BOSTON, MA, United States (UPI) — Attacking stomach cancer with anti-cancer drugs before and after surgery can dramatically increase the chances that patients will survive at least five years, researchers reported Wednesday.

In the United States, the standard of care for gastric cancers has been surgery when there is possibility that performing the operation could cure the patient. After the surgeon has finished his work, the patients often receive chemotherapy and/or radiation.

However, in a report to be published Thursday in the New England Journal of Medicine, doctors in the United Kingdom said their patients achieved a 36 percent five-year survival if they underwent the peri-operative chemotherapy schedule — three cycles of anti-cancer drugs before surgery and three cycles after surgery.

That compared to a 23 percent five-year survival for patients with cancers of the stomach, the junction of the stomach and esophagus or lower esophagus, who only received surgical excision of the their tumors.

‘This treatment should be considered as an option for patients with gastric cancer,’ said the study`s lead author David Cunningham, a surgeon at Royal Marsden Hospital, London.

He enrolled 503 patients in the study, randomly assigning 250 to receive chemotherapy and surgery; the other 253 patients were assigned to receive surgery.

In an accompanying editorial in the journal, John Macdonald, medical director of St. Vincent`s Comprehensive Cancer Center in New York, agreed with the findings.

‘Clinicians can have confidence in the solid evidence that peri-operative therapy improves the outcome for patients with respectable gastric cancer,’ he told United Press International. He also said the trial was well-designed and well-executed and had enough patients to show that the results did not appear to occur by chance.

However, he pointed out that the results apply to patients who are seen prior to surgery. ‘In the U.S.,’ he explained, ‘the medical oncology teams often only see stomach cancer patients after they have already undergone an operation.’

Robert Mayer, director of the Center for Gastrointestinal Oncology at the Dana-Farber Cancer Institute in Boston, told UPI that the study provides important lessons for treatment of gastric cancer.

‘This study tells us that gastric cancer is a treatable disease and it does respond to chemotherapy,’ said Mayer, also professor of medicine at the Harvard Medical School. ‘It tells us that chemotherapy should be added to surgery for this disease and it shows us that the chemotherapy used in this study is not only remarkably well-tolerated, but it is effective as well.’

The chemotherapy regimen of epirubicin, cisplatin and fluorouracil (ECF), he said, appears to be less toxic to patients that previous chemotherapy regiments used in the treatment of gastric cancer.

In the study, Cunningham and colleagues gave each patient in the chemotherapy group three cycles of ECF with each cycle lasting three weeks. The patients then waited another three weeks before undergoing surgery. After surgery, the patients had another three weeks of chemotherapy.

But some experts were skeptical about how the findings might be applied in the real world.

‘There are surgeons in the United States who might be nervous about letting a patient who is a candidate for curative surgery wait three to four months before having the operation,’ said William Blackstock, associate professor of radiation oncology at Wake Forest University in Winston-Salem, N.C.

‘If a surgeon told me, `William, I can get it all out now,` I think I would opt for the surgery,’ he told UPI.

However, Blackstock added that in the British study, it didn`t seem to make any difference in whether the surgeon ‘could get it all’ if he did surgery immediately or waited for the patient to complete chemotherapy. About 69 percent of the patients in the study had ‘curative’ operations — meaning the surgeon thought he got it all — if they have chemotherapy first; about 66 percent of the patients who went right to surgery had curative operations.

‘We know that in stomach cancer,’ Mayer said, ’surgery alone does not have a very good survival record. We also know that preoperative chemotherapy has improved survival rates in breast cancer and in rectal cancer, and we see the same pattern here with gastric cancer. So I don`t think surgeons should worry that much about letting their patients have chemotherapy first.’

Macdonald said that waiting to do the operation is an issue with surgeons. However, he said that the Cunningham study showed that patients who had chemotherapy before surgery generally has smaller tumors when the operation was undertaken and had less disease that had spread to lymph nodes

In the study, Cunningham reported that patients getting chemotherapy first had a relative risk reduction of 25 percent of dying after five years and a 34 percent lower risk of having their cancer spread or recur. He said that taking chemotherapy in advance of the surgery had little impact on complications from the operation — 46 percent of the chemotherapy patients and 45 percent of the surgery-only patients had post-surgical problems.