From twilight to starlight? Debating the role of chemoradiotherapy in gastric cancer in the D2 dissection era

Mauro Loi; Marcel Verheij; Joost Nuyttens; Marta Scorsetti; Lorenzo Livi; Maria A Hawkins; Florence Huguet

doi:10.1007/s11547-024-01892-x

From twilight to starlight? Debating the role of chemoradiotherapy in gastric cancer in the D2 dissection era

Radiol Med. 2024 Oct 1. doi: 10.1007/s11547-024-01892-x. Online ahead of print.

Authors

Mauro Loi¹, Marcel Verheij², Joost Nuyttens³, Marta Scorsetti⁴, Lorenzo Livi⁵, Maria A Hawkins⁶, Florence Huguet⁷

Affiliations

¹ Radiation Oncology, Azienda Universitaria Ospedaliera Careggi, Florence, Italy. mauro.loi82@gmail.com.
² Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
³ Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
⁴ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
⁵ Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy.
⁶ Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
⁷ Radiation Oncology Department, Tenon Hospital, AP-HP, Sorbonne University, Paris, France.

PMID: 39354292
DOI: 10.1007/s11547-024-01892-x

Abstract

Patients affected by resectable locally advanced gastric cancer (GC) should receive perioperative chemotherapy as a standard of care. However, an additional benefit of adjuvant chemoradiation (CRT) has been negated by modern trials in the era of extended surgical dissection, and CRT is currently only considered on an individual basis in case of suboptimal resection. However, the dismal prognosis of GC and the modest treatment completion rates of perioperative chemotherapy have pushed to reconsider CRT, particularly as a preoperative treatment, in light of modern treatment techniques, advances in the understanding of the immune landscape and development of targeted agents. The aim of this review is to critically assess the historical role of CRT, the limitations of current evidence and to debate its potential role in an integrated neoadjuvant strategy for patients with resectable GC.

Keywords: Chemoradiation; Chemotherapy; Gastric adenocarcinoma; Neoadjuvant; Preoperative.

Publication types

Review