[Related problems of perioperative radiotherapy for gastric cancer]

Radiotherapy has been an important component in the multidisciplinary treatment strategy of gastric cancer. INT0116 has showed the improvement of survival with adjuvant chemoradiation in resected gastric cancer. The benefit of adjuvant chemoradiation has been confirmed further in gastric cancer population. Recent reported ARTIST trial which all patients got D2 dissection has showed the benefit of adjuvant chemoradiation only seen in patients with lymph node positive. As the same observed in other two trail, ACT-GC and CLASSIC, extremely low local recurrence were reported in these trial. We should be very cautious when we interpret these results and treatment into our clinical practice due to the difference of local recurrence between trials and daily practice. Neoadjuvant radiation has been reported its effectiveness of cardiac gastric cancer in earlier randomized trial. Phase II( trials have shown the high pCR rate with neoadjuvant chemoradiation. However, concurrent chemoradiation was with more toxicity and limited it development. Even though, further investigation in neoadjuvant setting is worthy but with reduce of toxicity. New progress in high technique of radiation will help the application of radiotherapy in gastric cancer. The future of radiation in gastric cancer treatment will focus on the selection of patients which are of most benefit, detection of radiosensitivity and how to optimize combination of radiation with surgery and novel chemotherapy and target therapy.