CRITICS
Summary:
- Can a combination of chemotherapy with radiation improve survival when compared to chemotherapy only after surgery? One group in this clinical trial was given chemoradiotherapy after gastric cancer surgery. The other group received chemotherapy, but no radiation. There was no significant difference between the groups.
Link:
Where?
- Netherlands
When?
- Published 2018, The Lancet Oncology
Impact Factor (IF):
- 33.990
Gastric cancer may be treated with a gastrectomy. Even though the solid tumor is cut out with this surgery, the cancer can sometimes come back. This is possible when even one cancer cell is left in the body. This is known as a relapse of the disease. Other treatments given on top of the surgery can help to treat the cancer and keep it from coming back. Some examples are chemotherapy and radiation therapy. These can be given before and/or after surgery. When chemotherapy and radiation are given at the same time, this is known as chemoradiotherapy. The authors of this paper wanted to know if chemoradiotherapy was better than just having chemotherapy after surgery.
Patients with resectable gastric cancer participated in this experiment. There were 788 participants who were randomly assigned to one of two groups:
First, all patients were given the chemotherapy drugs epirubicin, cisplatin/oxaliplatin and capecitabine. This was given over three 3 cycles lasting 3 weeks each. So, everyone participating in this experiment had a total of 9 weeks of therapy before surgery.
- Epirubicin Hypochloride Injection: this drug kills cancer cells by breaking up the structure of their genetic material.
- Cisplatin (CDDP/CF): this drug stops cancer from making more cells.
- Oxaliplatin: this drug stops cancer cell genetic material from dividing properly.
- Capecitabine: this drug also stops cancer cells from dividing properly
All patients had a gastrectomy surgery. Then, both groups started their post-operative treatment 4-12 weeks after surgery.
After surgery:
- Group A patients took the same chemotherapy medications as they did before surgery. This treatment lasted for 9 weeks after the gastrectomy.
- Group B patients received a different treatment of chemoradiotherapy. This included the drugs cisplatin and capecitabine. They were also given radiation therapy. This combined treatment was given for 5 weeks after the gastrectomy.
Results: The researchers studied both groups of patients for about 5 years. They found that the median survival of Group A was 43 months. The median survival of Group B was 37 months. These two numbers are very close to each other. This means that both chemoradiotherapy and chemotherapy worked equally as well in this study. So, chemoradiotherapy did not have any significant benefit compared to just chemotherapy after gastrectomy.
Citation:
Cats, Annemieke, et al. “Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial.” The Lancet Oncology 19.5 (2018): 616-628. Available from: doi: dx.doi.org/10.1016/S1470-2045(18)30132-3