The role of radiation therapy in gastric cancer.

Radiation therapy has been used as an adjuvant, primary, and palliative treatment modality for gastric cancer. In the adjuvant setting, the role of postoperative radiation therapy plus chemotherapy is being examined in the phase III Intergroup trial 0116. Until the results of this trial are available, the standard treatment after a complete resection (with or without positive locoregional lymph nodes) is observation alone. In patients who are selected to receive adjuvant therapy, locoregional radiation to 45 Gy plus 5-fluorouracil (5-FU)-based chemotherapy is recommended. In patients with locally unresectable or residual disease, postoperative radiation therapy and 5-FU-based chemotherapy may decrease locoregional failure and improve survival. Intraoperative radiation therapy appears promising; however, it remains investigational. In the palliative setting, radiation therapy offers symptomatic relief in the majority of patients.