Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12900
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.
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.