Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3647–3657 | Cite as

Adjuvant Chemoradiotherapy for Non-Pretreated Gastric Cancer

  • V. K. Y. Ho
  • E. P. M. Jansen
  • B. P. L. Wijnhoven
  • K. J. Neelis
  • J. W. van Sandick
  • R. H. A. Verhoeven
  • V. E. P. Lemmens
  • H. W. M. van Laarhoven
Gastrointestinal Oncology



While the curative approach to gastric cancer includes perioperative regimens in several countries, a substantial proportion of patients may not receive treatment prior to surgery. This study examines the adjuvant provision of chemoradiotherapy (CRT) for non-pretreated patients with cancer of the stomach including the gastric cardia.


All surgically treated patients with primary adenocarcinoma of the stomach and gastric cardia diagnosed between January 2004–December 2013 were selected from the Netherlands Cancer Registry. Patients who did not receive neoadjuvant treatment were included. Early gastric cancers (cT1), postoperative deaths within 90 days, patients with metastatic disease (M1), patients who received adjuvant chemotherapy and patients with macroscopic tumor after surgery (R2) were excluded.


Some 3277 patients underwent surgery, and 99 patients (3%) received adjuvant CRT. Treatment was more often administered in patients with a younger age (<65 years) and a high socioeconomic status (SES), in case of non-cardia cancer, positive lymph nodes, and positive resection margins (R1). Median survival time was 28 months (95% CI 17–39), compared to 35 months (95% CI 33–38) in CRT-naïve patients. After adjustment for confounders, a small net benefit for adjuvant CRT was found (hazard ratio, HR: 0.75, 95% CI 0.58–0.96). In subgroup analyses, benefit was most pronounced for patients with seven or more lymph metastases.


Marginal survival benefit was observed for adjuvant CRT in gastric cancer patients who did not receive neoadjuvant treatment. Treatment could be considered for patients with disease involving nodal invasion and those left with microscopic residual disease after surgery.



The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for collecting data in the Netherlands Cancer Registry (NCR).


None declared.

Compliance with Ethical Standards

Ethical Approval

All procedures followed were in accordance with the ethical standards of the national supervisory committee of the Netherlands Cancer Registry (NCR) and with the Helsinki Declaration of 1964 and later versions.

Informed Consent

Informed consent or substitute for it was obtained from all patients for being included in the study.


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • V. K. Y. Ho
    • 1
  • E. P. M. Jansen
    • 2
  • B. P. L. Wijnhoven
    • 3
  • K. J. Neelis
    • 4
  • J. W. van Sandick
    • 5
  • R. H. A. Verhoeven
    • 1
  • V. E. P. Lemmens
    • 1
    • 6
  • H. W. M. van Laarhoven
    • 7
  1. 1.Departments of Registry and ResearchNetherlands Comprehensive Cancer Organization (IKNL)UtrechtThe Netherlands
  2. 2.Department of RadiotherapyAntoni van Leeuwenhoek Hospital/Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of SurgeryErasmus University Medical CenterRotterdamThe Netherlands
  4. 4.Department of RadiotherapyLeiden University Medical CenterLeidenThe Netherlands
  5. 5.Department of SurgeryAntoni van Leeuwenhoek Hospital/Netherlands Cancer InstituteAmsterdamThe Netherlands
  6. 6.Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
  7. 7.Department of Medical OncologyAcademic Medical CenterAmsterdamThe Netherlands

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