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Postoperative adjuvant chemoradiotherapy in d2-dissected gastric cancer: Is radiotherapy necessary after d2-dissection?

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World Journal of Gastroenterology 2014年第36期20卷 12900-12907页

作者： Jee Suk Chang Woong Sub Koom Youngin Lee Hong In Yoon Hyung Sik Lee department of Radiation Oncology Yonsei University College of Medicine Seoul 120-752 South Korea department of Radiation Oncology Dong-A University Hospital Busan 602-715 South Korea

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.

关键词： Gastric cancer d2-dissection Recurrence Radiothera

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