Evolving role of chemoradiation in the adjuvant treatment of gastric cancer.

The recently reported Intergroup trial (INT0116) has established combined chemoradiation as an important component of adjuvant therapy that should be considered for high-risk, completely resected adenocarcinoma of the stomach. However, implementation of this treatment has posed several problems with respect to the toxicity of the treatment, optimal chemotherapy regimen and optimal mode of radiotherapy delivery. At the same time, it has also provided new opportunities to build on the Intergroup results by attempting to improve treatment efficacy and reduce treatment toxicity. Strategies currently being developed include the use of newer generation cytotoxic agents, employing modern conformal techniques of radiation delivery and the use of preoperative chemoradiation.