Multimodality treatment of potentially curative gastric cancer: Geographical variations and future prospects

Table 1 Influential phase III trials for multimodality treatment of gastric cancer

Study name/region	Treatment arms	Total patients	Patients with lower oesophageal tumours	Patients undergoing D2 surgery	Hazard ratio for OS	95%CI	P value	Outcome summary
Intergroup-0116[10]North America	Surgery alone vs adjuvant chemoradiation	556	20%	10%	1.35	1.09-1.66	0.005	Favours surgery plus adjuvant chemoradiation
ARTIST[14] Asia	Surgery plus adjuvant chemotherapy vs surgery plus adjuvant chemoradiation	458	0%	100%	Not recorded		0.09	No advantage
MAGIC[17] Europe	Surgery alone vs neoadjuvant chemotherapy plus surgery	503	26%	38%	0.75	0.60-0.93	0.009	Favours surgery plus neoadjuvant chemotherapy
FNLCC[18] Europe	Surgery alone vs neoadjuvant chemotherapy plus surgery	224	75%	Not recorded but D2 recommended	0.69	0.50-0.95	0.02	Favours surgery plus neoadjuvant
ACTS-GC[23] Asia	Surgery alone vs adjuvant S-1 plus surgery	1059	0%	100%	0.68	0.52-0.87	0.003	Favours surgery plus adjuvant chemotherapy
CLASSIC[24] Asia	Surgery alone vs postoperative capecitabine and oxaliplatin plus surgery	1035	0%	100%	0.72	0.52-1.00	0.0493	Favours surgery plus adjuvant chemotherapy
DGTC[33] Europe	D1 surgery vs D2 surgery	711	0%	46%			0.34	Favours D2 resection
MRC[27] Europe	D1 surgery vs D2 surgery	400	0%	50%	1.10	0.87-0.39	0.43	No significant difference D1 vs D2
CALB8010[15]	Surgery plus enhanced adjuvant chemoradiation vs Intergroup-0166 outcomes	546	Not recorded	0%	1.03	0.80-1034	0.80	No advantage to enhanced adjuvant chemoradiation
ITACA-S[40] Europe	Surgery plus adjuvant chemotherapy vs surgery plus enhanced chemotherapy	1106	Not recorded	75%	1.00	0.83-1.20	0.97	No advantage to enhanced adjuvant chemotherapy
ToGA[45] Asia	Inoperable patients chemotherapy vs chemotherapy plus trastuzumab	584	18%	N/A	0.74	0.60-0.91	0.0046	Favours chemotherapy plus trastuzumab