Adjuvant Chemoradiotherapy for Gastric Cancer

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Abstract
The study by Macdonald and colleagues (Sept. 6 issue)1 is commendable for its duration, detailed analysis, and quality control. However, we believe that the authors should have randomly assigned the patients to one of the two study groups before surgery. The definitions of resectability and stratification according to tumor stage are meaningless because the surgical approach was not uniform. Moreover, the conclusion that postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence does not correlate with the aims of the study. There appears to have been a substantial number of major side effects associated with chemoradiotherapy (Table 3 of the article), and only 64 percent of the patients assigned to chemoradiotherapy could complete the treatment. One wonders whether it is really worth giving chemoradiotherapy to these patients postoperatively, for a nine-month median survival benefit. In addition, we would be interested to know the number of patients who were excluded before randomization because they opted not to enter the trial.