Skip to main content
SpringerLink
Log in
Book cover

Early Gastrointestinal Cancers pp 229–240Cite as

Can Adjuvant Chemoradiotherapy Replace Extended Lymph Node Dissection in Gastric Cancer?

  • Conference paper
  • First Online:

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 196))

Abstract

Surgical resection remains the essential part in the curative treatment of gastric cancer. However, with surgery only, long-term survival is poor (5-year survival <25 % in Europe). Randomized studies, which compared limited (D1) lymph node dissection with more extended (D2) resections in the Western world, failed to show a survival benefit for more extensive surgery. A substantial increase in survival was found with perioperative chemotherapy in the MAGIC study. In addition, the SWOG/Intergroup 0116 study showed that postoperative chemoradiotherapy (CRT) prolonged 5-year overall survival compared to surgery only. However, it has been argued that surgical undertreatment undermined survival in this trial. In a randomized Korean study, patients with advanced stage gastric cancer who received postoperative CRT had better outcome after a D2 dissection. At our institute phase I-II studies with adjuvant cisplatin and capecitabine-based CRT have been performed in over 120 patients with resected gastric cancer. Retrospective comparison of patients treated in these studies with those that had surgery only in the D1D2 study, demonstrated that postoperative CRT was associated with better outcome, especially after D1 or a R1 resection. For daily practice, it remains unclear whether patients after optimal (D2) gastric surgery will benefit from postoperative CRT. This is currently being tested in prospective randomized phase III trials (CRITICS; TOPGEAR).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Ajani JA, Ota DM, Jessup JM, Ames FC, McBride C, Boddie A, Levin B, Jackson DE, Roh M, Hohn D (1991) Resectable gastric carcinoma. An evaluation of preoperative and postoperative chemotherapy. Cancer 68:1501–1506

    Article  PubMed  CAS  Google Scholar 

  • Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, Lordick F, Ohtsu A, Omuro Y, Satoh T, Aprile G, Kulikov E, Hill J, Lehle M, Ruschoff J, Kang YK (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376:687–697

    Article  PubMed  CAS  Google Scholar 

  • Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, Lee KW, Kim YH, Noh SI, Cho JY, Mok YJ, Kim YH, Ji J, Yeh TS, Button P, Sirzen F, Noh SH (2012) Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 379:315–321

    Article  PubMed  CAS  Google Scholar 

  • Bischof D, Swallow C, Stotland P, Hagen J, Klein L (2012) Incorporation of laparoscopic D2 dissection into the management of gastric adenocarcinoma (GCa) in a community-based setting. J Clin Oncol 30:(suppl 4; abstract 117)

    Google Scholar 

  • Cascinu S, Giordani P, Catalano V, Agostinelli R, Catalano G (1999) Resection-line involvement in gastric cancer patients undergoing curative resections: implications for clinical management. Jpn J Clin Oncol 29:291–293

    Article  PubMed  CAS  Google Scholar 

  • Coburn NG, Guller U, Baxter NN, Kiss A, Ringash J, Swallow CJ, Law CH (2008) Adjuvant therapy for resected gastric cancer-rapid, yet incomplete adoption following results of intergroup 0116 trial. Int J Radiat Oncol Biol Phys 70:1073–1080

    Article  PubMed  Google Scholar 

  • Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ, MAGIC Trial P (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20

    Google Scholar 

  • Cunningham SC, Kamangar F, Kim MP, Hammoud S, Haque R, Maitra A, Montgomery E, Heitmiller RE, Choti MA, Lillemoe KD, Cameron JL, Yeo CJ, Schulick RD (2005) Survival after gastric adenocarcinoma resection: eighteen-year experience at a single institution. J Gastrointest Surg 9:718–725

    Article  PubMed  Google Scholar 

  • Dassen AE, Lemmens VE, van de Poll-Franse LV, Creemers GJ, Brenninkmeijer SJ, Lips DJ, Vd Wurff AA, Bosscha K, Coebergh JW (2010) Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. Eur J Cancer 46:1101–1110

    Article  PubMed  CAS  Google Scholar 

  • de Gara CJ, Hanson J, Hamilton S (2003) A population-based study of tumor-node relationship, resection margins, and surgeon volume on gastric cancer survival. Am J Surg 186:23–27

    Article  PubMed  Google Scholar 

  • Dikken JL, Jansen EP, Cats A, Bakker B, Hartgrink HH, Kranenbarg EM, Boot H, Putter H, Peeters KC, van de Velde CJ, Verheij M (2010) Impact of the extent of surgery and postoperative chemoradiotherapy on recurrence patterns in gastric cancer. J Clin Oncol 28:2430–2436

    Article  PubMed  Google Scholar 

  • Earle CC, Maroun JA (1999) Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer 35:1059–1064

    Article  PubMed  CAS  Google Scholar 

  • Fiorica F, Cartei F, Enea M, Licata A, Cabibbo G, Carau B, Liboni A, Ursino S, Camma C (2007) The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data. Cancer Treat Rev 33:729–740

    Article  PubMed  Google Scholar 

  • Gianni L, Panzini I, Tassinari D, Mianulli AM, Desiderio F, Ravaioli A (2001) Meta-analyses of randomized trials of adjuvant chemotherapy in gastric cancer. Ann Oncol 12:1178–1180

    PubMed  CAS  Google Scholar 

  • GITSG (1982) A comparison of combination chemotherapy and combined modality therapy for locally advanced gastric carcinoma. Gastrointestinal tumor study group. Cancer 49:1771–1777

    Article  Google Scholar 

  • GITSG (1990) The concept of locally advanced gastric cancer. Effect of treatment on outcome. Gastrointest tumor study group. Cancer 66:2324–2330

    Article  Google Scholar 

  • Hallissey MT, Jewkes AJ, Dunn JA, Ward L, Fielding JW (1993) Resection-line involvement in gastric cancer: a continuing problem. Br J Surg 80:1418–1420

    Article  PubMed  CAS  Google Scholar 

  • Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ (2009) Gastric cancer. Lancet 374:477–490

    Article  PubMed  Google Scholar 

  • Hartgrink HH, van de Velde CJ, Putter H, Songun I, Tesselaar ME, Kranenbarg EK, de Vries JE, Wils JA, van der Bijl J, van Krieken JH (2004) Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30:643–649

    Article  PubMed  CAS  Google Scholar 

  • Hermans J, Bonenkamp JJ, Boon MC, Bunt AM, Ohyama S, Sasako M, van de Velde CJ (1993) Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol 11:1441–1447

    PubMed  CAS  Google Scholar 

  • Hu JK, Chen ZX, Zhou ZG, Zhang B, Tian J, Chen JP, Wang L, Wang CH, Chen HY, Li YP (2002) Intravenous chemotherapy for resected gastric cancer: meta-analysis of randomized controlled trials. World J Gastroenterol 8:1023–1028

    PubMed  CAS  Google Scholar 

  • Hundahl SA, Macdonald JS, Benedetti J, Fitzsimmons T (2002) Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer: the effect of undertreatment. Ann Surg Oncol 9:278–286

    Article  PubMed  Google Scholar 

  • Jahne J, Piso P, Meyer HJ (2001) 1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma–a 30-year single institution experience. Hepatogastroenterology 48:1222–1226

    PubMed  CAS  Google Scholar 

  • Jansen EP, Boot H, Dubbelman R, Bartelink H, Cats A, Verheij M (2007a) Postoperative chemoradiotherapy in gastric cancer—a Phase I/II dose-finding study of radiotherapy with dose escalation of cisplatin and capecitabine chemotherapy. Br J Cancer 97:712–716

    Article  PubMed  CAS  Google Scholar 

  • Jansen EP, Boot H, Dubbelman R, Verheij M, Cats A (2010) Postoperative chemoradiotherapy in gastric cancer–a phase I-II study of radiotherapy with dose escalation of weekly cisplatin and daily capecitabine chemotherapy. Ann Oncol 21:530–534

    Article  PubMed  CAS  Google Scholar 

  • Jansen EP, Boot H, Saunders MP, Crosby TD, Dubbelman R, Bartelink H, Verheij M, Cats A (2007b) A Phase I-II Study of postoperative capecitabine-based chemoradiotherapy in gastric cancer. Int J Radiat Oncol Biol Phys 69:1424–1428

    Article  PubMed  CAS  Google Scholar 

  • Jansen EP, Saunders MP, Boot H, Oppedijk V, Dubbelman R, Porritt B, Cats A, Stroom J, Valdes Olmos R, Bartelink H, Verheij M (2007c) Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. Int J Radiat Oncol Biol Phys 67:781–785

    Article  PubMed  CAS  Google Scholar 

  • Jensen LS, Nielsen H, Mortensen PB, Pilegaard HK, Johnsen SP (2010) Enforcing centralization for gastric cancer in Denmark. Eur J Surg Oncol 36 Suppl 1:S50–S54

    Article  PubMed  Google Scholar 

  • Kattan MW, Karpeh MS, Mazumdar M, Brennan MF (2003) Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol 21:3647–3650

    Article  PubMed  Google Scholar 

  • Kim S, Lim do H, Lee J, Kang WK, Macdonald JS, Park CH, Park SH, Lee SH, Kim K, Park JO, Kim WS, Jung CW, Park YS, Im YH, Sohn TS, Noh JH, Heo JS, Kim YI, Park CK, Park K (2005) An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys 63:1279–1285

    Article  PubMed  Google Scholar 

  • Kim SH, Karpeh MS, Klimstra DS, Leung D, Brennan MF (1999) Effect of microscopic resection line disease on gastric cancer survival. J Gastrointest Surg 3:24–33

    Article  PubMed  CAS  Google Scholar 

  • Klaassen DJ, MacIntyre JM, Catton GE, Engstrom PF, Moertel CG (1985) Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil–an eastern cooperative oncology group study. J Clin Oncol 3:373–378

    PubMed  CAS  Google Scholar 

  • Kozak KR, Moody JS (2008) The survival impact of the intergroup 0116 trial on patients with gastric cancer. Int J Radiat Oncol Biol Phys 72:517–521

    Google Scholar 

  • Lee J, Lim do H, Kim S, Park SH, Park JO, Park YS, Lim HY, Choi MG, Sohn TS, Noh JH, Bae JM, Ahn YC, Sohn I, Jung SH, Park CK, Kim KM, Kang WK (2012) Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol 30:268–273

    Article  PubMed  CAS  Google Scholar 

  • Lepage C, Sant M, Verdecchia A, Forman D, Esteve J, Faivre J (2010) Operative mortality after gastric cancer resection and long-term survival differences across Europe. Br J Surg 97:235–239

    Article  PubMed  CAS  Google Scholar 

  • Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730

    Article  PubMed  CAS  Google Scholar 

  • Mari E, Floriani I, Tinazzi A, Buda A, Belfiglio M, Valentini M, Cascinu S, Barni S, Labianca R, Torri V (2000) Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo studio dei carcinomi dell’apparato digerente). Ann Oncol 11:837–843

    Article  PubMed  CAS  Google Scholar 

  • McCulloch P, Nita ME, Kazi H, Gama-Rodrigues J (2004) Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev 4:CD001964

    Google Scholar 

  • Moertel CG, Childs DS, O’Fallon JR, Holbrook MA, Schutt AJ, Reitemeier RJ (1984) Combined 5-fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol 2:1249–1254

    PubMed  CAS  Google Scholar 

  • Morgagni P, Garcea D, Marrelli D, de Manzoni G, Natalini G, Kurihara H, Marchet A, Saragoni L, Scarpi E, Pedrazzani C, Di Leo A, De Santis F, Panizzo V, Nitti D, Roviello F (2008) Resection line involvement after gastric cancer surgery: clinical outcome in nonsurgically retreated patients. World J Surg 32:2661–2667

    Article  PubMed  CAS  Google Scholar 

  • Ott K, Sendler A, Becker K, Dittler HJ, Helmberger H, Busch R, Kollmannsberger C, Siewert JR, Fink U (2003) Neoadjuvant chemotherapy with cisplatin, 5-FU, and leucovorin (PLF) in locally advanced gastric cancer: a prospective phase II study. Gastric Cancer 6:159–167

    Article  PubMed  CAS  Google Scholar 

  • Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, Pignon JP, Rougier P, Sakamoto J, Sargent D, Sasako M, Van Cutsem E, Buyse M (2010) Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 303:1729–1737

    Article  PubMed  CAS  Google Scholar 

  • Ringash J, Perkins G, Brierley J, Lockwood G, Islam M, Catton P, Cummings B, Kim J, Wong R, Dawson L (2005) IMRT for adjuvant radiation in gastric cancer: a preferred plan? Int J Radiat Oncol Biol Phys 63:732–738

    Article  PubMed  Google Scholar 

  • Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, Furukawa H, Nakajima T, Ohashi Y, Imamura H, Higashino M, Yamamura Y, Kurita A, Arai K (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820

    Article  PubMed  CAS  Google Scholar 

  • Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R (2009) EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary. Eur J Cancer 45:931–991

    Article  PubMed  Google Scholar 

  • Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393

    Article  PubMed  CAS  Google Scholar 

  • Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462

    Article  PubMed  CAS  Google Scholar 

  • Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, Haag C, Mauer ME, Hasan B, Welch J, Ott K, Hoelscher A, Schneider PM, Bechstein W, Wilke H, Lutz MP, Nordlinger B, Cutsem EV, Siewert JR, Schlag PM (2010) neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: european organisation for research and treatment of cancer randomized trial 40954. J Clin Oncol 28:5210–5218

    Article  PubMed  Google Scholar 

  • Shiu MH, Moore E, Sanders M, Huvos A, Freedman B, Goodbold J, Chaiyaphruk S, Wesdorp R, Brennan MF (1987) Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis. Arch Surg 122:1347–1351

    Article  PubMed  CAS  Google Scholar 

  • Siewert JR, Bottcher K, Stein HJ, Roder JD (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German gastric cancer study. Ann Surg 228:449–461

    Article  PubMed  CAS  Google Scholar 

  • Songun I, Bonenkamp JJ, Hermans J, van Krieken JH, van de Velde CJ (1996) Prognostic value of resection-line involvement in patients undergoing curative resections for gastric cancer. Eur J Cancer 32A:433–437

    Article  PubMed  CAS  Google Scholar 

  • Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449

    Article  PubMed  Google Scholar 

  • Sun P, Xiang JB, Chen ZY (2009a) Meta-analysis of adjuvant chemotherapy after radical surgery for advanced gastric cancer. Br J Surg 96:26–33

    Article  PubMed  CAS  Google Scholar 

  • Sun Z, Li DM, Wang ZN, Huang BJ, Xu Y, Li K, Xu HM (2009b) Prognostic significance of microscopic positive margins for gastric cancer patients with potentially curative resection. Ann Surg Oncol 16:3028–3037

    Article  PubMed  Google Scholar 

  • Valentini V, Cellini F, Minsky BD, Mattiucci GC, Balducci M, D’Agostino G, D’Angelo E, Dinapoli N, Nicolotti N, Valentini C, La Torre G (2009) Survival after radiotherapy in gastric cancer: systematic review and meta-analysis. Radiother Oncol 92:176–183

    Article  PubMed  Google Scholar 

  • Wanebo HJ, Kennedy BJ, Chmiel J, Steele G, Jr., Winchester D, Osteen R (1993) Cancer of the stomach. A patient care study by the American college of surgeons. Ann Surg 218:583–592

    Article  PubMed  CAS  Google Scholar 

  • Wang SY, Yeh CN, Lee HL, Liu YY, Chao TC, Hwang TL, Jan YY, Chen MF (2009) Clinical impact of positive surgical margin status on gastric cancer patients undergoing gastrectomy. Ann Surg Oncol 16:2738–2743

    Article  PubMed  Google Scholar 

  • Wieland P, Dobler B, Mai S, Hermann B, Tiefenbacher U, Steil V, Wenz F, Lohr F (2004) IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys 59:1236–1244

    Article  PubMed  Google Scholar 

  • Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, Lui WY, Whang-Peng J (2006) Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 7:309–315

    Article  PubMed  CAS  Google Scholar 

  • Ychou M, Boige V, Pignon JP, Conroy T, Bouche O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, Geneve J, Lasser P, Rougier P (2011) Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29:1715–1721

    Article  PubMed  CAS  Google Scholar 

  • Yu CC, Levison DA, Dunn JA, Ward LC, Demonakou M, Allum WH, Hallisey MT (1995) Pathological prognostic factors in the second British stomach cancer group trial of adjuvant therapy in resectable gastric cancer. Br J Cancer 71:1106–1110

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiotherapy, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Edwin P. M. Jansen & Marcel Verheij

  2. Department of Gastroenterology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Henk Boot & Annemieke Cats

  3. Department of Surgery, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Johanna van Sandick

  4. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Cornelis J. H. van de Velde

Authors
  1. Edwin P. M. Jansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henk Boot
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cornelis J. H. van de Velde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johanna van Sandick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Annemieke Cats
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcel Verheij
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edwin P. M. Jansen .

Editor information

Editors and Affiliations

  1. Tumor- und Brustzentrum ZeTuP AG, Rorschacherstr. 150, St. Gallen, 9006, Switzerland

    Florian Otto

  2. Rheinstr. 2, Saarbrücken, 66113, Germany

    Manfred P. Lutz

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Jansen, E.P., Boot, H., van de Velde, C.J., van Sandick, J., Cats, A., Verheij, M. (2012). Can Adjuvant Chemoradiotherapy Replace Extended Lymph Node Dissection in Gastric Cancer?. In: Otto, F., Lutz, M. (eds) Early Gastrointestinal Cancers. Recent Results in Cancer Research, vol 196. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-31629-6_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-31629-6_16

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-31628-9

  • Online ISBN: 978-3-642-31629-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation