Table 6. Randomized trials comparing postoperative CRT vs. postoperative CT—study characteristics.
| Author | Year | Site | Eligibility | Characteristics* | N |
Surgery | Control arm |
Study arm |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CRT | CT | CRT | CT | RT dose | RT volume | Technique | |||||||
| Kim (32) | 2012 | Korea | Stomach Ca (no GE jc) | No GE jc | 46 | 44 | R0 | FL | FL | 45 Gy in 25 fractions | Standard RT except | APPA | |
| Adenocarcinoma | Diffuse: 56% | D2 | —tumor bed for T4 only | ||||||||||
| SIII-IV (M0) AJCC 2002 | T2,3,4: 59%, 57%, 7% | —modifiy stomach remnant coverage to maintain renal tolerance | |||||||||||
| R0 | R0: 100% | ||||||||||||
| D2 | D2: 100% | ||||||||||||
| Total gastrectomy: 51% | |||||||||||||
| Nodes removed (mean): 41 CT, 46.5 CRT | |||||||||||||
| Nodes involved (mean): 9 CT, 8 CRT | |||||||||||||
| Lee (33) (ARTIST) | 2012 | Korea | Stomach Ca | No GE jc documented | 230 | 228 | R0 | XP | XP | 45 Gy in 25 fractions | Standard RT except | APPA | |
| Adenocarcinoma | Diffuse: 60% | D2 | —tumor bed for T4 only | ||||||||||
| SII-IV (M0) AJCC 2002 | SIV (M0): 12% | —stomach remnant not routinely included | |||||||||||
| R0 | R0: 100% | ||||||||||||
| D2 | D2: 100% | ||||||||||||
| Total gastrectomy: NA | |||||||||||||
| Nodes removed (median): 40 | |||||||||||||
| Nodes involved (median): 3 | |||||||||||||
| Yu (34) | 2012 | China | Stomach Ca | No GE jc documented | 34 | 34 | R Ns | FL | FL | 45 Gy in 28 fractions | Standard RT | IMRT | |
| Adenocarcinoma | Histology type: NS | D1-2 | No other modifications described | ||||||||||
| T3-4 and/or N+ | T2,3,4: 11%, 62%, 28% | ||||||||||||
| R status Ns | R0: NA | ||||||||||||
| D1 or 2 | D2: 69% | ||||||||||||
| Total gastrectomy: NA | |||||||||||||
| Nodes removed: NA | |||||||||||||
| Zhu (35) | 2012 | China | Stomach Ca (GE jc included) | GE jc: 9% CT, 16% CRT | 56 | 59 | R0 | FL | FL | 45 Gy in 25 fractions | Standard RT | IMRT | |
| Adenocarcinoma | Histology type: NA | D2 | |||||||||||
| T3-4 ± N+ UICC 7th editon | SIV (M0): 15% | ||||||||||||
| R0 | R0: 100% | ||||||||||||
| D2 | D2: 100% | ||||||||||||
| Total gastrectomy: NS | |||||||||||||
| Nodes removed: NS | |||||||||||||
| Nodes involved ≥7: 21% | |||||||||||||
| Bamias (36) | 2010 | Greece | Stomach Ca (GEjc included) | GE jc: Ns (esophagogastrectomy 7%) | 72 | 71 | R0 | XP | DP | 45 Gy in 25 fractions | Standard RT | APPA | |
| Adenocarcinoma | Diffuse: 32% CRT, 59% CT | D0-2 | —proximal T3 include medial L hemidiaphragm | ||||||||||
| T3 ± N+ (AJCC 2002) | T2,3,4: 3%, 18%, 75% | —proximal lesions may exclude pancreaticoduodenal nodes | |||||||||||
| R0 | R0: 100% | —antral lesions exclude splenic hilar | |||||||||||
| D status Ns | D0: 56% | ||||||||||||
| D1+2: 44% | |||||||||||||
| Total gastrectomy: 40% | |||||||||||||
| Nodes removed (median): 14 | |||||||||||||
| Nodes involved (median): 4 | |||||||||||||
| Kwon (37) | 2010 | Korea | Stomach Ca | No GE jc documented | 31 | 30 | R0 | FP | FP | 45 Gy in 25 fractions | Standard RT | Conformal RT | |
| Adenocarcinoma | Diffuse: 65% CRT, 43% CT | D2 | —preoperative tumor bed included | ||||||||||
| SIIIa-IV (M0) (AJCC 2002) | SIV (M0): 23% CRT, 10% CT | ||||||||||||
| R0 | R0: 100% | ||||||||||||
| D2 | D2: 100% | ||||||||||||
| Total gastrectomy: Ns | |||||||||||||
| Nodes removed (median): Na | |||||||||||||
| Nodes involved (median): Na | |||||||||||||
| Dent (38) | 1979 | S. Africa | Stomach Ca | ||||||||||
| Adenocarcinoma | |||||||||||||
| All stages | |||||||||||||
| Resection not stated | |||||||||||||
*, when key characteristics are equally distributed between the arms, total for the whole study is presented. Where imbalance is noted, data by treatment arm is presented. CRT, chemoradiotherapy; CT, chemotherapy; RT, radiotherapy; Ca, cancer; GE jc, gastroesophageal junction cancers; AJCC, American Joint Committee on Cancer; R0, complete resection of disease en bloc, negative resection margins; D status (D0/1/2), describes extent of nodal dissection; FL, 5 cycles: (fluorouracil 425 mg/m2, leucovorin 20 mg/m2) ×4 days, 4 weeks interval (as used in INT 0116); FL with RT, (fluorouracil 425 mg/m2, leucovoring 20mg/m2) ×5 days ×1 cycle, RT (45 Gy in 25 days, 5 days/week) with 2 cycles of FL (fluorouracil 400 mg/m2, leucovorin 20 mg/m2 days 1-4, days 29-31), FL (fluorouracil 425 mg/m2, leucovorin 20 mg/m2, 4 weeks interval) ×2 cycles; standard RT volumes, anastomosis, duodenal stump, regional nodes, residual stomach, tumor bed; APPA, anterior posterior versus posterior anterior beam arrangement; NA, not available; XP, 6 cycles: capecitabine 1 g/m2 bid days 1-14, cisplatin 60 mg/m2 day 1 every 3 weeks; XP with RT arms, XP (2 cycles), capecitabine 825 mg/m2 bid daily during RT, XP (2 cycles); NS, not specified; IMRT, intensity-modulated radiation therapy; UICC, Union for International Cancer Control; DP, docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 (or carboplatin AUC 5) days 1, 3, weekly, ×6 cycles; DP during RT, same as CT alone, RT 3-4 weeks after cycle 3; FP, 5-fluorouracil 1 g/m2 continuous infusion days 1-5, cisplatin 60 mg/m2 day 1 ×6 cycles; FP with XRT, 5-fluorouracil 1 g/m2 continuous infusion days 1-5, cisplatin 60 mg/m2 day 1, 3 weeks gap, 1 cycle, day 28 XRT ×5 weeks with capecitabine 1,650 mg/m2 daily in 2 doses, 4 weeks post RT, FP ×3.