Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1131
Peer-review started: May 12, 2015
First decision: August 25, 2015
Revised: September 24, 2015
Accepted: November 24, 2015
Article in press: November 24, 2015
Published online: January 21, 2016
Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer (GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a well-performed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the disease-free survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the post-operative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to post-operative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients.
Core tip: This is a review of the recent literature that analyze the impact of prognostic factors in patients affected by gastric cancer (GC). The results from the principal clinical trials regarding treatment for GC patients are controversial. Adjuvant therapy for locally advanced disease remains undefined in different countries. Prognostic factors can help clinicians to select those patients who can benefit more from combined post-operative therapy with radiochemotherapy and should be considered in the multidisciplinary meetings.