Phase III Trial to Compare Adjuvant Chemotherapy With Capecitabine and Cisplatin Versus Concurrent Chemoradiotherapy in Gastric Cancer: Final Report of the Adjuvant Chemoradiotherapy in Stomach Tumors Trial, Including Survival and Subset Analyses.

Journal Article (Clinical Trial, Phase III;Journal Article)

PURPOSE: The Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) trial tested whether the addition of radiotherapy to adjuvant chemotherapy improved disease-free survival (DFS) in patients with D2-resected gastric cancer (GC). PATIENTS AND METHODS: Between November 2004 and April 2008, 458 patients with GC who received gastrectomy with D2 lymph node dissection were randomly assigned to either six cycles of adjuvant chemotherapy with capecitabine and cisplatin (XP) or to two cycles of XP followed by chemoradiotherapy and then two additional cycles of XP (XPRT). This final update contains the first publication of overall survival (OS), together with updated DFS and subset analyses. RESULTS: With 7 years of follow-up, DFS remained similar between treatment arms (hazard ratio [HR], 0.740; 95% CI, 0.520 to 1.050; P=.0922). OS also was similar (HR, 1.130; 95% CI, 0.775 to 1.647; P=.5272). The effect of the addition of radiotherapy on DFS and OS differed by Lauren classification (interaction P=.04 for DFS; interaction P=.03 for OS) and lymph node ratio (interaction P<.01 for DFS; interaction P<.01 for OS). Subgroup analyses also showed that chemoradiotherapy significantly improved DFS in patients with node-positive disease and with intestinal-type GC. There was a similar trend for DFS and OS by stage of disease. CONCLUSION: In D2-resected GC, both adjuvant chemotherapy and chemoradiotherapy are tolerated and equally beneficial in preventing relapse. Because results suggest a significant DFS effect of chemoradiotherapy in subsets of patients, the ARTIST 2 trial evaluating adjuvant chemotherapy and chemoradiotherapy in patients with node-positive, D2-resected GC is under way.

Full Text

Duke Authors

Cited Authors

  • Park, SH; Sohn, TS; Lee, J; Lim, DH; Hong, ME; Kim, K-M; Sohn, I; Jung, SH; Choi, MG; Lee, JH; Bae, JM; Kim, S; Kim, ST; Park, JO; Park, YS; Lim, HY; Kang, WK

Published Date

  • October 1, 2015

Published In

Volume / Issue

  • 33 / 28

Start / End Page

  • 3130 - 3136

PubMed ID

  • 25559811

Electronic International Standard Serial Number (EISSN)

  • 1527-7755

Digital Object Identifier (DOI)

  • 10.1200/JCO.2014.58.3930


  • eng

Conference Location

  • United States