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World J Gastroenterol. Sep 28, 2014; 20(36): 12900-12907
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12900
Postoperative adjuvant chemoradiotherapy in D2-dissected gastric cancer: Is radiotherapy necessary after D2-dissection?
Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Hyung Sik Lee
Jee Suk Chang, Woong Sub Koom, Youngin Lee, Hong In Yoon, Department of Radiation Oncology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Hyung Sik Lee, Department of Radiation Oncology, Dong-A University Hospital, Busan 602-715, South Korea
Author contributions: Chang JS and Koom WS contributed equally to this work as first authors; Koom WS and Lee HS designed the research; Chang JS, Koom WS, Lee Y, Yoon HI and Lee HS performed the research; Chang JS, Koom WS, Lee Y, Yoon HI and Lee HS analyzed the data; Chang JS, Koom WS, Lee Y and Lee HS wrote the paper.
Correspondence to: Hyung Sik Lee, MD, Department of Radiation Oncology, Dong-A University Hospital, 1-3 Dongdaesindong, Seo-gu, Busan 602-715, South Korea.
Telephone: +82-51-2405380 Fax: +82-51-2402135
Received: October 28, 2013
Revised: January 24, 2014
Accepted: April 5, 2014
Published online: September 28, 2014

Studies from the Far East have demonstrated that D2-dissection is superior to D0/1-dissection. The effect of postoperative chemoradiotherapy (CRT) after D2-dissection has not been accepted due to the lack of D2-dissection in Western countries, as well as the potential harmful effect of radiotherapy. In the current NCCN guideline, adjuvant chemotherapy alone is recommended in D2-dissected patients. However, three recent prospective randomized controlled trials in South Korea and China (ARTIST, NCC and Multicenter IMRT Trials) demonstrated that adjuvant CRT can be safely administered to D2-dissected patients with notable benefits. To identify the role of radiotherapy (RT) in the D2-dissected postoperative setting, clinical research attempts should include (1) identification of high-risk patients for loco-regional recurrence who might benefit from CRT; (2) modification of RT target volume based on the findings that failure patterns should be different after D1- and D2-dissection; and (3) integration of new RT techniques to decrease treatment-related toxicity. The present paper is a review of recent studies addressing these fields. Well-designed prospective randomized studies are needed to clearly define the role of adjuvant CRT in D2-dissected gastric cancer, however, future clinical studies should also focus on answering these questions.

Keywords: Gastric cancer, D2-dissection, Recurrence, Radiotherapy, Chemotherapy

Core tip: The survival benefits of postoperative chemoradiotherapy (CRT) in gastric cancer with D0/1-dissection have been established in Western countries. However, in Eastern areas, where D2-dissection is the standard surgical procedure, most surgeons are skeptical about the benefit of CRT in D2-dissected patients, and CRT has not been examined in this setting in clinical trials. Here we aimed to provide a review of recent research and to suggest future directions regarding adjuvant CRT after D2-dissection.