title: Chemoradiation therapy versus chemotherapy alone for gastric cancer after R0 surgical resection: a meta-analysis of randomized trials.
abstract: OBJECTIVE
  Current national guidelines include category 1 recommendations for perioperative chemotherapy or adjuvant chemoradiation with surgical resection for patients with stage IB-IIIB gastric cancer. We conducted a meta-analysis of randomized trials in which chemotherapy was prospectively tested against chemoradiation with surgical resection.
  
  
  METHODS
  We electronically searched PubMed and EMBASE for randomized, controlled clinical trials involving patients with gastric adenocarcinoma, status post-R0 resection. The interventions compared were adjuvant chemotherapy versus chemoradiation, with any chemotherapy regimen. The primary outcomes of interest were disease-free survival and overall survival. The Mantel-Haenszel random-effects model was used to calculate effect sizes.
  
  
  RESULTS
  Six trials that included 1,171 patients were evaluated; 599 were randomized to adjuvant chemoradiation and 572 to chemotherapy alone. Chemoradiation was associated with a significant increase in disease-free survival (odds ratio 1.48, 95% confidence interval 1.08-2.03) when compared to chemotherapy alone. However, there was no significant difference in overall survival (odds ratio 1.27, 95% confidence interval 0.95-1.71). Five trials found no statistically significant differences in toxicities between the two groups.
  
  
  CONCLUSIONS
  In patients with gastric cancer status post-R0 resection, adjuvant chemoradiation was associated with higher disease-free survival when compared to chemotherapy alone. It remains appropriate to design trials testing new systemic agents with radiotherapy.
authors.affiliation: New York University School of Medicine, New York, N.Y. USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Min
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Sachin
authors.initials: S
authors.lastname: Jhawar
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.forename: Joseph
authors.initials: J
authors.lastname: Nicholson
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Leichman
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Du
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005743:Gastrectomy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome