Preoperative Radiotherapy in Patients with Gastric and Gastro-Oesophageal Cancer: A Systematic Review and Meta-analysis.

backgroundGastric (GC) and gastroesophageal junction (GEJ) cancers are among the most prevalent digestive cancers, characterized by a poor prognosis, particularly in advanced stages, where the 5-year survival rate remains below 20%. While surgery is still the standard treatment, its limited ability to lower recurrence rates highlights the necessity for effective perioperative therapies. In this context, Radiotherapy (RT) and chemoradiotherapy (CRT) have been investigated for their potential to improve tumor control, pathologic complete response (pCR), and overall survival (OS) in advanced GC. This systematic review and meta-analysis aimed to assess the efficacy and safety of preoperative RT/CRT on key clinical outcomes in patients with GC, focusing on pathologic complete response (pCR), overall survival (OS), and postoperative complications, such as anastomotic leaks and postoperative mortality.

methodsA systematic search of PubMed, Embase, and Web of Science databases was conducted for randomized controlled trials and single-arm studies comparing preoperative RT/CRT with chemotherapy or surgery alone. Outcomes were pooled using risk ratios (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs), and heterogeneity was assessed using I

resultsTen studies including 6 RCTs and 4 single-arm studies, comprising 2,138 patients were included. CRT significantly improved pCR rates compared to control groups (RR 2.72; 95% CI 1.89-3.92; p < 0.000001; I

conclusionPreoperative CRT significantly improves pCR rates, highlighting its potential as a valuable strategy in tumor downstaging. However, it does not enhance survival outcomes, while notably, it does not increase surgical complications. Future studies incorporating biomarkers and standardized protocols are essential to refine patient selection, ensuring optimized treatment strategies and maximizing clinical benefits.