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Perioperative Chemotherapy Versus Surgery Alone For Resectable Gastroesophageal Cancer.

D. Cunningham, W. Allum, S. Stenning, J. Thompson, C. V. D. van de Velde, M. Nicolson, J. Howard Scarffe, F. Lofts, S. Falk, T. Iveson, D. Smith, R. Langley, Monica Verma, S. Weeden, Y. Chua, MAGIC Trial Participants
Published 2006 · Medicine

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BACKGROUND A regimen of epirubicin, cisplatin, and infused fluorouracil (ECF) improves survival among patients with incurable locally advanced or metastatic gastric adenocarcinoma. We assessed whether the addition of a perioperative regimen of ECF to surgery improves outcomes among patients with potentially curable gastric cancer. METHODS 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). 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. The primary end point was overall survival. RESULTS ECF-related adverse effects were similar to those previously reported among patients with advanced gastric cancer. 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. The resected tumors were significantly smaller and less advanced in the perioperative-chemotherapy group. With a median follow-up of four years, 149 patients in the perioperative-chemotherapy group and 170 in the surgery group had died. 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. 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). CONCLUSIONS 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. (Current Controlled Trials number, ISRCTN93793971 [].).
This paper references
Adjuvant chemotherapy in operable gas- 10
Prognostic relevance of systematic lymph node dissection in gastric carcinoma
J. R. Siewert (1993)
A controlled, prospective, randomised trial of adjuvant chemotherapy or radiotherapy in resectable gastric cancer: interim report. British Stomach Cancer Group.
W. Allum (1989)
[Extended lymph-node dissection for gastric cancer].
M. Huguier (1999)
Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.
J. Macdonald (2001)
J. Rahamin; East Surrey Hospital — R.G. Lightwood; Epsom General Hospital — W.H. Allum
R Anderson
A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination with continuous infusion 5-fluorouracil (ECF).
M. Findlay (1994)
Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial.
H. Hartgrink (2004)
Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial.
H. Hartgrink (2004)
New Zealand: Wellington Hospital — M
C Nortier
Whipps Cross Hospital -A. Botha; Whiston Hospital -L.S. Chagla; Worcester Royal Infirmary -C. Robertson; York District Hospital
-L CTraffordGeneralHospital
Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer.
A. Webb (1997)
A controlled, prospective, randomized trial of adjuvant chemotherapy or radiotherapy in resectable gastric cancer: interim report
WH Allum (1989)
Radical surgery.
A. Zagorin (1993)
Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials.
C. Earle (1999)
Southport & Formby District General Hospital — M. Zeiderman; St. Bartholomews Hospital — M
Southmead Salter
Patient survival after D 1 and D 2 resections for gastric cancer: long-term results of the MRC randomized surgical trial
A. Cuschieri (1999)
Northern Centre for Cancer Treatment, Newcastle General Hospital — F
King Sayer
Medical Research Council Esophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in esophageal cancer: a randomized controlled trial
W H Allum (1987)
Perioperative chemotherapy in operable gastric and lower esophageal cancer: a randomized, controlled trial (the MAGIC trial, ISRCTN 93793971)
Adjuvant chemotherapy with 5-FU, adriamycin, and mitomycin-C (FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma: A southwest oncology group study
J. Macdonald (2006)
Chemotherapy for advanced gastric can
P Hermanek (2005)
Eur J Cancer
Prognostic relevance of systematic lymph node dissection in gastric carcinoma
W. J. Lee (1994)
Patient survival after D1 and D2 resections for gastric cancer: long-term results of MRC randomized surgical trial
J. Fielding (2001)
For personal use only. No other uses without permission. Copyright ©
A N Grimley (2006)
Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group.
J. R. Siewert (1993)
Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial
J. Waters (1999)
Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF
K. Sumpter (2005)
Chemotherapy for advanced gastric cancer.
S. Al-Batran (2007)
Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente).
E. Mari (2000)
Perioperative chemotherapy in operable gastric and lower oesophageal cancer: Final results of a randomised, controlled trial (the MAGIC trial, ISRCTN 93793971)
D. Cunningham (2005)
Perioperative chemotherapy in operable gastric and lower esophageal cancer : a randomized , controlled trial ( the MAGIC trial , ISRCTN 93793971 )
W Allum (2004)
Butler (1876)
Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a metaanalysis of published randomised trials -a study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell
E Mari
Copyright © 2006 Massachusetts Medical Society
FAM) versus surgery alone for patients with locally advanced gastric adenocarcinoma: a Southwest Oncology Group study
Adriamycin Fu (1993)
Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach.
P. Mcculloch (2003)
Gastric cancer: a curable disease in Britain.
H. Sue-Ling (1993)
Chase Farm Hospital — J. Bolton; Chelsea & Westminster Hospital — C. Wastell; Cheltenham General Hospital — R. Counsell, S. Elyan
Bedford Khan
International Union against Cancer: TNM classification of malignant tumours
P Hermanek (1987)
Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomized FAMTX trial
HH Hartgrink (2004)
ADJUVANT CHEMOTHERAPY IN OPERABLE GASTRIC CANCER: 5 Year Follow-up of First British Stomach Cancer Group Trial
W. Allum (1989)
J Clin Oncol
Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials.
J. Hermans (1993)
Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer.
P. Ross (2002)
Extended lymph-node dissection for gastric cancer.
J. Bonenkamp (1999)

This paper is referenced by
Multimodal Treatment of Resectable Gastric Cancer with Intensive Neoadjuvant Radiation Therapy: Obninsk Radiological Center Experience
V. Skoropad (2011)
Chapter 14 – Esophageal Cancer
John F. Bruzzi (2012)
Poor Survival Rate in Patients with Postoperative Intra-Abdominal Infectious Complications Following Curative Gastrectomy for Gastric Cancer
M. Tokunaga (2012)
Institutionen för molekylär medicin och kirurgi OESOPHAGEAL CANCER: SURGERY, SYMPTOMS AND SURVIVAL
Maartje van der Schaaf (2014)
Impact of Annexin A3 expression in gastric cancer cells.
S. Y. Yu (2014)
Prognostication and New Treatment Strategies for Esophageal and Junctional Cancer
Joël Shapiro (2016)
BAX and CDKN1A polymorphisms correlated with clinical outcomes of gastric cancer patients treated with postoperative chemotherapy
X. Wang (2014)
Current management of gastric cancer.
A. Viúdez-Berral (2012)
Impact of postoperative chemotherapy in patients with locally advanced gastroesophageal adenocarcinoma treated with perioperative chemotherapy strategy.
G. Luc (2015)
Tumoren des oberen Gastrointestinaltraktes
I. Gockel (2015)
Gastric cancer adjuvant therapy.
F. Lordick (2016)
Impact of Centralizing Gastric Cancer Surgery on Treatment, Morbidity, and Mortality
S. Nelen (2017)
Annexin A2 is implicated in multi-drug-resistance in gastric cancer through p38MAPK and AKT pathway.
Z. Zhang (2014)
Current management of oesophageal cancer
N. Rashid (2015)
Lumbar sympathectomy combined endarterectomy and percutaneous transluminal balloon angioplasty in patients with TAO
H. Wang (2018)
Surgical Treatment of Adenocarcinomas of the Gastro-esophageal Junction
K. Parry (2014)
Probable Cure of Two Patients with Advanced Gastric Carcinoma by Chemotherapy Only: Long-term Follow-up of a Phase I Trial with a Weekly Carboplatin and Epirubicin Regimen
Ester J. M. Siemerink (2009)
Tumour deposits are a significant prognostic factor in gastric cancer – a systematic review and meta‐analysis
C. Graham Martínez (2019)
Risk factors for selection of patients at high risk of recurrence or death after complete surgical resection in stage I gastric cancer
J. H. Park (2015)
Oesophagogastric cancer: exploring the way to an individual approach
J. Stiekema (2015)
HER2/neu testing in gastric cancer by immunohistochemistry: assessment of interlaboratory variation.
B. Sheffield (2014)
Prevalence of False-Negative Results of Intraoperative Consultation on Surgical Margins During Resection of Gastric and Gastroesophageal Adenocarcinoma
J. C. Mcauliffe (2018)
Metabolic reprogramming in gastric cancer
E. Linnane (2015)
Overexpressed targeting protein for Xklp2 (TPX2) serves as a promising prognostic marker and therapeutic target for gastric cancer
B. Liang (2016)
Phase II multi-institutional prospective randomised trial comparing S-1+paclitaxel with S-1+cisplatin in patients with unresectable and/or recurrent advanced gastric cancer
E. Mochiki (2012)
clinical practice guidelines Gastric cancer : ESMO Clinical Practice Guidelines for diagnosis , treatment and follow-up
A. Okines (2010)
The Effect of Adjuvant Chemotherapy on Stage IV ( T 4 N 1-3 M 0 and T 1-3 N 3 M 0 ) Gastric Cancer
T. K. Ha (2009)
[Perspectives of the stomach cancer treatment: the introduction of molecular targeted therapy and the hope for cure].
D. Y. Cheung (2013)
Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: a single western center experience.
S. Scaringi (2008)
Advanced stage gastric cancer and neoadjuvant chemotherapy: our experience in surgical resectability.
P. Del Rio (2013)
CHAPTER 11 – EUS in the Evaluation of Gastric Tumors
T. Roesch (2011)
Short and long term outcomes of oesophagectomy in a provincial New Zealand hospital.
F. Alherz (2012)
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