Survival after radiotherapy in gastric cancer: Systematic review and meta-analysis

Abstract Background and purpose A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer. Methods Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or int...

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Published in:Radiotherapy and oncology 2009-08, Vol.92 (2), p.176-183
Main Authors: Valentini, Vincenzo, Cellini, Francesco, Minsky, Bruce D, Mattiucci, Gian Carlo, Balducci, Mario, D’Agostino, Giuseppe, D’Angelo, Elisa, Dinapoli, Nicola, Nicolotti, Nicola, Valentini, Chiara, La Torre, Giuseppe
Format: Article
Language:English
Subjects:
Gastric cancer
Hematology, Oncology and Palliative Medicine
Humans
Meta-analysis
Odds Ratio
Radiotherapy
Randomized Clinical Trial
Randomized Controlled Trials as Topic
Stomach Neoplasms - mortality
Stomach Neoplasms - radiotherapy
Systematic review
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Summary:Abstract Background and purpose A systematic review and meta-analysis was performed to assess the impact of radiotherapy on both 3- and 5-year survival in patients with resectable gastric cancer. Methods Randomized Clinical Trials (RCTs) in which radiotherapy, (preoperative, postoperative and/or intraoperative), was compared with surgery alone or surgery plus chemotherapy in resectable gastric cancer were identified by searching web-based databases and supplemented by manual examination of reference lists. Meta-analysis was performed using Risk Ratios (RRs). Random or fixed effects models were used to combine data. The methodological quality was evaluated by Chalmers’ score. Results Radiotherapy had a significant impact on 5-year survival. Using an intent to treat (ITT) and a Per Protocol (PP) analysis, the overall 5-year RR was 1.26 (95% CI: 1.08–1.48; NNT = 17) and 1.31 (95% CI: 1.04–1.66; NNT = 13), respectively. Although the quality of the studies was variable, the data were consistent and no clear publication bias was found. Conclusion This meta-analysis showed a statistically significant 5-year survival benefit with the addition of radiotherapy in patients with resectable gastric cancer. Radiotherapy remains a standard component in the treatment of resectable gastric cancer and new RCTs need to address the impact of new conformal radiotherapy technologies.
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2009.06.014