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Postoperative adjuvant chemoradiotherapy in D2-dissected gastric cancer: Is radiotherapy necessary after D2-dissection?

 Jee Suk Chang  ;  Woong Sub Koom  ;  Youngin Lee  ;  Hong In Yoon  ;  Hyung Sik Lee 
 WORLD JOURNAL OF GASTROENTEROLOGY, Vol.20(36) : 12900-12907, 2014 
Journal Title
Issue Date
Chemoradiotherapy, Adjuvant*/adverse effects ; Chemoradiotherapy, Adjuvant*/mortality ; Gastrectomy*/adverse effects ; Gastrectomy*/mortality ; Humans ; Lymph Node Excision*/adverse effects ; Lymph Node Excision*/mortality ; Neoplasm Staging ; Patient Selection ; Radiotherapy, Adjuvant ; Risk Factors ; Stomach Neoplasms/mortality ; Stomach Neoplasms/pathology ; Stomach Neoplasms/therapy* ; Treatment Outcome
Chemotherapy ; D2-dissection ; Gastric cancer ; Radiotherapy ; Recurrence
Studies from the Far East have demonstrated that D2-dissection is superior to D0/1-dissection. The effect of postoperative chemoradiotherapy (CRT) after D2-dissection has not been accepted due to the lack of D2-dissection in Western countries, as well as the potential harmful effect of radiotherapy. In the current NCCN guideline, adjuvant chemotherapy alone is recommended in D2-dissected patients. However, three recent prospective randomized controlled trials in South Korea and China (ARTIST, NCC and Multicenter IMRT Trials) demonstrated that adjuvant CRT can be safely administered to D2-dissected patients with notable benefits. To identify the role of radiotherapy (RT) in the D2-dissected postoperative setting, clinical research attempts should include (1) identification of high-risk patients for loco-regional recurrence who might benefit from CRT; (2) modification of RT target volume based on the findings that failure patterns should be different after D1- and D2-dissection; and (3) integration of new RT techniques to decrease treatment-related toxicity. The present paper is a review of recent studies addressing these fields. Well-designed prospective randomized studies are needed to clearly define the role of adjuvant CRT in D2-dissected gastric cancer, however, future clinical studies should also focus on answering these questions.
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1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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