바로가기  >

Abstract

PURPOSE:

The Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) trial tested whether the addition of radiotherapy to adjuvant chemotherapy improved disease-free survival (DFS) in patients with D2-resected gastric cancer (GC).

PATIENTS AND METHODS:

Between November 2004 and April 2008, 458 patients with GC who received gastrectomy with D2 lymph node dissection were randomly assigned to either six cycles of adjuvant chemotherapy with capecitabine and cisplatin (XP) or to two cycles of XP followed by chemoradiotherapy and then two additional cycles of XP (XPRT). This final update contains the first publication of overall survival (OS), together with updated DFS and subset analyses.

RESULTS:

With 7 years of follow-up, DFS remained similar between treatment arms (hazard ratio [HR], 0.740; 95% CI, 0.520 to 1.050; P = .0922). OS also was similar (HR, 1.130; 95% CI, 0.775 to 1.647; P = .5272). The effect of the addition of radiotherapy on DFS and OS differed by Lauren classification (interaction P = .04 for DFS; interaction P = .03 for OS) and lymph node ratio (interaction P < .01 for DFS; interaction P < .01 for OS). Subgroup analyses also showed that chemoradiotherapy significantly improved DFS in patients with node-positive disease and with intestinal-type GC. There was a similar trend for DFS and OS by stage of disease.

CONCLUSION:

In D2-resected GC, both adjuvant chemotherapy and chemoradiotherapy are tolerated and equally beneficial in preventing relapse. Because results suggest a significant DFS effect of chemoradiotherapy in subsets of patients, the ARTIST 2 trial evaluating adjuvant chemotherapy and chemoradiotherapy in patients with node-positive, D2-resected GC is under way. 

Author information

Park SH1, Sohn TS1, Lee J1, Lim do H1, Hong ME1, Kim KM1, Sohn I1, Jung SH1, Choi MG1, Lee JH1, Bae JM1, Kim S1, Kim ST1, Park JO1, Park YS1, Lim HY1, Kang WK2.

1All authors: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

2All authors: Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. wkkang@skku.edu.