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Great Debate: Chemoradiation Should be Added to Chemotherapy as a Neoadjuvant Treatment Strategy for Resectable Gastric Adenocarcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Most patients with resectable gastric cancer present with locally advanced disease and warrant neoadjuvant chemotherapy based on level 1 evidence. However, the incremental benefit of adding radiation to chemotherapy as a neoadjuvant treatment strategy for these patients is less clear.

Methods

While awaiting the results of two ongoing randomized clinical trials attempting to specifically address this question (TOPGEAR and CRITICS-II), this article presents the debate between two gastric cancer surgery experts supporting each side of the argument on the use or omission of neoadjuvant radiation in this setting.

Results

On the one hand, neoadjuvant radiation may be better tolerated compared with modern triplet chemotherapy and may be associated with higher rates of major pathologic response. Additionally, there is evidence to suggest that radiation may offer a survival benefit when the tumor is located at the gastroesophageal junction or there is concern for a margin-positive resection. However, in the setting of adequate surgery, no survival benefit has been demonstrated by adding radiation to modern chemotherapy, likely reflecting the fact that death from gastric cancer is a result of distant recurrence, which is not addressed by local treatment such as radiotherapy.

Conclusion

While awaiting the results of the TOPGEAR and CRITICS-II trials, this discussion of current evidence can facilitate the refinement of an optimal neoadjuvant therapy strategy in patients with resectable gastric cancer.

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Author information

Authors and Affiliations

  1. Department of Surgery, Stanford University, Stanford, CA, USA

    Sara K. Daniel MD & George A. Poultsides MD

  2. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Brian D. Badgwell MD, MS

  3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sophia K. McKinley MD, EdM & Vivian E. Strong MD

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  1. Sara K. Daniel MD
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  2. Brian D. Badgwell MD, MS
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  3. Sophia K. McKinley MD, EdM
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Correspondence to George A. Poultsides MD.

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Disclosures

Sara K. Daniel, Brian D. Badgwell, Sophia K. McKinley, Vivian E. Strong, and George A. Poultsides declare no conflicts of interest.

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This work was presented as a featured Upper GI Great Debate at the Annual Society of Surgical Oncology Meeting, 24 March 2023, Boston, MA, USA.

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Daniel, S.K., Badgwell, B.D., McKinley, S.K. et al. Great Debate: Chemoradiation Should be Added to Chemotherapy as a Neoadjuvant Treatment Strategy for Resectable Gastric Adenocarcinoma. Ann Surg Oncol 31, 405–412 (2024). https://doi.org/10.1245/s10434-023-14378-3

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  • DOI: https://doi.org/10.1245/s10434-023-14378-3

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