A population-based analysis of surgical and adjuvant therapy for resected gastric cancer: Are patients receiving appropriate treatment following publication of the intergroup 0116 results?

BACKGROUND: The use of adjuvant therapy for resectable gastric adeno-carcinoma has become standard of care since the publication of the Intergroup 0116 data. The aims of this study were to (1) assess current practice patterns in gastric cancer treatment, and (2) determine the effect of increasing use of adjuvant chemoradiotherapy on survival in patients with gastric cancer. PATIENTS AND METHODS: Data from the Oregon State Cancer Registry were abstracted for demographics, disease stage, resection type, number of lymph nodes resected, adjuvant chemoradiotherapy (CRT), and survival for 1996-2006. Patients with stages IB-III disease were divided into cohorts treated through year 2001 (Group 1) or after 2001 (Group 2). Chemoradiotherapy use between groups was compared with the chi-square test. Univariate and multivariate analyses of survival were performed. Binary logistic regression determined predictors for the receipt of CRT. RESULTS: A total of 308 patients met study criteria. Adjuvant therapy was employed in 17.0% of cases in Group 1 vs. 36.8% in Group 2 (P <.001). Tumor stage, tumor location, and American Joint Committee on Cancer (AJCC) stage were independent predictors of survival in both univariate and multivariate analyses. In this retrospective analysis, a modest survival benefit was associated with CRT, but this benefit did not reach statistical significance. Independent predictors for the receipt of CRT included age, AJCC stage, N2 disease, and treatment era. CONCLUSIONS: While the use of adjuvant CRT increased after publication of Intergroup 0116 data, 63.2% of potentially eligible patients did not receive CRT. Future efforts should focus on identifying and removing barriers to the receipt of adjuvant therapy following resection of gastric adenocarcinoma.