Postoperative adjuvant chemoradiation therapy in cases of high-risk gastric cancer

Gastric cancer is a common cancer worldwide with a high mortality rate. Despite curative intent resection, locoregional failure as a frequent site of recurrence is responsible in part for this high mortality. Many attempts have been made to decrease the risk of recurrence after resection. Studies involving postoperative chemotherapy as a single modality have not clearly demonstrated benefit. Similarly, most studies of postoperative radiation therapy have not clearly shown an improvement in overall survival. Recently, however, a USA Intergroup study indicated a survival advantage for chemoradiation therapy compared to surgery alone for patients with locally advanced gastric cancer. "Intergroup-116" is a large-scale randomized trial designed to evaluate the role of adjuvant chemotherapy plus radiotherapy following curative intent gastric resection. The data from this study demonstrate a survival benefit with adjuvant chemoradiation that may in large part be due to better locoregional control. While many patients had a less then adequate lymph node dissection, survival was not associated with the type of lymph node dissection performed. Toxicity was acceptable. "Intergroup-116" indicates that postoperative chemoradiation should be considered as a standard care option for patients with locally advanced gastric cancer. Future studies should evaluate potentially more effective systemic therapy, molecularly-directed treatment, and possibly, whether or not more formal lymph node dissections would obviate the need for radiation.