Grant: Operating Grant

In Canada, stomach and esophageal cancer are the 9th and 10th leading causes of cancer death respectively. For patients with stomach cancer, surgery may cure those with localized cancer, but most patients present with more advanced cancer and when treated with surgery, cancer will recur in 70% of patients. Thus, surgery alone is not an adequate treatment. There are currently two 'standard' methods used worldwide to treat patients whose stomach cancer is more advanced - either treatment with chemotherapy before and after surgery, or a combination of radiation plus chemotherapy following surgery. We believe that combining these two approaches will provide even greater benefit, especially if the combination of radiation plus chemotherapy is given prior to surgery. This randomized controlled trial will build on research conducted to date and compare chemotherapy given both before and after surgery with or without adding concurrent chemotherapy + radiation before surgery. The proposed trial is being conducted in Canada by an established network of Canadian cancer investigators known as the NCIC Clinical Trials Group and includes participation by groups in Australia and Europe. The objective of this trial is to determine whether adding chemo-radiotherapy improves patient survival. Important secondary outcomes include evaluation of quality of life, toxicity, cost-effectiveness, cost-utility. The trial will include 750 patients from across the world, including approximately 375 from Canada, and will take 8 years to complete.