title: Improved survival in patients with lymph node-positive gastric cancer who received preoperative radiation: an analysis of the Surveillance, Epidemiology, and End Results database.
abstract: BACKGROUND
  Several trials have been conducted to determine the feasibility of preoperative radiotherapy (RT) for gastric cancer. However, the absolute benefit from radiotherapy remains to be defined. In this study, the authors examined the use of preoperative RT (Pre-RT) and postoperative RT (PORT) in patients with gastric cancer from the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  METHODS
  The overall survival of patients who had nonmetastatic, resected gastric cancer between 2000 and 2006 was analyzed from the SEER database. Kaplan-Meier survival curves comparing Pre-RT, PORT, and no RT (No-RT) were analyzed using the log-rank test. A multivariate analysis (MVA) was conducted using Cox proportional hazards regression.
  
  
  RESULTS
  The authors identified 10,251 patients. There was no survival benefit for patients who received Pre-RT or PORT compared with No-RT patients for the entire cohort. Conversely, among lymph node-positive patients, there was a significant survival benefit from both Pre-RT and PORT compared with No-RT (log-rank test: PORT, P < .0001; Pre-RT, P = .0261). The median survival and 5-year overall survival among lymph node-positive patients were 22 months and 24%, respectively, for Pre-RT;29 months and 34%, respectively, for PORT; and 19 months and 20%, respectively, for No-RT. MVA demonstrated that Pre-RT, PORT, and removing ≥ 15 lymph nodes were independent predictors of improved survival, whereas tumor classification, lymph node status, tumor size, and tumor location were independent predictors of death.
  
  
  CONCLUSIONS
  The current results supported the use of Pre-RT in select patients with gastric cancer. However, additional trials will be needed to confirm these findings.
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA. ravi.shridhar@moffitt.org
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: George W
authors.initials: GW
authors.lastname: Dombi
authors.forename: Steven E
authors.initials: SE
authors.lastname: Finkelstein
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016019:Survival Analysis