Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2018; 10(9): 271-281
Published online Sep 15, 2018. doi: 10.4251/wjgo.v10.i9.271
Between evidence and new perspectives on the current state of the multimodal approach to gastric cancer: Is there still a role for radiation therapy?
Linda Agolli, Luca Nicosia
Linda Agolli, Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01037, Germany
Luca Nicosia, Department of Radiation Oncology, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy
Author contributions: Agolli L and Nicosia L wrote the paper analyzed the literature and selected accurately the cited articles; Agolli L critically reviewed and 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, Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany.
Telephone: +49-351-45819550 Fax: +49-351-4587263
Received: March 29, 2018
Peer-review started: March 30, 2018
First decision: May 9, 2018
Revised: June 8, 2018
Accepted: June 26, 2018
Article in press: June 27, 2018
Published online: September 15, 2018

In patients affected by gastric cancer (GC), especially those in advanced stage, the multidisciplinary approach of treatment is fundamental to obtain a good disease control and quality of life. Although many chemotherapeutics in combination to radiotherapy are adopted in the peri- or postoperative setting, the most optimal timing, regimens and doses remains controversial. In the era of radical surgery performed with D2-lymphadenectomy, the role of radiation therapy remains to be better defined. Categories of patients, who could benefit more from an intensified local treatment rather than more toxic systemic therapy, are still under investigation. Evidence and recent updates of the randomized trials, meta-analysis and prospective trials show that the postoperative radiotherapy plays a fundamental role in reducing the loco-regional recurrence and in turn the disease-free survival in operable advanced GC patients, also after a well performed D2 surgery. Therapeutic decisions should be taken considering the individual patients, but the multimodal approach is necessary to guarantee a longer survival and a good quality of life. Ongoing randomized trials could better define the timing and the combination of radiotherapy and systemic therapy.

Keywords: Adjuvant chemoradiation, Locally advanced, Perioperative chemotherapy, Gastric cancer, Combined treatment

Core tip: This is a review of recent updates from randomized data and prospective phase I/II trial regarding the role of radiotherapy in the multimodal approach of gastric cancer (GC). The actual state of art is still controversial and in particular adjuvant therapy for locally advanced disease remains undefined in different countries. Recent efforts show that a more intensified local therapy such as radiation therapy cold have a benefit in increasing the disease-free survival, especially in the category of patients with positive pathological lymph nodes. A carefully multidisciplinary evaluation of the patients with GC is then recommended in the clinical practice.