Adjuvant radiochemotherapy combined with surgery improves survival in gastric cancer but not pancreatic cancer, likely depending on adequate coverage of regional lymph node stations.
Does surgery combined with adjuvant radiochemotherapy improve survival in patients with major abdominal malignancies?
The efficacy of adjuvant radiochemotherapy combined with surgery varies by primary tumor site in abdominal malignancies, potentially depending on adequate coverage of regional lymph nodes.
The rationale for combining surgery, radiotherapy and chemotherapy is discussed and the clinical results seen with surgery and adjuvant radiochemotherapy in three major abdominal malignancies are reviewed. A systematic approach to the literature was used. In rectal cancer, postoperative radiochemotherapy is an established treatment, although there is weak scientific support for the combined approach. The same clinical gains can also be reached much more easily with preoperative radiotherapy. In gastric cancer, a recent large randomised trial showed improved survival from postoperative radiotherapy. This was not seen in a comparably large trial in pancreatic cancer. The reasons for the different results according to primary tumour site are discussed. It is argued that adequate coverage of all adjacent regional lymph node stations is necessary for an effect on survival.
Wu et al. (Tue,) conducted a review in Abdominal malignancies (rectal, gastric, and pancreatic cancer). Surgery and adjuvant radiochemotherapy was evaluated on Survival. Adjuvant radiochemotherapy combined with surgery improves survival in gastric cancer but not pancreatic cancer, likely depending on adequate coverage of regional lymph node stations.
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