Radiotherapy in gastric cancer: a systematic review of literature and new perspectives.
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.
Valentini
Vincenzo
V
Università Cattolica S.Cuore, Radiotherapy Department, Largo F.Vito, 1, 00168 Rome, Italy. vvalentini@rm.unicatt.it
Cellini
Francesco
F
D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005544:Forecasting; D005743:Gastrectomy; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000532:radiotherapy; D010166:Palliative Care; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000639:trends*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents