Usually chemotherapy isn't recommended if you are having an operation to take away stomach cancer. This is because most studies found very little if any benefit from giving chemotherapy after surgery. However, a recent clinical trial, the MAGIC trial, has shown promising results for chemotherapy when it is given both before and after surgery for cancer of the stomach.

The study looked at people who had a type of stomach cancer called adenocarcinoma and who were able to have an operation to take the cancer away.

Surgery is the main treatment for most stomach cancers. The operation usually involves taking away some or all of the stomach. Often the lymph glands are taken away at the same time.

However, even when the cancer has been removed by surgery, there is a risk that some cancer cells will be left behind or already have spread. These cells are too small to be seen on a scan and can cause the cancer to come back later on. So, doctors are always looking for new ways to try to reduce the risk of the cancer returning.

In the MAGIC study people were either given surgery on its own or chemotherapy before and after surgery. This is called peri-operative chemotherapy.

In the study half the people taking part in the trial were to be given three doses of ECF chemotherapy before their operation and three doses afterwards.

Doctors hoped that giving chemotherapy in this way would:

• help more people to live for longer, this is called overall survival
• help more people to live for longer without any signs of the cancer, this is called progression free survival.

The results of the study showed that peri-operative chemotherapy improved both overall survival and progression free survival. People who had peri-operative chemotherapy were less likely to have the cancer return and were more likely to be alive five years after treatment than people who only had surgery.

This is good news. However, there are some drawbacks to having chemotherapy as well as surgery. Only 42 out of every 100 (42%) patients taking chemotherapy were able to complete all of the planned treatment.

There were different reasons for this. Some people found it difficult to cope with the side effects of treatment and asked to stop early. Sometimes the cancer grew despite the chemotherapy and so no more was given.

But despite these problems the results are encouraging. You may find it helpful to talk to your specialist about chemotherapy to find out whether it may be helpful in your situation.

Reference:

• Cunningham D et al 2006 Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England journal of medicine. 355(1)11-19.