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What is the role of adjuvant radiation for gastric cancer found to be locally advanced after up-front surgery in the setting of
NCCN recommends floropyrimidine-based chemoradiation (sandwiched by 5-FU or capecitabine), but many medical oncologists are utilizing multi-agent chemotherapy regimens (such as FOLFOX). Considering ARTIST (D2 resections, multi-agent chemotherapy, East Asian population) and other evidence, would you still utilize adjuvant radiation in addition to multi-agent chemotherapy in this setting?
NCCN recommends floropyrimidine-based chemoradiation (sandwiched by 5-FU or capecitabine), but many medical oncologists are utilizing multi-agent chemotherapy regimens (such as FOLFOX). Considering ARTIST (D2 resections, multi-agent chemotherapy, East Asian population) and other evidence, would you still utilize adjuvant radiation in addition to multi-agent chemotherapy in this setting?
Answer from: Radiation Oncologist at Academic Institution
I think one has to be very careful making blanket statements regarding management of the type of tumor described. The only real data supporting the standard use of RT in virtually all of these patients was the Macdonald trial from a couple of decades ago (and the patients were often treated three de...
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Answer from: Radiation Oncologist at Academic Institution
For patients who have not received preoperative chemotherapy or chemoradiation therapy, following an R0 resection but a < D2 lymph node dissection, postoperative chemoradiation should be recommended for patients with pT3-T4, any pN tumors or any pT, pN+ tumors. Selected patients with pT2, pN0 tum...