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

Abstract

In patients affected by gastric cancer (GC), especially those in advanced stage, the multidisciplinary approach of treatment is fundamental to obtain a good disease control and quality of life. Although many chemotherapeutics in combination to radiotherapy are adopted in the peri- or postoperative setting, the most optimal timing, regimens and doses remains controversial. In the era of radical surgery performed with D2-lymphadenectomy, the role of radiation therapy remains to be better defined. Categories of patients, who could benefit more from an intensified local treatment rather than more toxic systemic therapy, are still under investigation. Evidence and recent updates of the randomized trials, meta-analysis and prospective trials show that the postoperative radiotherapy plays a fundamental role in reducing the loco-regional recurrence and in turn the disease-free survival in operable advanced GC patients, also after a well performed D2 surgery. Therapeutic decisions should be taken considering the individual patients, but the multimodal approach is necessary to guarantee a longer survival and a good quality of life. Ongoing randomized trials could better define the timing and the combination of radiotherapy and systemic therapy.

Keywords: Adjuvant chemoradiation; Locally advanced; Perioperative chemotherapy; Gastric cancer; Combined treatment

Core tip: This is a review of recent updates from randomized data and prospective phase I/II trial regarding the role of radiotherapy in the multimodal approach of gastric cancer (GC). The actual state of art is still controversial and in particular adjuvant therapy for locally advanced disease remains undefined in different countries. Recent efforts show that a more intensified local therapy such as radiation therapy cold have a benefit in increasing the disease-free survival, especially in the category of patients with positive pathological lymph nodes. A carefully multidisciplinary evaluation of the patients with GC is then recommended in the clinical practice.