Chemotherapy and Radiation Therapy After Surgery in Treating Patients With Stomach or Esophageal Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the stomach or gastroesophageal junction (adenocarcinoma of the esophagus must involve the gastroesophageal junction) meeting the following criteria:

  • Tumor extension beyond muscularis propria and/or nodal involvement without evidence of M1 disease
  • Stage II, IIIA, IIIB, or IV (T2, N2, M0)
  • Stage IB (T1, N1, M0; T2, N0, M0 allowed if extension beyond muscularis propia)

• Prior en bloc resection, with curative intent, of all known tumor

  • No microscopic evidence of tumor at the line of resection
  • No noncontiguous resection
• No known unresected or recurrent disease at the distal or proximal line of stomach resection
• No metastatic disease

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Granulocyte count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic

• Bilirubin no greater than 2.0 mg/dL
• AST no greater than 3 times upper limit of normal

Renal

• Creatinine no greater than 1.5 mg/dL
• No unilateral renal function

Cardiovascular

• No myocardial infarction within the past 6 months
• No uncontrolled high blood pressure
• No unstable angina
• No symptomatic congestive heart failure
• No serious uncontrolled cardiac arrhythmia
• No New York Heart Association class III or IV heart disease
• No cardiac disease resulting in marked limitation or inability of physical activity

Other

• Stable weight for at least one week before study
• Not pregnant or nursing
• Fertile patients must use effective contraception
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or fully resected noninvasive carcinoma in situ
• No other uncontrolled serious medical condition or psychiatric illness that would preclude study entry
• No active infection
• No peripheral neuropathy grade 2 or greater
• All patients must be evaluated by a radiation oncologist prior to enrollment to ensure patient is appropriate for radiotherapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Prior biologic therapy allowed

Chemotherapy

• No prior chemotherapy
• No other concurrent chemotherapy

Endocrine therapy

• Prior hormonal therapy allowed

• No concurrent hormonal therapy except the following:

  • Steroids for adrenal failure
  • Hormones for non-disease-related conditions (e.g., insulin for diabetes)
  • Intermittent dexamethasone as an antiemetic

Radiotherapy

• No prior radiotherapy

Surgery

• See Disease Characteristics
• At least 3 weeks since prior surgery
• No more than 12 weeks since prior surgery