title: Is postoperative adjuvant chemoradiotherapy efficacious and safe for gastric cancer patients with D2 lymphadenectomy? A meta-analysis of the literature.
abstract: BACKGROUND
  Adjuvant chemoradiotherapy (CRT) for patients with gastric cancer after D2 lymphadenectomy remains controversial. The objective of the present meta-analysis was to analyze efficacy and safety of postoperative CRT and establish a consensus on whether it is suitable for the patients.
  
  
  METHODS
  We searched PubMed, Ovid, Cochrane, and Web of Science. Statistical analysis was carried out by STATA version 12.0 software. The quality of evidence was assessed by Jadad and the Newcastle-Ottawa quality assessment scale.
  
  
  RESULTS
  Six studies involving 2135 patients were included for the meta-analysis. The results showed that, compared with non-CRT, postoperative adjuvant CRT was associated with a significant improvement in 5-year overall survival (OS) (HR = 0.79, 95% CI 0.68-0.92, P = 0.002) and 5-year relapse-free survival (RFS) (HR = 0.81, 95% CI 0.70-0.93, P = 0.004). However, there were no differences in distant metastasis (RR = 0.93, 95% CI 0.82-1.06, P = 0.304) and treatment-related toxicity between the two groups.
  
  
  CONCLUSIONS
  From the results of our study, postoperative adjuvant CRT may be associated with longer 5-year OS and 5-year RFS in patients with D2 lymphadenectomy, but might not improve 5-year disease-free survival compared to non-CRT. Methodologically high-quality comparative studies are needed for further evaluation.
authors.affiliation: Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China. Electronic address: liangjiwang1985@163.com.
authors.forename: J W
authors.initials: JW
authors.lastname: Liang
authors.affiliation: Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China.
authors.forename: Z C
authors.initials: ZC
authors.lastname: Zheng
authors.affiliation: Department of Radiology, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China.
authors.forename: T
authors.initials: T
authors.lastname: Yu
authors.affiliation: Center of Tumor Diagnosis and Therapy, The Second Workers Hospital of Liaohe Oil Field, Panjin, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China.
authors.forename: J J
authors.initials: JJ
authors.lastname: Zhang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery*; D016019:Survival Analysis
keywords: Chemoradiotherapy; D2 lymphadenectomy; Gastric cancer; Meta-analysis; Postoperative