Just when you thought post-op radiation for D2-resected gastric cancer was consigned to the history books, a Chinese retrospective analysis is here to suggest it may still have a niche role. Following outcomes for 1169 patients after D2-resection for stage I-III gastric cancer, mostly followed by oxaliplatin-based chemo, revealed most failures were peritoneal (29%) followed by distant (23%) followed by locoregional (20%). As expected, location of regional failure was dependent on tumor location but consistently involved the para-aortic nodes spanning 6 cm above to 5 cm below the renal veins. A predictive nomogram was developed to identify those at highest risk of regional failure relying heavily on advanced T-stage and >25% of sampled nodes being involved. Ultimately, the discussion gives excellent detailed guidance on when and how to employ post-op gastric radiation in select circumstances from colleagues with noteworthy experience. | Jiang, Pract Radiat Oncol 2025
