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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2016; 22(3): 1131-1138
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1131
Adjuvant radiochemotherapy for gastric cancer: Should we use prognostic factors to select patients?
Linda Agolli, Riccardo Maurizi Enrici, Mattia Falchetto Osti
Linda Agolli, Riccardo Maurizi Enrici, Mattia Falchetto Osti, Radiation Oncology, Sant’Andrea Hospital, 00189 Rome, Italy
Author contributions: Agolli L wrote the paper; Agolli L and Maurizi Enrici R analyzed the literature and selected accurately the cited articles; Osti MF and Maurizi Enrici R critically reviewed/revised the present review; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Linda Agolli, MD, Radiation Oncology, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
Telephone: +39-63-3776160 Fax: +39-63-3776608
Received: April 29, 2015
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.

Keywords: Gastric cancer, Adjuvant radiotherapy, Prognostic factors, Locally advanced disease, Selected 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.