TOPGEAR trial-results show no significant benefit of chemoradiotherapy before surgery for gastroesophageal junction cancer

The TOPGEAR trial, a major international study involving EORTC and other global research groups, examined whether adding chemoradiotherapy before surgery improves survival for patients with resectable gastric and gastroesophageal junction (GOJ) cancer- an area located at the meeting point between the esophagus and the stomach. The study aimed to determine if this combination was more effective than chemotherapy alone in improving long-term outcomes.
“Cancer of the stomach, including the gastroesophageal junction, remains an aggressive and difficult-to-treat disease with a high incidence and mortality rate worldwide,” said Professor Florian Lordick of University Hospital Leipzig, Germany, who co-chaired the study on behalf of the EORTC Gastro-Intestinal Tract Cancer Group.
Key Study Findings
Although more patients in the chemoradiotherapy group showed complete tumour response (17% vs. 8%), the trial found no significant improvement in overall survival or progression-free survival compared to chemotherapy alone. The median overall survival was 46 months for those receiving chemoradiotherapy and 49 months for those receiving only chemotherapy. Five-year survival rates were similar in both groups, at around 45%.
Based on these results, the current standard of care—perioperative chemotherapy—remains the best option.
“The results of the TOPGEAR trial will be practice-changing for many centres worldwide,” said Professor Karin Haustermans of University Hospital Leuven, Belgium, who co-chaired the trial on behalf of the EORTC Radiation Oncology Group. “Preoperative chemoradiation has been used in some centres in North America for locally advanced resectable gastric cancer and has been the standard of care in Europe, Canada, and Australia for patients with locally advanced gastroesophageal junction cancer, who comprised one-third of the TOPGEAR patient cohort. Following the results of ESOPEC earlier this year, and now TOPGEAR, national and international guideline committees will need to reconsider the current role of radiation therapy in this setting. Our role as radiation oncologists is to incorporate new imaging and precision techniques into the multimodality management of patients with gastric cancer to help improve long-term outcomes for this still dangerous disease,” said Dr Haustermans.
Further information on coordination and funding
The study was coordinated by the NHMRC Clinical Trials Centre (NHMRC CTC) at the University of Sydney. Funding was provided by NHMRC grants and the Cancer Australia Priority-driven Collaborative Cancer Research Scheme Grant, as well as by AGITG and NHMRC CTC, with regional funding from EORTC and CCTG through the Canadian Institutes of Health Research and the Canadian Cancer Society.
The trial results were published in the New England Journal of Medicine.
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