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Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent

A Case, F Williams, S Prosser, Hayley Hutchings Orcid Logo, T Crosby, R Adams, Gareth Jenkins Orcid Logo, Sarah Gwynne

Clinical Oncology, Volume: 37, Start page: 103693

Swansea University Authors: Hayley Hutchings Orcid Logo, Gareth Jenkins Orcid Logo, Sarah Gwynne

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DOI (Published version): 10.1016/j.clon.2024.103693

Abstract

The role of radiotherapy (RT) for inoperable gastric cancer (IGC) is commonly low-dose, given reactively for symptoms (e.g. bleeding), in contrast to the oesophagus, where high quality evidence exists for higher doses of RT. This systematic review aims to evaluate the use of, and evidence for, defin...

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Published in: Clinical Oncology
ISSN: 0936-6555 1433-2981
Published: Elsevier BV 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68611
first_indexed 2025-01-09T20:33:58Z
last_indexed 2025-01-09T20:33:58Z
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This systematic review aims to evaluate the use of, and evidence for, definitive and high-dose palliative RT for IGC and whether a change in practice is warranted. Following registration with PROSPERO (CRD42022297080), MEDLINE, EMBASE and The Cochrane Library were searched in accordance with PRISMA standards for studies evaluating definitive (non-metastatic disease, BED10 &gt;45Gy) or high-dose palliative RT (for symptom/local control, minimum BED10 &gt;30Gy). A manual search of meeting proceedings and clinical trial registries was also performed. 31 studies were selected for analysis. 10 definitive studies totalling n = 354 patients receiving RT with 45-50.4Gy/25-28#, showed median overall survival ranging between 11 and 26.4 months, clinical complete response range 12%-45%, G3 gastrointestinal toxicity 0-31% (range) and RT completion rates ranging from 81% to 100%. 21 high-dose palliative studies (n = 955) mostly evaluated haemostatic control and reported 38 different RT regimens (most commonly 30Gy/10#). Bleeding response rate (RR) was 59.6%-90%, pain RR 45.5-100%, obstruction RR 52.9%-100%, G3 gastrointestinal toxicity &lt;5% and RT completion 68%-100%. An additional American National Cancer Database review &gt;4700 non metastatic IGC patients which combined both definitive and palliative doses found significant benefit to RT in addition to chemotherapy. Evidence regarding a dose-response relationship is conflicting, limited by retrospective data. Two studies report high quality -of-life (QOL) scores following gastric RT. There is a body of mainly non-randomised, observational evidence showing high-dose RT is efficacious, safe and may maintain QOL for patients with IGC. A change in practice will require a prospective randomised controlled trial, which should explore the role of prophylactic, high-BED RT combined with optimal systemic therapy using modern IMRT techniques and RT quality assurance. [Abstract copyright: Copyright &#xA9; 2024. 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spelling 2025-01-07T14:30:06.5190754 v2 68611 2024-12-20 Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent bdf5d5f154d339dd92bb25884b7c3652 0000-0003-4155-1741 Hayley Hutchings Hayley Hutchings true false a44095d26187304e903da7ca778697b6 0000-0002-5437-8389 Gareth Jenkins Gareth Jenkins true false 01bb85bf0f42776da3858b569ba5319a Sarah Gwynne Sarah Gwynne true false 2024-12-20 MEDS The role of radiotherapy (RT) for inoperable gastric cancer (IGC) is commonly low-dose, given reactively for symptoms (e.g. bleeding), in contrast to the oesophagus, where high quality evidence exists for higher doses of RT. This systematic review aims to evaluate the use of, and evidence for, definitive and high-dose palliative RT for IGC and whether a change in practice is warranted. Following registration with PROSPERO (CRD42022297080), MEDLINE, EMBASE and The Cochrane Library were searched in accordance with PRISMA standards for studies evaluating definitive (non-metastatic disease, BED10 >45Gy) or high-dose palliative RT (for symptom/local control, minimum BED10 >30Gy). A manual search of meeting proceedings and clinical trial registries was also performed. 31 studies were selected for analysis. 10 definitive studies totalling n = 354 patients receiving RT with 45-50.4Gy/25-28#, showed median overall survival ranging between 11 and 26.4 months, clinical complete response range 12%-45%, G3 gastrointestinal toxicity 0-31% (range) and RT completion rates ranging from 81% to 100%. 21 high-dose palliative studies (n = 955) mostly evaluated haemostatic control and reported 38 different RT regimens (most commonly 30Gy/10#). Bleeding response rate (RR) was 59.6%-90%, pain RR 45.5-100%, obstruction RR 52.9%-100%, G3 gastrointestinal toxicity <5% and RT completion 68%-100%. An additional American National Cancer Database review >4700 non metastatic IGC patients which combined both definitive and palliative doses found significant benefit to RT in addition to chemotherapy. Evidence regarding a dose-response relationship is conflicting, limited by retrospective data. Two studies report high quality -of-life (QOL) scores following gastric RT. There is a body of mainly non-randomised, observational evidence showing high-dose RT is efficacious, safe and may maintain QOL for patients with IGC. A change in practice will require a prospective randomised controlled trial, which should explore the role of prophylactic, high-BED RT combined with optimal systemic therapy using modern IMRT techniques and RT quality assurance. [Abstract copyright: Copyright © 2024. Published by Elsevier Ltd.] Journal Article Clinical Oncology 37 103693 Elsevier BV 0936-6555 1433-2981 Inoperable; Radiation; Radical; Stomach cancer; Symptoms 1 1 2025 2025-01-01 10.1016/j.clon.2024.103693 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Not Required This work was partially funded by Wales Cancer Research Centre (AC) and Health and Care Research Wales (SG). 2025-01-07T14:30:06.5190754 2024-12-20T10:55:29.1793737 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science A Case 1 F Williams 2 S Prosser 3 Hayley Hutchings 0000-0003-4155-1741 4 T Crosby 5 R Adams 6 Gareth Jenkins 0000-0002-5437-8389 7 Sarah Gwynne 8
title Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
spellingShingle Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
Hayley Hutchings
Gareth Jenkins
Sarah Gwynne
title_short Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
title_full Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
title_fullStr Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
title_full_unstemmed Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
title_sort Reconsidering the Role of Radiotherapy for Inoperable Gastric Cancer: A Systematic Review of Gastric Radiotherapy Given With Definitive and Palliative Intent
author_id_str_mv bdf5d5f154d339dd92bb25884b7c3652
a44095d26187304e903da7ca778697b6
01bb85bf0f42776da3858b569ba5319a
author_id_fullname_str_mv bdf5d5f154d339dd92bb25884b7c3652_***_Hayley Hutchings
a44095d26187304e903da7ca778697b6_***_Gareth Jenkins
01bb85bf0f42776da3858b569ba5319a_***_Sarah Gwynne
author Hayley Hutchings
Gareth Jenkins
Sarah Gwynne
author2 A Case
F Williams
S Prosser
Hayley Hutchings
T Crosby
R Adams
Gareth Jenkins
Sarah Gwynne
format Journal article
container_title Clinical Oncology
container_volume 37
container_start_page 103693
publishDate 2025
institution Swansea University
issn 0936-6555
1433-2981
doi_str_mv 10.1016/j.clon.2024.103693
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 0
active_str 0
description The role of radiotherapy (RT) for inoperable gastric cancer (IGC) is commonly low-dose, given reactively for symptoms (e.g. bleeding), in contrast to the oesophagus, where high quality evidence exists for higher doses of RT. This systematic review aims to evaluate the use of, and evidence for, definitive and high-dose palliative RT for IGC and whether a change in practice is warranted. Following registration with PROSPERO (CRD42022297080), MEDLINE, EMBASE and The Cochrane Library were searched in accordance with PRISMA standards for studies evaluating definitive (non-metastatic disease, BED10 >45Gy) or high-dose palliative RT (for symptom/local control, minimum BED10 >30Gy). A manual search of meeting proceedings and clinical trial registries was also performed. 31 studies were selected for analysis. 10 definitive studies totalling n = 354 patients receiving RT with 45-50.4Gy/25-28#, showed median overall survival ranging between 11 and 26.4 months, clinical complete response range 12%-45%, G3 gastrointestinal toxicity 0-31% (range) and RT completion rates ranging from 81% to 100%. 21 high-dose palliative studies (n = 955) mostly evaluated haemostatic control and reported 38 different RT regimens (most commonly 30Gy/10#). Bleeding response rate (RR) was 59.6%-90%, pain RR 45.5-100%, obstruction RR 52.9%-100%, G3 gastrointestinal toxicity <5% and RT completion 68%-100%. An additional American National Cancer Database review >4700 non metastatic IGC patients which combined both definitive and palliative doses found significant benefit to RT in addition to chemotherapy. Evidence regarding a dose-response relationship is conflicting, limited by retrospective data. Two studies report high quality -of-life (QOL) scores following gastric RT. There is a body of mainly non-randomised, observational evidence showing high-dose RT is efficacious, safe and may maintain QOL for patients with IGC. A change in practice will require a prospective randomised controlled trial, which should explore the role of prophylactic, high-BED RT combined with optimal systemic therapy using modern IMRT techniques and RT quality assurance. [Abstract copyright: Copyright © 2024. Published by Elsevier Ltd.]
published_date 2025-01-01T14:39:18Z
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