The research was conducted by Stephen Smalley, MD, medical director of the radiation oncology department at Olathe Regional Medical Center in Olathe, Kansas. Smalley and his team studied 603 men and women with locally advanced stomach cancer. About half of the patients were treated with surgical removal of their tumors alone, which was standard therapy at the time. The other patients had surgery and were then treated with radiation therapy and with chemotherapy, using a drug known as 5-fluorouracil (5-FU).

Among the patients who had surgery alone, 22% survived five years or longer after diagnosis. Among those who were given chemotherapy and radiation after surgery, 42% survived five years or longer.

Chemo, Radiation Alone Not Helpful

Previously, doctors had tried chemotherapy alone, and radiation alone to lower recurrence rates in stomach cancer patients, but neither was helpful by itself. The high recurrence rate among patients who had surgery alone led Smalley and his team to look for a better treatment approach.

"We knew from earlier work that recurrences of stomach cancer after successful surgery usually occurred where the tumor had been in the lymph nodes in that region," he says. "We also knew radiotherapy used with chemotherapy had eliminated microscopic cancer in such areas in other gastrointestinal cancers. We sought to learn if applying these additional treatments to those areas would make a difference in these patients, since survival rates were so poor at that time."

The near-doubling of the number of patients who survived for five years or longer represents a significant improvement for patients with stomach cancer, Smalley says. "We’ve actually made a dramatic step forward in the treatment of the most common form of gastric cancer in the United States, and one of the biggest cancer killers in the world," he says, adding that that his work in this area began 14 years ago with an early funding grant from the American Cancer Society (ACS).

ACS Expert Agrees

Another ACS-affiliated gastrointestinal cancer expert agrees that chemotherapy and radiation after surgery makes a big difference in survival. "It is now recognized by top cancer centers as standard practice to offer chemotherapy and radiotherapy after successful surgery for stomach cancer," says Paul F. Engstrom, MD, senior vice president of population science at Fox Chase Cancer Center in Philadelphia, and a member of the ACS advisory board on gastrointestinal cancers.

Engstrom expects the treatment to become more widely available after more radiation oncologists are trained to deliver it safely and effectively. This training is vital, as many radiation oncologists are unfamiliar with treating stomach cancer, he says.

"Patients with locally advanced stomach cancer should talk with their surgeons about this treatment, and if the surgeon is not familiar with it, the patient should ask for a consultation with a specialist who is," Engstrom says.

Smalley points out that the treatment causes some additional side effects, including serious fatigue, nausea and lowered levels of blood cells and immune system cells, but those side effects were mostly temporary.

The ACS estimates 13,000 people will die of stomach cancer in the U.S. this year. It is the tenth leading cause of cancer deaths in this country. In 1999, stomach cancer was the second leading cause of cancer deaths worldwide, with approximately 800,000 deaths from the disease.