Radiotherapy in gastric cancer: a systematic review of literature and new perspectives

Abstract

Gastric cancer is still a major problem for oncologists. Surgery is the main therapeutic approach; a complete surgical resection is usually necessary to offer potentially curative therapy to patients with adenocarcinoma of the stomach. However, many patients with more locally advanced tumors will experience local and distal recurrences. When a recurrence occurs, only palliative therapy is possible. In operable gastric cancer, both the extent of surgery and the value of adjuvant treatment remain subject to considerable international controversies. To improve local control, surgeons address the role of standardized surgery and of more extended surgery. Radiotherapy appears to improve local control and survival in the adjuvant arms, but perspective randomized trials are scarce and reported over many years. Retrospective experience demonstrated a low local recurrence rate, but was affected by large heterogeneity. However, evidence published in the last few years, improved radiotherapy technologies, better knowledge of the at-risk areas (enabling smaller radiotherapy volumes) and growing interest in neoadjuvant approaches support the role of radiotherapy in gastric cancer.

Keywords::

• chemoradiation preoperative
• combined modality treatment
• gastric cancer
• IORT
• postoperative
• radiation therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.