title: Postoperative chemoradiotherapy versus chemotherapy for R0 resected gastric cancer with D2 lymph node dissection: an up-to-date meta-analysis.
abstract: BACKGROUND
  This meta-analysis aims to provide more evidence on the role of postoperative chemoradiotherapy (CRT) for gastric cancer (GC) patients in Asian countries where D2 lymphadenectomy is prevalent.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials (RCTs), extracted data of survival and toxicities, and pooled data to evaluate the efficacy and toxicities of CRT compared with chemotherapy (CT) after D2 lymphadenectomy.
  
  
  RESULTS
  A total of 960 patients from four RCTs were selected. The results showed that postoperative CRT significantly reduced loco-regional recurrence rate (LRRR: RR = 0.50, 95 % CI = 0.34-0.74, P = 0.0005) and improved disease-free survival (DFS: HR = 0.73, 95 % CI = 0.60-0.89, P = 0.002). However, CRT did not affect distant metastasis rate (DMR: RR = 0.81, 95 % CI = 0.60-1.08, P = 0.15) and overall survival (OS: HR = 0.91, 95 % CI = 0.74-1.11, P = 0.34). The main grade 3-4 toxicities manifested no significant differences between the two groups.
  
  
  CONCLUSIONS
  Overall, CRT after D2 lymphadenectomy may reduce LRRR and prolong DFS. The role of postoperative CRT should be further investigated in the population with high risk of loco-regional recurrence.
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China.|Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors: Meng-Long
authors: ML
authors: Zhou
authors: Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, School of Public Health, Fudan University, 130 Dong An Rd, Shanghai, 200032, PR China.
authors: Mei
authors: M
authors: Kang
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China.|Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors: Gui-Chao
authors: GC
authors: Li
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China. guoxm1800@163.com.|Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China. guoxm1800@163.com.
authors: Xiao-Mao
authors: XM
authors: Guo
authors: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China. zhenzhang7@163.com.|Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China. zhenzhang7@163.com.
authors: Zhen
authors: Z
authors: Zhang
mesh_terms: D001208:Asia / Q000453:epidemiology; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D018572:Disease-Free Survival; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
keywords: Chemoradiotherapy; D2 surgery; Meta-analysis; Stomach neoplasms