Role of Radiation Therapy in Management of Gastric Cancer

The survival between Western and Eastern studies differs markedly except the early stage. Whereas the 5-year survival rates for patients with stage II and III a gastric carcinoma in the United States are around 30% and 15%, respectively, the rates are 45% and 30% in Germany and 75% and 60% in Japan and Korea. Loco-regional failures are common even after radical resection. Gastric carcinoma is as sensitive as other types of adenocarcinoma to radiation. Preoperative radiation was proven to be effective in reducing the tumor bulk and lymph node metastasis. There are substantial data to show that adequate radiation dose with combined chemotherapy is effective in management of local failure and improvement of survival. But there is no well designed randomized study to evaluate the adjuvant treatment for patients after optimal radical operation. In summary, 1) radical operation has improved the cure rate of stomach cancer, 2) local failure is still one of the common failure patterns, 3) abdominal radiation can be delivered safely in the modern era, and 4) study of pattern of failure on patients after radical surgery is necessary before designing clinical trial to evaluate the efficacy of adjuvant radiation/chemotherapy.