MacDonald versus MAGIC treatment protocols for gastric cancer: age as a decision factor
Keywords:Gastric cancer, MacDonald protocol, MAGIC protocol
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.
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