The outcome among patients with gastric or lower esophageal cancer is determined by the stage of the disease at presentation. (Current Controlled Trials number, ISRCTN93793971.) Introduction In patients with operable gastric or lower esophageal adenocarcinomas, a perioperative regimen of ECF decreased tumor size and stage and significantly improved progression-free and overall survival. 23 percent) and of progression-free survival (hazard ratio for progression, 0.66 95 percent confidence interval, 0.53 to 0.81 P<0.001).
As compared with the surgery group, the perioperative-chemotherapy group had a higher likelihood of overall survival (hazard ratio for death, 0.75 95 percent confidence interval, 0.60 to 0.93 P=0.009 five-year survival rate, 36 percent vs. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. Rates of postoperative complications were similar in the perioperative-chemotherapy group and the surgery group (46 percent and 45 percent, respectively), as were the numbers of deaths within 30 days after surgery. ResultsĮCF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. The primary end point was overall survival. Chemotherapy consisted of three preoperative and three postoperative cycles of intravenous epirubicin (50 mg per square meter of body-surface area) and cisplatin (60 mg per square meter) on day 1, and a continuous intravenous infusion of fluorouracil (200 mg per square meter per day) for 21 days. We randomly assigned patients with resectable adenocarcinoma of the stomach, esophagogastric junction, or lower esophagus to either perioperative chemotherapy and surgery (250 patients) or surgery alone (253 patients). We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ī regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma.
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