Is there any role of radiation therapy added to chemotherapy after D2 surgery?

The update analysis of INT0116 study showed that chemoradiotherapy in this trial reduced mainly local regional recurrence but not systemic recurrence. These data support the finding that this treatment is effective after D0/1 surgery but not after D2 surgery [16]. After the results of INT0116 study were published, a Korean group performed a phase III study to compare adjuvant chemoradiation with surgery with chemotherapy (XELOX) alone (ARTIST trial) [17]. Although there was a subgroup in which borderline benefit of this treatment was suggested, primary endpoints did not meet [17]. Chemoradiation after D2 surgery was not accepted as efficient adjuvant treatment for gastric cancer but there remains a question about role of radiation therapy after D2 surgery in advanced stage.