Between evidence and new perspectives on the current state of the multimodal approach to gastric cancer: Is there still a role for radiation therapy?

Table 1 The main randomized trials in gastric cancer that evaluate the postoperative therapy

Trial	Year	Randomization scheme	OS	DFS, PFS	Limits
SWOG/INT-0116[6]	2001	S-alone vs S + CRT	3-yr: 50% vs 41% (P = 0.005)	3-yr: 48% vs 31% (P < 0.001)	Low rates of D2 node dissection, 2D RT technique
Update SWOG/INT-0116[7]	2012	S-alone vs S + CRT	HR = 1.32 (95%CI: 1.10-1.60; P = 0.0046)	HR = 1.51 (95%CI: 1.25-1.83; P < 0.001)	Low rates of D2 node dissection, 2D RT technique
ARTIST[11] CRITICS[16]	2012 2018	S + CT + CRT + CT vs S + CT CT + S + CT vs CT + S + CRT	NR Median OS 43 vs 37 mo (P = 0.09)	3-yr: 78% vs 74% (P = 0.086)	Planned events not reached, lower % of locally advanced tumors Poor postoperative patient compliance in both treatment arms
NCC, South Korea[17]	2012	S + CRT vs S + CT	NR	5-yr: 73.5% vs 54.6%, (P = 0.056)	Poor accrual Sometimes 2D RT technique
Chinese Study[18]	2012	S + CRT vs S + CT	5-yr: 48.4% vs 41.8% (P = 0.122)	5-yr: 45.2% vs 35.8% (P = NS)	Small series
ACTS-GC[19]	2007	S-alone vs S + CT	3-yr: 80.1% vs 70.1% (P = 0.003)	3-yr: 59.6% vs 72.2% (P < 0.001)	Closed earlier due to significant survival benefit in the CT-arm
CLASSIC[20]	2012	S-alone vs S + CT	NR	3-yr: 59% vs 74% (P < 0.0001)	Stopped after the interim efficacy analysis

OS: Overall survival; DFS: Disease-free survival; PFS: Progression-free survival; RT: Radiotherapy; S: Surgery; CT: Chemotherapy; CRT: Chemoradiation; NR: Not reported; HR: Hazard ratio; CI: Confidence interval; NS: Not significant.