Published: 2020-01-23

MacDonald versus MAGIC treatment protocols for gastric cancer: age as a decision factor

André Figueiredo, Diogo Delgado, Helena Luna Pais, Maria Filomena de Pina


Background: A multimodality approach is the standard of care in the treatment of locally advanced non-metastatic gastric cancer. However, it lacks studies that compares the adjuvant chemoradiotherapy strategy of the landmark MacDonald clinical trial with the perioperative chemotherapy strategy of the landmark MAGIC clinical trial.

Methods: Retrospective study of patients with gastric cancer stage IB-III treated at a single cancer center between 2010 and 2013 with MacDonald or MAGIC treatment protocols.

Results: Sixty-two patients were identified (38 patients in the MacDonald protocol and 24 in the MAGIC protocol), with a mean age of 68 years (range: 39-84). At a median follow-up of 37 months, the DFS survival at 12 and 36 months of the patients in the MacDonald protocol was 83.5% and 61.1% versus 79.2% and 49.7% in the MAGIC protocol, respectively (p=0.319). The overall survival at 12 and 36 months of the patients in the MacDonald protocol was 89.5% and 65.8% versus 83.3% and 54.2% in the MAGIC protocol, respectively (p=0.168). At multivariate analysis, the risk of death was significantly superior in older patients undergoing the MAGIC protocol (p=0.02), but not the MacDonald protocol (p=0.627). The differences in toxicity between the two protocols were not statistically different.

Conclusions: This result suggest that patient age is a factor to consider when choosing between the MacDonald or MAGIC protocols. However, the limitations inherent to a retrospective study of small sample size must be accounted for.


Gastric cancer, MacDonald protocol, MAGIC protocol

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Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Przeglad Gastroenterol. 2019;14(1):26.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. Cancer J Clinici. 2018;68(6):394-424.

National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology: Gastric Cancer. Version 2. 2019. Available at: Accessed on 3 June 2019.

Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. New Engl J Med. 2001;345(10):725-30.

Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New Engl J Med. 2006;355(1):11-20.

Chelakkot PG, Ravind R, Sruthi K, Menon D. Treatment in resectable non-metastatic adenocarcinoma of stomach: Changing paradigms. Ind J Cancer. 2019;56(1):74.

Jayanathan M, Erwin RP, Molacek N, Fluck M, Hunsinger M, Wild J, et al. MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and predictors of multimodal therapy for gastric cancer using the National Cancer Database. The Am J Surg. 2020;219(1):129-35.

Cheng J, Squires III MH, Mikell JL, Fisher SB, Staley III CA, Kooby DA, et al. Radiotherapy patterns of care in gastric adenocarcinoma: a single institution experience. J Gastrointestinal Oncol. 2015;6(3):247.

Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. The Lancet. 2019;393(10184):1948-57.

Lee J, Lim Do H KS, Park SH, Park JO, Park YS, Lim HY, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012;30(3):268-73.

Park SH, Zang DY, Han B, Ji JH, Kim TG, Oh SY, et al. ARTIST 2: Interim results of a phase III trial involving adjuvant chemotherapy and/or chemoradiotherapy after D2-gastrectomy in stage II/III gastric cancer (GC).

Cats A, Jansen EP, van Grieken NC, Sikorska K, Lind P, Nordsmark M, et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised phase 3 trial. The Lancet Oncol. 2018;19(5):616-28.