Analysis Radiation therapy under used
News Date: 01/19/2007
Outlet: United Press International

Analysis Radiation therapy under used By ED SUSMAN

ORLANDO, Fla., Jan. 19 (UPI) -- Despite clinical studies showing longer survival with the use of radiation after stomach cancer surgery, doctors said Friday that less than half the people undergoing the procedure are given the potentially life-saving additional therapy.

Researchers at the 4th annual Gastrointestinal Cancer Symposium in Orlando, Fla., actually noted that radiation following stomach cancer surgery has more than doubled since key publication of clinical trials that showed improvement in outcomes with radiation after surgery. 'The increasing use of radiation treatment following surgery for gastric cancer is highly significant,' Ulrich Guller, a fellow in surgical oncology at the University of Toronto, said at a news briefing. 'However the percentage of patients getting such treatment is still low and further efforts are needed to ensure that the results of the Intergroup 0116 trial are put into practice for the appropriate patients,' he said. The Intergroup 0116 trial results were first presented in 2000 at a meeting of the American Society of Clinical Oncology and then were published a year later in the New England Journal of Medicine. The study indicated that giving the patients a combination of radiation and chemotherapy resulted in a 10-percent decrease in survival.

Guller examined the U.S. National Cancer Institute's Surveillance Epidemiology and End Results (SEER) in the years preceding the Intergroup report and in the years following.

Prior to the presentation of the Intergroup 0116 study, he found that about 15 percent of patients underwent post operative radiation. Immediately after the presentation, the percentage of stomach cancer patients getting radiation therapy jumped to 30 percent. Then, when the paper was published in the journal in 2001, the number again increased to about 37 percent. By 2003, however, the percentage had fallen back to about 30.4 percent. 'Not everyone should have radiation after stomach cancer surgery. Many people are just too sick or frail to tolerate additional therapy after surgery,' said William Blackstock, associate professor of radiation oncology and attending physician at North Carolina Baptist Hospital in Winston-Salem. 'However,' he told , 'I would think that about two-thirds of the people should be having adjuvant therapy. So we have a way to go yet. We know that additional post-operative therapy -- whether radiation or chemotherapy -- improves outcomes in these patients.' David Ilson, associate attending physician at Memorial Sloan-Kettering Cancer Center in New York, told UPI, 'in 2007 it is clear that treating gastric cancer with surgery alone is no longer an acceptable therapy.' Robert Mayer, professor of medicine at Harvard Medical School/Dana-Farber Cancer Institute in Boston, concurred. 'Everyone needs to be on something after surgery,' he told UPI. He suggested that patients either be on the Intergroup protocol or in a clinical trial.

In his presentation, Guller said the results showed there were differences in age with 46 percent of younger patients -- those under age 60 -- receiving radiation after surgery whereas only 13 percent of those over age 75 were given radiation.

Married patients were more likely -- 31.8 percent versus 14.9 percent of unmarried individuals -- to receive radiation.

Patients with more advanced cancer were more likely to receive radiation. About 36.8 percent of patients with advanced tumors received radiation compared with 8.9 patients of patients with early-stage cancer. Similarly, 38.7 percent of patients with lymph-node involvement were irradiated, while 13.5 percent of patients without lymph-node involvement were given radiation.

Blackstock said the differences in the groups due to age was more likely a reflection of the general health of the patients. He said that adding chemoradiation to the treatment regimen is more grueling for patients who have already lost their stomach, and elderly patients are usually suffering additional illnesses.

Married patients are generally in better health than unmarried individuals, Guller noted.

About 2,300 scientists are attending the symposium, jointly sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the American Gastroenterological Association Institute and the Society of Surgical Oncology.