Localized gastric cancer: chemoradiation is not always needed.

Despite resection with curative intent, a majority of patients with gastric cancer will develop disease recurrence. In the past, numerous trials had failed to demonstrate an improvement in survival with adjuvant therapy compared with surgery alone. Several meta-analyses showed a very modest benefit of adjuvant chemotherapy. The North American Intergroup 0116 trial was the first to demonstrate a survival benefit of postoperative concurrent radiation and chemotherapy (5-fluorouracil based) compared with surgery alone. More recently, the Medical Research Council Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC) study demonstrated superior survival post-gastrectomy in patients treated with preoperative and postoperative chemotherapy (epirubicin, cisplatin, and 5-fluorouracil) vs. observation. Differences in the designs and patient populations of the two trials do not allow for direct comparison of the results. Questions remain regarding the optimal treatment regimen and clinical trials are ongoing. However, in patients with localized gastric cancer, perioperative chemotherapy without the use of postoperative radiation therapy can be a reasonable option.