Questionnaire survey on adjuvant chemotherapy for elderly patients after gastrectomy indicates their vulnelabilities
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In Japan, S-1 adjuvant chemotherapy for 1 year is the standard of care for the treatment of stage II and III patients under 80 years old with gastric cancer after curative operation. However, the feasibility of S-1 chemotherapy in patients over 80 years old has not yet been elucidated.
To clarify the current treatment situation and feasibility of S-1 treatment in patients over 80 years old, a questionnaire survey of the patients treated from January 2011 to December 2012 was conducted at 58 member institutions of the Stomach Cancer Study Group of the JCOG (Japan Clinical Oncology Group).
Gastrectomy was performed in 15,573 patients of all ages, and 1,660 (10.7%) patients were over 80 years of age. Of these elderly patients, 661 (4.2%) were diagnosed as stage II and III. While S-1 adjuvant chemotherapy was recommended to 248 (37.5%) of the stageII/III patients, only 99 (15.0%) of them actually received S-1. Interestingly, the creatinine clearance rate was between 30 and 80 mL/min in 87 (87.9%) of the patients suggesting that S-1 dose modification should be considered. Moreover, S-1 compliance was poor in patients with more than 15% body weight loss.
In general practice, surgery alone can be regarded as the standard of care for stage II and III gastric cancer patients over 80 years old. The feasibility and efficacy of S-1 adjuvant chemotherapy should be elucidated in a randomized control trial considering the vulnerabilities of the elderly.
KeywordsGastric cancer Elderly patients Adjuvant chemotherapy S-1
The authors wish to acknowledge to all members and facilities who answered the questionnaire survey in the Stomach Cancer Study Group of the JCOG.: Aichi Cancer Center Hospital, Cancer Institute Hospital, Chiba Cancer Center, Fukuyama City Hospital, Gifu Municipal Hospital, Gifu University School of Medicine, Hakodate Goryoukaku Hospital, Hiroshima City Asa Citizens Hospital, Hiroshima City Hiroshima Citizens Hospital, Hiroshima University Hospital, Hyogo Cancer Center, Hyogo College of Medicine, Ishikawa Prefectural Central Hospital, Itami City Hospital, Iwate Medical University, Kanagawa Cancer Center, Kansai Medical University Hospital, Kansai Rosai Hospital, Keiyukai Sapporo Hospital, Kindai University Faculty of Medicine, Kitasato University School of Medicine, Kobe University School of Medicine, Miyagi Cancer Center, Nagaoka Chuo General Hospital, Nagoya University Graduate School of Medicine, National Cancer Center Hospital, National Cancer Center Hospital East, National Hospital Organization Kyoto Medical Center, Niigata Cancer Center Hospital, Oita University Hospital, Okayama University Hospital, Osaka Prefectural General Medical Center, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Medical College, Osaka University Faculty of Medicine, Saitama Cancer Center, Saitama Medical University International Medical Center, Sakai City Medical Center, Sendai Medical Center, Shikoku Cancer Center, Shimane University Faculty of Medicine, Shizuoka Cancer Center, Shizuoka General Hospital, Tenri Hospital, Tochigi Cancer Center, Tokyo Medical and Dental University, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Toranomon Hospital, Toyama Prefectural Central Hospital, Wakayama Medical University, Yamagata Prefectural Central Hospital.
Compliance with ethical standards
Conflict of interest
K. Yoshida has received grant, personal fees and nonfinancial support from Taiho Pharm. Co., Ltd; Ono Pharm. Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Yakult Honsha Co., Ltd.; Eli Lilly Japan K.K.; Daiichi Sankyo Co., Ltd.; Merk Serono Co., Ltd.; Novartis Pharma; EA Pharma Co., Ltd.; Takeda Pharmaceutical Company; Sanofi K.K.; grant and personal fees from Johnson & Johnson K.K.; Covidien Japan; grant from Nippon Kayaku Co., Ltd.; Otsuka Pharma Co., Ltd.; Dainippon Sumitomo Pharma; personal fees from MSD K.K.; Bayer Yakuhin, Ltd. N. Takiguchi has received grant from Ministry of Health, Labor and Welfare, Japan. N. Boku has received grant and personal fees from Taiho Pharm. Co., Ltd. T. Yoshikawa has received grant from Japanese Foundation for Multidisciplinary Treatment of Cancer; grant and personal fees from Chugai Pharmaceutical Co., Ltd.; Taiho Pharm. Co., Ltd; Noartis Pharma; personal fees from Abbott Japan; Ono Pharm. Co., Ltd.; Eli Lilly Japan K.K.; Kaken Pharmaceutical; Yakult Honsha Co., Ltd.; Nippon Kayaku Co., Ltd.; Johnson & Johnson K.K.; Covidien Japan; Takeda Pharmaceutical Company; Olympus. All remaining authors declared that they have no conflict of interest.
Human rights statement and informed consent
All the questions asked in this survey were about the preference of the clinical practice of each investigator. Any patient information such as names, initials, addresses, admission dates, hospital numbers, or any other data that might identify patients were not asked or included in this survey.
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