After surgery, patients are next concerned about postoperative treatment, even including when to start and when to finish. This article goes over the timing of postoperative adjuvant chemotherapy.
When does chemotherapy start?
Patients with gastric cancer are ready to start antitumor therapy after their physical status has largely returned to normal after surgery. Usually, postoperative adjuvant chemotherapy is started within 1 month after surgery. If the patient does not recover well after surgery, it can be postponed to 6-8 weeks after surgery. However, chemotherapy should generally be started no later than 3 months after surgery.
How long do you do chemotherapy?
There are no definitive recommendations in national and international guidelines for the duration of adjuvant chemotherapy after surgery for gastric cancer. In recent years, the adjuvant chemotherapy regimens for gastric cancer with Class 1 evidence (i.e., the highest level of evidence) recommended by our guidelines include the XELOX regimen [Oxaliplatin + Capecitabine], the XP regimen [Capecitabine + Cisplatin], and the Tegeo monotherapy regimen.
In postoperative adjuvant chemotherapy for gastric cancer, the duration recommended by physicians is generally 1 year (8 cycles) of tegeo monotherapy or 6 months (8 cycles) of the XELOX regimen, and for XP, 6 months (8 cycles) of adjuvant chemotherapy is also generally recommended; for patients who have received preoperative neoadjuvant chemotherapy, the duration of postoperative chemotherapy is slightly adjusted depending on the number of preoperative chemotherapy cycles, usually peri For patients who have received preoperative neoadjuvant chemotherapy, the duration of postoperative chemotherapy varies slightly depending on the number of preoperative chemotherapy cycles.
Adjuvant chemotherapy can be discontinued after the prescribed course of treatment has been achieved and the disease has stabilized. However, in practice, the course of chemotherapy is not set in stone. If the doctor determines that the patient cannot tolerate further treatment because of their medical condition, he or she may consider discontinuing or withholding adjuvant chemotherapy. For example, studies have shown that at cumulative doses of oxaliplatin of 850 mg/m (approximately 6 weeks), more than half of patients develop neurotoxicity and the risk of persistent symptoms approaches 10%, making it difficult for many patients to achieve a full dose and duration of chemotherapy. In a Japanese study, only 65.8% of patients in a single-agent postoperative adjuvant chemotherapy with tegeo completed all 12 months of continuous therapy, and 46.5% had dose reductions due to side effects. It is clear that efficacy and safety sometimes do not go hand in hand.
Summary
Summary
The start, stop, and duration of postoperative adjuvant chemotherapy are not set in stone, and physicians will follow these principles with flexibility to maximize the therapeutic benefit to patients while maintaining safety. (Contributed by Yanwen Diao, Department of Medical Oncology, The First Affiliated Hospital of China Medical University)