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World J Gastroenterol. Mar 14, 2006; 12(10): 1511-1520
Published online Mar 14, 2006. doi: 10.3748/wjg.v12.i10.1511
Role of radiation therapy in gastric adenocarcinoma
Lisa Hazard, John O’Connor, Courtney Scaife
Lisa Hazard, Departments of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, United States
John O’Connor, Department of Radiation Oncology, Tulane University, New Orleans, LA, United States
Courtney Scaife, Departments of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Lisa Hazard, MD, Department of Radiation Oncology, Huntsman Cancer Hospital, 1950 Circle of Hope, Salt Lake City, UT, 84112-5560, United States.
Telephone: +1-801-5812396 Fax: +1-801-5853502
Received: August 9, 2005
Revised: August 16, 2005
Accepted: August 26, 2005
Published online: March 14, 2006

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined.

In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone.

The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study.

The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

Keywords: Radiation therapy, Gastric cancer, Stomach cancer, Chemoradiation, Adjuvant therapy, Neoadjuvant therapy, Intra-operative radiation therapy, 3D conformal radiation therapy, Intensity modulated radiation therapy