Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy...

Area of Science:

• Oncology
• Radiation Oncology

Background:

• Radiotherapy (RT) for inoperable gastric cancer (IGC) is often low-dose and palliative.
• High-dose RT evidence is more established for esophageal cancer.
• A practice change for IGC requires evaluating definitive and high-dose palliative RT.

Purpose of the Study:

• To systematically review the evidence for definitive and high-dose palliative RT in IGC.
• To assess the efficacy, safety, and impact on quality of life (QOL).
• To determine if a change in clinical practice is warranted.

Main Methods:

• Systematic review of MEDLINE, EMBASE, and Cochrane Library adhering to PRISMA standards.
• Inclusion of studies on definitive RT (BED10 >45Gy) and high-dose palliative RT (BED10 >30Gy).
• Manual search of conference proceedings and clinical trial registries.

Main Results:

• 31 studies analyzed: 10 definitive RT (n=354) showed median survival 11-26.4 months, response 12-45%, toxicity 0-31%, completion 81-100%.
• 21 high-dose palliative RT studies (n=955) reported bleeding response 59.6-90%, pain response 45.5-100%, obstruction response 52.9-100%, toxicity <5%, completion 68-100%.
• Database review indicated RT benefit with chemotherapy; dose-response data conflicting; QOL data limited.

Conclusions:

• Observational evidence suggests high-dose RT is effective and safe for IGC, potentially preserving QOL.
• A shift in practice necessitates prospective randomized controlled trials.
• Future trials should investigate prophylactic high-BED RT with systemic therapy and modern techniques.