Adjuvante Radiochemotherapie vs. alleinige Chemotherapie beim Magenkarzinom: Eine Metaanalyse

Translated title of the contribution: Adjuvant radiochemotherapy vs. chemotherapy alone in gastric cancer: a meta-analysis

Christiane Matuschek, Jan Haussmann, Edwin Bölke, Bálint Tamaskovics, Freddy Joel Djiepmo Njanang, Klaus Orth, Matthias Peiper, Peter Arne Gerber, Bahar Anooshar, Kai Kammers, Wilfried Budach

Research output: Contribution to journalArticle

Abstract

Background: As an adjuvant therapeutic strategy in advanced gastric cancer, both adjuvant chemotherapy (CTx) and postoperative radiochemotherapy (RCTx) can be considered. Both approaches have been shown to improve overall survival compared to resection alone. Several prospective randomized trials have compared the two postoperative concepts. Methods: We performed a literature search to identify prospective randomized trials which compared adjuvant chemotherapy to adjuvant radiochemotherapy in patients with advanced gastric cancer. As effect sizes, we extracted hazard ratios (HR) as well as event rates from the included trials for the endpoints overall survival, disease-free survival and locoregional control. Results: We identified seven studies that enrolled 1807 patients overall. Combined radiochemotherapy showed no significant improvement of overall survival in comparison to chemotherapy alone (HR = 0.93; 95%CI: 0.82–1.06; p = 0.28). For disease-free survival (HR = 0.86; 95%CI: 0.76–0.98; p = 0.023) and locoregional control (odds ratio [OR] = 0.56; 95%CI: 0.42–0.75; p = <0.001) we detected significant advantages from the addition of radiation to chemotherapy. A subgroup analysis demonstrated an improvement in survival when the radiochemotherapy protocol was not de-intensified. Conclusions: Adjuvant chemotherapy or radiochemotherapy demonstrate similar oncologic efficacy and therapy-associated toxicity. Individual patient characteristics should therefore determine the therapeutic approach in a multidisciplinary discussion. Irradiation added to standard-dose chemotherapy possibly results in a survival benefit.

Original languageGerman
JournalStrahlentherapie und Onkologie
DOIs
StatePublished - Jan 1 2019

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Adjuvant Chemoradiotherapy
Stomach Neoplasms
Chemoradiotherapy
Adjuvant Chemotherapy
Drug Therapy
Survival
Disease-Free Survival
Therapeutics
Odds Ratio
Radiation

Keywords

  • Advanced gastric cancer
  • Disease free survival
  • Literature search
  • Local regional control
  • Randomized trials

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

Cite this

Matuschek, C., Haussmann, J., Bölke, E., Tamaskovics, B., Djiepmo Njanang, F. J., Orth, K., ... Budach, W. (2019). Adjuvante Radiochemotherapie vs. alleinige Chemotherapie beim Magenkarzinom: Eine Metaanalyse. Strahlentherapie und Onkologie. https://doi.org/10.1007/s00066-019-01431-y

Adjuvante Radiochemotherapie vs. alleinige Chemotherapie beim Magenkarzinom : Eine Metaanalyse. / Matuschek, Christiane; Haussmann, Jan; Bölke, Edwin; Tamaskovics, Bálint; Djiepmo Njanang, Freddy Joel; Orth, Klaus; Peiper, Matthias; Gerber, Peter Arne; Anooshar, Bahar; Kammers, Kai; Budach, Wilfried.

In: Strahlentherapie und Onkologie, 01.01.2019.

Research output: Contribution to journalArticle

Matuschek, C, Haussmann, J, Bölke, E, Tamaskovics, B, Djiepmo Njanang, FJ, Orth, K, Peiper, M, Gerber, PA, Anooshar, B, Kammers, K & Budach, W 2019, 'Adjuvante Radiochemotherapie vs. alleinige Chemotherapie beim Magenkarzinom: Eine Metaanalyse', Strahlentherapie und Onkologie. https://doi.org/10.1007/s00066-019-01431-y
Matuschek, Christiane ; Haussmann, Jan ; Bölke, Edwin ; Tamaskovics, Bálint ; Djiepmo Njanang, Freddy Joel ; Orth, Klaus ; Peiper, Matthias ; Gerber, Peter Arne ; Anooshar, Bahar ; Kammers, Kai ; Budach, Wilfried. / Adjuvante Radiochemotherapie vs. alleinige Chemotherapie beim Magenkarzinom : Eine Metaanalyse. In: Strahlentherapie und Onkologie. 2019.
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abstract = "Background: As an adjuvant therapeutic strategy in advanced gastric cancer, both adjuvant chemotherapy (CTx) and postoperative radiochemotherapy (RCTx) can be considered. Both approaches have been shown to improve overall survival compared to resection alone. Several prospective randomized trials have compared the two postoperative concepts. Methods: We performed a literature search to identify prospective randomized trials which compared adjuvant chemotherapy to adjuvant radiochemotherapy in patients with advanced gastric cancer. As effect sizes, we extracted hazard ratios (HR) as well as event rates from the included trials for the endpoints overall survival, disease-free survival and locoregional control. Results: We identified seven studies that enrolled 1807 patients overall. Combined radiochemotherapy showed no significant improvement of overall survival in comparison to chemotherapy alone (HR = 0.93; 95{\%}CI: 0.82–1.06; p = 0.28). For disease-free survival (HR = 0.86; 95{\%}CI: 0.76–0.98; p = 0.023) and locoregional control (odds ratio [OR] = 0.56; 95{\%}CI: 0.42–0.75; p = <0.001) we detected significant advantages from the addition of radiation to chemotherapy. A subgroup analysis demonstrated an improvement in survival when the radiochemotherapy protocol was not de-intensified. Conclusions: Adjuvant chemotherapy or radiochemotherapy demonstrate similar oncologic efficacy and therapy-associated toxicity. Individual patient characteristics should therefore determine the therapeutic approach in a multidisciplinary discussion. Irradiation added to standard-dose chemotherapy possibly results in a survival benefit.",
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AU - Haussmann, Jan

AU - Bölke, Edwin

AU - Tamaskovics, Bálint

AU - Djiepmo Njanang, Freddy Joel

AU - Orth, Klaus

AU - Peiper, Matthias

AU - Gerber, Peter Arne

AU - Anooshar, Bahar

AU - Kammers, Kai

AU - Budach, Wilfried

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AB - Background: As an adjuvant therapeutic strategy in advanced gastric cancer, both adjuvant chemotherapy (CTx) and postoperative radiochemotherapy (RCTx) can be considered. Both approaches have been shown to improve overall survival compared to resection alone. Several prospective randomized trials have compared the two postoperative concepts. Methods: We performed a literature search to identify prospective randomized trials which compared adjuvant chemotherapy to adjuvant radiochemotherapy in patients with advanced gastric cancer. As effect sizes, we extracted hazard ratios (HR) as well as event rates from the included trials for the endpoints overall survival, disease-free survival and locoregional control. Results: We identified seven studies that enrolled 1807 patients overall. Combined radiochemotherapy showed no significant improvement of overall survival in comparison to chemotherapy alone (HR = 0.93; 95%CI: 0.82–1.06; p = 0.28). For disease-free survival (HR = 0.86; 95%CI: 0.76–0.98; p = 0.023) and locoregional control (odds ratio [OR] = 0.56; 95%CI: 0.42–0.75; p = <0.001) we detected significant advantages from the addition of radiation to chemotherapy. A subgroup analysis demonstrated an improvement in survival when the radiochemotherapy protocol was not de-intensified. Conclusions: Adjuvant chemotherapy or radiochemotherapy demonstrate similar oncologic efficacy and therapy-associated toxicity. Individual patient characteristics should therefore determine the therapeutic approach in a multidisciplinary discussion. Irradiation added to standard-dose chemotherapy possibly results in a survival benefit.

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KW - Randomized trials

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