Adjuvant therapy for gastric cancer: Current and future directions

Table 1 American Joint Committee on Cancer 6^thvs 7^th edition staging of gastric cancer

	AJCC 6th		AJCC 7th
T1	Tumour invades lamina propria or submucosa	T1a	Invades Lamina propria or muscularis mucosae
		T1b	Invades Submucosa
T2a	Invades Muscularis propria	T2	Invades Muscularis propria
T2b	Invades Subserosa
T3	Penetrates Serosa (visceral peritoneum), without invasion of adjacent structures	T3	Penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures
T4	Invades adjacent structures	T4a	Tumor invades serosa (visceral peritoneum)
		T4b	Tumor invades adjacent structures
N1	1-6 nodes involved	N1	1-2 nodes involved
N2	7-15 nodes involved	N2	3-6 nodes involved
N3	> 15 nodes involved	N3a	7-15 nodes involved
		N3b	> 15 nodes involved

AJCC: American Joint Committee on Cancer.

Table 2 Meta-analyses of adjuvant chemo-radiotherapy trials after 2006

Ref.	Year	Number of trials	Number of patients	HR	P value
Ohri et al[33]	2013	13	2811	HR = 0.78 [0.70-0.86]	< 0.001
Guo et al[36]	2011	9	1548	OR = 0.57 [0.34-0.95]	0.03
Valentini et al[35]	2009	9	2025	RR = 1.26 [1.08-1.48]	0.004
Fiorica et al[34]	2007	9	1694	OR = 0.54 [0.43-0.68]	< 0.00001

Table 3 Meta-analyses of adjuvant chemotherapy after 2006

Author	Year	Number of trials included	Number of patients	HR for OS	P value
GASTRIC	2010	17	3838	HR = 0.82 [0.76-0.90]	< 0.001
Sun et al	2009	12	3809	HR = 0.78 [0.71-0.85]	< 0.001
Zhao et al	2008	15	3212	RR = 0.88 [0.77-0.99]	0.001
Liu et al	2008	19	4599	RR = 0.85 [0.80-0.90]	< 0.00001

GASTRIC: Global Advanced/Adjuvant Stomach Tumor Research International Collaboration; OS: Overall survival.

Table 4 Trials of adjuvant chemo-radiotherapy vs adjuvant chemotherapy in gastric cancer after 2006

Ref.	Year		Postop CRT arms	No. of patients	% having D2 dissection	Survival Outcome	P value	Outcome	P value
Lee et al[37]	2012	Surg	Cape/Cis x2 - 45Gy/Cape - Cape/Cis x2	458	100%			3-yr DFS 78.2% vs 74.2%	0.862
		Surg	Cape/Cis - x6
Yu et al[42]	2012	Surg	FU/LV - 45Gy/FU/LV - FU/LV	404	100%	5-yr OS 48% vs 41.8	0.122 (for median OS)	5-yr RFS 45.2% vs 35.8%	0.029 (for median OS)
		Surg	FU/LV
Kim et al[39]	2012	Surg	5-FU/LV x5	90	100%	54.6% vs 65.2%	0.67
		Surg	x1 5-FU/LV - 45Gy/5-FU - x2 5-FU/LV
Bamias et al[40]	2010	Surg	Docetaxel/Cisplatin x6	147	44% D1-2	OS/DFS no difference
		Surg	Docetaxel/Carboplatin + 45Gy
Yu et al[42]	2012	Surg	5-FU/LV x5	68	69%	3yr OS 68% vs 44%	< 0.05	3-yr DFS 56% vs 29%	< 0.05
		Surg	INT-0116
Kwon et al[41]	2010	Surg	5-FU/Cis x6	61	100%	5-yr OS 70.1 vs 70%	0.814	5-yr DFS 80% vs 75%	0.887
		Surg	FPx1 - 45Gy/Cape - FP x3

Cape: Capecitabine; Cis: Cisplatin; FU/LV: Fluorouracil/leucovorin; FP: Fluorouracil/cisplatin; OS: Overall survival; DFS: Disease-free survival; RFS: Relapse-free survival.

Table 5 Prospective phase 2 trials of preoperative chemo-radiotherapy

Ref.	Year	No. of patients	Induction CT	CRT	Proceeded to surgery	R0 resection	pCR
Ajani et al[62]	2004	34	x2 FU/Cis/LV	45Gy/FU	85%	70%	30%
Ajani et al[63]	2005	41	x2 FU/Cis/Paclitaxel	45Gy/FU/Paclitaxel	98%	78%	20%
Ajani et al[64]	2006	49	x2 FU/Cis/LV	45Gy/FU/Paclitaxel	83%	77%	26%

pCR: Pathological complete response; Cis: Cisplatin; CRT: Chemo-radiotherapy; FU: Fluorouracil; CT: Chemotherapy; LV: Leucovorin.