Is postoperative chemoradiotherapy benefit to D2-resected gastric cancer?

In Journal of Clinical Oncology, Park et al. report the final results of a phase III trial (ARTIST) examining whether the addition of radiotherapy to adjuvant chemotherapy improved disease-free survival (DFS) in patients with D2-resected gastric cancer (1). In 2002, Lee and his colleagues reported the initial analysis of the ARTIST trial (2), which was the only one randomized phase III trial in the world so far performed in Asian patients undergoing D2 lymph node dissection comparing the efficacy of capecitabine plus cisplatin (XP) versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy (XPRT). The 3-year DFS showed no statistically significant difference (74% for XP vs. 78% for XPRT; P=0.0862), and as a result, chemoradiotherapy (CRT) in addition to adjuvant chemotherapy was not recommended in patients with gastric cancer underwent D2 surgery. With a median follow-up time of 7 years, the overall survival (OS) results was presented to update showing that both DFS and OS remained similar between two treatment arms. However, significant increased DFS and OS were presented in patients with intestinal-type and node-positive gastric cancer.