Gastric Cancer: The role of radiation therapy in the management of gastric cancer

Abstract

Gastric cancer continues to be one of the most important gastrointestinal cancers. Despite improved surgery and resection rates of 30%-60% still most of the patients die of loco-regional recurrence or distant metastasis. The role of adjuvant and palliative treatment of gastric cancer has world-wide been assessed in uncontrolled and prospective studies. Many of those were insufficient with respect to the number of patients and inclusion of prognostic factors as stratification criteria. Furthermore, the radiation oncologist would have preferred if these studies had looked at loco-regional tumor control instead of response rates or overall survival. A comprehensive overview of the currently available data for radiation therapy in adjuvant and palliative treatment schedules of gastric cancer is given and the limits of these studies are critically discussed. Until now, there is no clear evidence of improved overall survival from the addition of radiation therapy. However, the data suggest radiation therapy might be an effective measure to reduce loco-regional recurrence rates and similarly increase the recurrence-free survival. For the next future, optimally designed phase III trials with sufficient numbers of patients should be initiated to assess the definite value of radiation therapy for gastric cancer.