title: Adjuvant radiochemotherapy for gastric cancer: Should we use prognostic factors to select patients?
abstract: Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer (GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a well-performed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the disease-free survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the post-operative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to post-operative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients.
authors.affiliation: Linda Agolli, Riccardo Maurizi Enrici, Mattia Falchetto Osti, Radiation Oncology, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.affiliation: Linda Agolli, Riccardo Maurizi Enrici, Mattia Falchetto Osti, Radiation Oncology, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maurizi Enrici
authors.affiliation: Linda Agolli, Riccardo Maurizi Enrici, Mattia Falchetto Osti, Radiation Oncology, Sant'Andrea Hospital, 00189 Rome, Italy.
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
mesh_terms: D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Adjuvant radiotherapy; Gastric cancer; Locally advanced disease; Prognostic factors; Selected patients
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