Adjuvant chemoradiotherapy in gastric cancer and carcinoma of the oesophago-gastric junction

Patients with oesophago-gastric adenocarcinomas still have a poor prognosis, since about 30% of the tumours cannot be completely resected and about 40% of patients will relapse even after complete resection. Adjuvant chemotherapy did not influence these results, although more recent meta-analyses showed a small advantage for patients with adjuvant treatment compared with surgery alone. The high rate of locoregional tumour recurrence in gastric cancer favours radiotherapy to be included into the concept of adjuvant treatment. A US trial (INT 0116) was the first to identify a significant benefit regarding relapse-free and overall survival for adjuvant radiochemotherapy after surgery compared with surgery alone. However, divergent from the study protocol, more than 50% of the patients underwent only limited surgery, e. g. without any lymphadenectomy. Comparing the results of this trial with European studies of the same time and with similar patient criteria, it appears that limited surgery leads to significantly worse results. Adjuvant chemoradiation is able to improve the prognosis of the patients, but only to an extent comparable with optimal surgery alone. Current data do not exclude that adjuvant radiochemotherapy may improve survival even after extended surgery ( e. g. at least D1-lymphadenectomy). But as far as this has not been proven by randomised trials, this potentially harmful treatment can not be defined as standard therapy. A European study investigating the role of adjuvant chemoradiotherapy after optimal surgery will be initiated.