Evidence based radiation therapy for locally advanced resectable and unresectable gastric cancer

Despite the fact that gastric cancer is decreasing in incidence in the United States, it remains one of the most commonly diagnosed and most fatal cancers worldwide. In localised disease, surgery remains the cornerstone of treatment. Nevertheless, the low overall survival rates at 5 years due to locoregional and distant recurrences has led to a large debate regarding the role of radiation therapy and chemotherapy in addition to curative resection. Recent data have shown that, even with improved surgical techniques, locoregional failure rates in these patients ranged between 57% and 88%. Failures were noted in the gastric bed, regional nodes, gastric remnant, anastomosis and duodenal stump, all of which can be encompassed in a regional radiation field, indicating the need of further locoregional treatment. In this article, a comprehensive literature review of the reliable medical databases of PubMed and Cochrane is made and we present all available information on the role of radiation therapy in the preoperative and postoperative setting of gastric cancer. Data reported show that in locally advanced gastric cancer the addition of radiation therapy post surgery has significantly improved disease-free survival as well as overall survival. Moreover, in unresectable gastric cancer, the combination of radiation therapy with chemotherapy has significantly improved mean and overall survival rates. The role of radiation therapy in patients with resectable gastric cancer is being further evaluated in ongoing phase III trials.