title: Postoperative adjuvant chemoradiotherapy in D2-dissected gastric cancer: is radiotherapy necessary after D2-dissection?
abstract: Studies from the Far East have demonstrated that D2-dissection is superior to D0/1-dissection. The effect of postoperative chemoradiotherapy (CRT) after D2-dissection has not been accepted due to the lack of D2-dissection in Western countries, as well as the potential harmful effect of radiotherapy. In the current NCCN guideline, adjuvant chemotherapy alone is recommended in D2-dissected patients. However, three recent prospective randomized controlled trials in South Korea and China (ARTIST, NCC and Multicenter IMRT Trials) demonstrated that adjuvant CRT can be safely administered to D2-dissected patients with notable benefits. To identify the role of radiotherapy (RT) in the D2-dissected postoperative setting, clinical research attempts should include (1) identification of high-risk patients for loco-regional recurrence who might benefit from CRT; (2) modification of RT target volume based on the findings that failure patterns should be different after D1- and D2-dissection; and (3) integration of new RT techniques to decrease treatment-related toxicity. The present paper is a review of recent studies addressing these fields. Well-designed prospective randomized studies are needed to clearly define the role of adjuvant CRT in D2-dissected gastric cancer, however, future clinical studies should also focus on answering these questions.
authors.affiliation: Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Jee Suk
authors.initials: JS
authors.lastname: Chang
authors.affiliation: Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Woong Sub
authors.initials: WS
authors.lastname: Koom
authors.affiliation: Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Youngin
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hong In
authors.initials: HI
authors.lastname: Yoon
authors.affiliation: Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Hyung Sik
authors.initials: HS
authors.lastname: Lee
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D009367:Neoplasm Staging; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chemotherapy; D2-dissection; Gastric cancer; Radiotherapy; Recurrence