Can Perioperative Chemotherapy for Advanced Gastric Cancer Be Recommended on the Basis of Current Research? A Critical Analysis
Journal of Gastric Cancer
;
: 39-46, 2014.
Artigo
em Inglês
| WPRIM
| ID: wpr-22697
ABSTRACT
PURPOSE:
According to current guidelines, perioperative chemotherapy is an integral part of the treatment strategy for advanced gastric cancer. Randomized controlled studies have been conducted in order to determine whether perioperative chemotherapy leads to improved R0 resection rates, fewer recurrences, and prolonged survival. The aim of our project was to critically appraise three major studies to establish whether perioperative chemotherapy for advanced, potentially resectable gastric cancer can be recommended on the basis of their findings. MATERIALS ANDMETHODS:
We analyzed the validity of the three most important studies (MAGIC, ACCORD, and EORTC) using a standardized questionnaire. Each study was evaluated for the study design, patient selection, randomization, changes in protocol, participating clinics, preoperative staging, chemotherapy, homogeneity of subjects, surgical quality, analysis of the results, and recruitment period.RESULTS:
All three studies had serious shortcomings with respect to patient selection, homogeneity of subjects, changes in protocol, surgical quality, and analysis of the results. The protocols of the MAGIC and ACCORD-studies were changed during the study period because of insufficient recruitment, such that carcinomas of the lower esophagus and the stomach were examined collectively. In neither the MAGIC study nor the ACCORD study did patients undergo adequate lymphadenectomy, and only about half of the patients in the chemotherapy group could undergo the treatment specified in the protocol. The EORTC study had insufficient statistical power.CONCLUSIONS:
We concluded that none of the three studies was sufficiently robust to justify an unrestrained recommendation for perioperative chemotherapy in cases of advanced gastric cancer.
Texto completo:
DisponíveL
Índice:
WPRIM (Pacífico Ocidental)
Assunto principal:
Recidiva
/
Estômago
/
Neoplasias Gástricas
/
Distribuição Aleatória
/
Inquéritos e Questionários
/
Seleção de Pacientes
/
Tratamento Farmacológico
/
Esôfago
/
Excisão de Linfonodo
/
Magia
Tipo de estudo:
Ensaio Clínico Controlado
/
Guia de Prática Clínica
/
Pesquisa qualitativa
Limite:
Humanos
Idioma:
Inglês
Revista:
Journal of Gastric Cancer
Ano de publicação:
2014
Tipo de documento:
Artigo
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