Chemoradiation for resectable gastric cancer

Lancet Oncol. 2003 Aug;4(8):498-505. doi: 10.1016/s1470-2045(03)01170-7.


The incidence of gastric cancer has been declining in recent years, however, the disease continues to be a worldwide public health problem. About two thirds of patients with gastric cancer undergo surgical resection with curative intent. R0 resection--complete local-regional tumour removal with negative resection margins--is the only curative modality. The optimum extent of lymph-node dissection (D1 vs D2) is controversial. Disease relapse, both local and distant, is common and the 5-year survival rate is disappointing. Adjuvant chemotherapy has been studied extensively in this setting but an effective regimen has not yet been identified. A recent intergroup study has shown that postoperative chemoradiation is effective in improving both disease-free survival (3-year, 48% vs 31%, p<0.001) and overall survival (3-year, 50% vs 41%, p=0.005) compared with surgery alone. Preoperative radiation as a single adjuvant therapy has also yielded improvements in local-regional control, disease-free survival, and overall survival compared with surgery alone. Preoperative chemotherapy or chemoradiation has been accepted to have a theoretical advantage over postoperative therapy and has now been shown to be a feasible option. Its efficacy, however, remains to be tested.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Humans
  • Radiotherapy, Adjuvant
  • Stomach Neoplasms / drug therapy*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / radiotherapy*
  • Stomach Neoplasms / surgery
  • Survival Rate