gastric carcinoma
An Eastern Cooperative Oncology Group study (E5292).
Hudes GR, et al.
Cancer 1999 Jan 15;85(2):290-4.This study evaluated the effects of a combination chemotherapy regimen consisting of 5-fluorouracil, leucovorin and interferon-alpha in patients with advanced cancer of the stomach. Twenty-seven patients were enrolled. Severe diarrhea and inflammation of the lining of the mouth occurred in approximately one-third of patients. Severe reduction in number of white blood cells and fatigue occurred in 20% and 10% of patients, respectively. Fever and flu-like symptoms were commonly experienced. Partial tumor shrinkage was observed in 12% of patients, and overall median survival was 7.8 months. These data indicate that use of this chemotherapy regimen is associated with minimal activity and significant toxicity in patients with gastric cancer.
Treatment of advanced gastric cancer with oral etoposide, leucovorin and tegafur: experience with an oral modification of the etoposide, leucovorin and 5-fluorouracil (ELF) regimen.
Raderer M; et al.
Eur J Cancer, 34(7):1128-30 1998 Jun.This study evaluated the effects of a modified version of the widely used oral combination chemotherapy regimen of etoposide, leucovorin and 5-fluorouracil in the management of patients with advanced pancreatic cancer. Thirty-two patients were enrolled. Tumor shrinkage was observed only in 16% of patients. Overall average survival was 6 months. Treatment was discontinued in 8 patients due to severe nausea and vomiting. Additionally, 12 patients experienced anorexia and progressive weight loss. The authors concluded that this regimen is not recommended for patients with advanced stomach cancer.
Efficacy of prolonged intermittent therapy with combined 5-FU and methyl-CCNU following resection for gastric carcinoma.
A Veterans Administration Surgical Oncology, Group report.
Higgins GA; Amadeo JH; Smith DE; Humphrey EW; Keehn RJ.
Cancer, 52(6):1105-12 1983 Sep 15.The results of this study show that combination chemotherapy given after surgery does not improve relapse-free or overall survival in patients with gastric cancer, but substantially increases toxicity.
Morbidity and mortality of early postoperative intraperitoneal chemotherapy as adjuvant therapy for gastric cancer.
Yu W, Whang I, Averbach A, Chang D, Sugarbaker PH.
Am Surg 1998 Nov;64(11):1104-8.This study evaluated the impact of chemotherapy delivered in the abdominal cavity early after surgery, on the morbidity and mortality of patients with cancer of the stomach. Two hundred and forty-eight patients were randomized to undergo either surgery alone, or surgery followed by intraperitoneal administration of mitomycin C and 5-fluorouracil in the 5 days after the operation. Overall morbidity and mortality were significantly higher in patients in the chemotherapy group compared to those in the surgery-only group. In particular, morbidity and post-operative mortality occurred in 29% and 5.6% of patients who received chemotherapy, respectively, compared to 20% and 0.8% of those who received surgery only. Minor complications occurred in over a third of patients in the chemotherapy group. These data do not support the use of this regimen in the management of patients with gastric cancer.
Adjuvant intraperitoneal chemotherapy with carbon-adsorbed mitomycin in patients with gastric cancer:
Results of a randomized multicenter trial of the Austrian Working Group for Surgical Oncology.
Rosen HR; et al.
J Clin Oncol, 16(8):2733-8 1998 Aug.This study evaluated the effects of a chemotherapy protocol consisting of intra-abdominal infusion of mitomycin in patients with gastric cancer. The trial was conducted after several studies reported a beneficial effect associated with use of this regimen. Ninety-one patients were randomized to receive surgery only (45 subjects) or surgery followed by chemotherapy (46 subjects). Morbidity and mortality were significantly higher in patients assigned to chemotherapy compared to those receiving surgery only. In particular, 35% of patients in the chemotherapy group experienced complications after surgery, compared to 16% of those in the surgery-only group. Furthermore, 11% of patients who received chemotherapy died in the 60 days after surgery, compared to 2% of those who received surgery only. These data do not support use of this protocol in the treatment of patients with gastric cancer.
Fotemustine in patients with advanced gastric cancer
A phase II trial from the EORTC-GITCCG (European Organization for Research and Treatment of Cancer, Gastrointestinal Tract Cancer Cooperative Group).
Rougier P, et al.
Eur J Cancer 1996 Jul;32A(8):1432-3.This study evaluated the activity of the anti-cancer drug fotemustine in the treatment of patients with advanced gastric cancer. Twenty-six patients were enrolled in the trial. Severe decrease in the number of white blood cells was observed in one-third of patients, while platelet depletion was observed in half of them. Two patients died of treatment-related hemorrhage. No partial or complete tumor responses were observed. Overall median survival was only 11 weeks.
A randomized trial comparing adjuvant fluorouracil, epirubicin, and
mitomycin with no treatment in operable gastric cancer.
Tsavaris N, et al.
Chemotherapy 1996 May-Jun;42(3):220-6.This study evaluated the effects of combination chemotherapy on the outcome of patients with gastric cancer. Eighty-four patients were randomized to receive either surgery alone or surgery followed by chemotherapy with 5-fluorouracil, epirubicin, and mitomycin C. No significant differences in survival were observed between both groups. This treatment regimen cannot be recommended in the management of patients with gastric cancer.
Adjuvant chemotherapy with 5-FU, adriamycin, and mitomycin-C (FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma
A Southwest Oncology Group study.
Macdonald JS, et al.
Ann Surg Oncol 1995 Nov;2(6):488-94.The results of this study show that combination chemotherapy is ineffective in the management of patients with gastric cancer. One hundred ninety-three patients with stage I, II, and III gastric cancer were randomized to receive either surgery followed by a chemotherapy regimen consisting of 5-fluorouracil, adriamycin, and mitomycin-C (93 patients), or surgery only (100 patients). No differences in disease-free and overall survival were observed between the two groups.
Adjuvant therapy for gastric carcinoma patients in the past 15 years: a review of western and oriental trials.
Shimada K, Ajani JA.
Cancer 1999 Nov 1;86(9):1657-68.This study reviewed all the randomized trials published in the world literature that investigated the effects of adjuvant treatments (chemotherapy, radiotherapy, and chemo-immunotherapy) in the management of patients with gastric cancer. All trials performed in the West failed to detect any benefit derived from use of post-operative adjuvant treatments. The conclusions derived from studies performed in the East are inconclusive. In spite of these results, adjuvant treatments are commonly administered to Asian patients diagnosed with gastric cancer.
Phase II trial of etoposide, doxorubicin, and cisplatin combination in advanced measurable gastric cancer.
An Eastern Cooperative Oncology Group study.
Clark JL, et al.
Am J Clin Oncol, 18(4):318-24 1995 Aug.The results of this study show that combination chemotherapy consisting of etoposide, doxorubicin, and cisplatin for patients with advanced gastric cancer is associated with high toxicity and modest efficacy, and cannot be recommended for the management of this disease. In particular, of 31 patients undergoing treatment, 4 (13%) died of treatment-related complications and only 6 (23%) underwent partial tumor shrinkage. Average survival time was 9 months for the all group.
Cancer of the upper gastrointestinal tract. Palliative chemotherapy unproved in advanced gastric cancer. Letter.
Kunkler I.
BMJ 1994;308:1508-1509 (4 June).This letter is a response to an article written by Ellis and Cunningham advocating the use of palliative chemotherapy to relieve the symptoms and increase life expectancy in patients with gastric cancer. The author of the letter casts doubt on the validity of the results of the study presented by Ellis and Cunningham in support of the use of palliative chemotherapy. In that study, randomization was stopped early, after only 10 and 12 patients had been enrolled in the chemotherapy and supportive care group, respectively, due to an apparent prolonged survival in patients receiving chemotherapy. Stopping randomization prematurely, however, can introduce a bias in the selection of patients so that the two groups may not be properly compared any more (because they may differ, for example, as to the extension of disease or the general medical status). In addition, the study failed to assess quality of life in patients from both treatment arms. The author concludes that better data are required before chemotherapy can be recommended over supportive care in the management of patients with advanced gastric cancer.
No survival benefit from combined pancreaticosplenectomy and total gastrectomy for gastric cancer.
Kitamura K, et al.
Br J Surg 1999 Jan;86(1):119-22.The results of this study indicate that patients with gastric cancer who undergo more extensive surgery have similar survival rates but higher morbidity, compared to patients who receive more conservative surgery. The data of 190 patients with gastric cancer, who, between 1969 and 1996, underwent total stomach resection accompanied by removal of the spleen and the pancreas, were compared to those of 206 comparable patients who underwent removal of the stomach and the spleen only. No survival differences were observed between the two groups. However, morbidity was significantly increased in patients receiving more extensive surgery. Based on these data, the authors concluded that pancreas and spleen resection should not be routinely performed in patients with gastric cancer.
Role of radiotherapy in cancers of the stomach.
Bleiberg H; Jeziorsky K; Hendlisz A; Gerard B.
Bull Cancer, 84(9):913-6 1997 Sep.This study reviewed all randomized trials investigating the effects of radiotherapy on survival, in patients with cancer of the stomach. No benefits could be demonstrated associated with use of radiation therapy.
