Survival after radiotherapy in gastric cancer: systematic review and meta-analysis.
OBJECTIVE
A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer.


METHODS
Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers' score.


RESULTS
Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08-1.48; NNT=17) and 1.31 (95% CI: 1.04-1.66; NNT=13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found.


CONCLUSIONS
This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies.
Valentini
Vincenzo
V
Radiotherapy Department, Catholic University of Sacred Heart, Largo F. Vito 1, Rome, Italy.vvalentini@rm.unicatt.it
Cellini
Francesco
F
Minsky
Bruce D
BD
Mattiucci
Gian Carlo
GC
Balducci
Mario
M
D'Agostino
Giuseppe
G
D'Angelo
Elisa
E
Dinapoli
Nicola
N
Nicolotti
Nicola
N
Valentini
Chiara
C
La Torre
Giuseppe
G
D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000401:mortality / Q000532:radiotherapy*