Abstract
Background: The American Intergroup 0116 study (Macdonald et al; NEJM; 2001) and the British MAGIC trial (Cunningham et al; NEJM; 2006) changed clinical practice for resectable gastric cancer. It was shown that overall survival after surgery improved with postoperative chemoradiotherapy and perioperative chemotherapy, respectively. Intention-to-treat analysis of the data in the CRITICS trial (chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer; Lancet Oncology; 2018) did not show a survival difference between the two treatment arms. Due to comorbidity, the aging society, treatment related toxicity and major surgery, compliance is a problem in clinical studies. A per protocol analysis was performed acknowledging the limitations of such analysis.
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