Lu HH, Xie JH, Li XR. Adjuvant chemoradiotherapy vs chemotherapy after R0 D2 gastrectomy for gastric cancer: Meta-analysis of randomized trials. World J Gastrointest Surg 2026; 18(10): 124385 [DOI: 10.4240/wjgs.124385]
Corresponding Author of This Article
Han-Hao Lu, Department of Medical Oncology, Fujian Medical University, No. 134 Dongjie Street, Gulou District, Fuzhou 350000, Fujian Province, China. 18259385886@163.com
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Gastroenterology & Hepatology
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research-article
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Lu HH, Xie JH, Li XR. Adjuvant chemoradiotherapy vs chemotherapy after R0 D2 gastrectomy for gastric cancer: Meta-analysis of randomized trials. World J Gastrointest Surg 2026; 18(10): 124385 [DOI: 10.4240/wjgs.124385]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 124385 Published online Oct 27, 2026. doi: 10.4240/wjgs.124385
Adjuvant chemoradiotherapy vs chemotherapy after R0 D2 gastrectomy for gastric cancer: Meta-analysis of randomized trials
Han-Hao Lu, Jian-Hua Xie, Xiao-Rong Li
Han-Hao Lu, Department of Medical Oncology, Fujian Medical University, Fuzhou 350000, Fujian Province, China
Jian-Hua Xie, Department of Radiotherapy, Mindong Hospital Affiliated to Fujian Medical University, Ningde 350000, Fujian Province, China
Xiao-Rong Li, Department of Cardiovascular Medicine, Mindong Hospital Affiliated to Fujian Medical University, Ningde 350000, Fujian Province, China
Author contributions: Lu HH conceived the study, performed the literature search and data extraction, and drafted the manuscript; Xie JH contributed to study design, data interpretation, and critical revision of the manuscript; Li XR participated in data verification, methodological assessment, and manuscript revision; all authors reviewed and approved the final version of the manuscript and agreed to be accountable for the work.
AI contribution statement: No AI tools were used in this study.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Han-Hao Lu, Department of Medical Oncology, Fujian Medical University, No. 134 Dongjie Street, Gulou District, Fuzhou 350000, Fujian Province, China. 18259385886@163.com
Received: June 23, 2026 Revised: September 1, 2026 Accepted: October 10, 2026 Published online: October 27, 2026 Processing time: 117 Days and 15.6 Hours
Abstract
BACKGROUND
Whether postoperative radiotherapy adds meaningful benefit to contemporary multiagent chemotherapy (CT) after an R0 D2 gastrectomy remains uncertain.
AIM
To synthesize randomized evidence comparing postoperative chemoradiotherapy (CRT) with CT alone after R0 D2 gastrectomy and to evaluate disease-free survival (DFS) or recurrence-free survival (RFS), overall survival (OS), recurrence patterns, and treatment tolerability.
METHODS
We searched PubMed/MEDLINE, Europe PMC and ClinicalTrials.gov, verified a targeted Chinese Clinical Trial Registry record, and examined backward and forward citations through August 19, 2026. Eligible randomized trials compared postoperative CRT with CT after R0 D2 gastrectomy. DFS/RFS and OS were synthesized as hazard ratios (HRs) using restricted maximum-likelihood random-effects models and modified Knapp-Hartung confidence intervals (CIs). Two legacy trials contributed secondary reconstructed survival estimates; the published Adjuvant Chemoradiotherapy in Stomach Tumors 2 (ARTIST 2) CI was used directly. Risk of bias and certainty were evaluated using the Cochrane RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively.
RESULTS
Eight independent randomized comparisons were included; seven trials (2256 participants) contributed DFS/RFS estimates. The all-era pooled HR was 0.82 (95%CI: 0.69-0.98; I² = 0%). The oral fluoropyrimidine–platinum doublet subgroup yielded HR = 0.88 (4 trials; 1754 participants; 95%CI: 0.66-1.18), and exclusion of the two legacy secondary reconstructions yielded HR = 0.84 (5 trials; 2105 participants; 95%CI: 0.68-1.03). The OS estimate was imprecise (5 trials; 1580 participants; HR = 0.89, 95%CI: 0.69-1.15). Exploratory analyses of four legacy trials suggested fewer locoregional recurrences [odds ratio (OR) = 0.50, 95%CI: 0.26–0.94], but distant recurrence was uncertain (OR = 0.81, 95%CI: 0.50-1.29). Severe toxicity and treatment completion were not pooled because reporting was insufficiently comparable.
CONCLUSION
Randomized evidence is insufficient to establish a consistent DFS or OS benefit from routine postoperative CRT over effective CT after R0 D2 gastrectomy. The doublet-subgroup CI remains compatible with clinically important benefit and harm; these results do not establish equivalence or absence of effect. A possible local-control benefit is supported mainly by low-certainty legacy evidence.
Core Tip: This synthesis links eight randomized trials after R0 D2 gastrectomy. The all-era disease-free survival estimate favored chemoradiotherapy, but treatment-backbone and provenance analyses remained imprecise. These findings do not establish equivalence or exclude meaningful benefit. The published Adjuvant Chemoradiotherapy in Stomach Tumors 2 CI is used, and source-tagged numerical inputs and reproducible sensitivity calculations are supplied.
