Gastric Cancer Radiotherapy

Introduction

Gastric cancer, or stomach cancer, ranks among the top causes of cancer mortality worldwide. While surgery and chemotherapy remain the primary treatments, gastric cancer radiotherapy plays an important role in multimodal management—especially in locally advanced, inoperable, or recurrent cases.

Radiation therapy, either alone or in combination with chemotherapy (chemoradiation), can help shrink tumors, relieve symptoms, and improve survival. This article provides a complete overview of gastric cancer radiotherapy, including indications, techniques, effectiveness, side effects, global treatment costs, and clinical trials in China.

About the Disease

Gastric cancer arises from the lining of the stomach, with adenocarcinoma being the most common type. It typically progresses silently until it reaches advanced stages, making early detection challenging. Risk factors include:

• Helicobacter pylori infection

• Smoking

• Diet high in smoked/salty foods

• Family history

• Chronic gastritis

The cancer can spread locally or metastasize to lymph nodes, liver, or peritoneum. Based on stage, treatment may include surgery, chemotherapy, radiotherapy, or combinations.

Indications for Radiotherapy

Radiotherapy is usually not the first-line treatment for early gastric cancer but is used in specific situations:

• Adjuvant radiotherapy: After surgery to eliminate residual cancer cells.

• Neoadjuvant chemoradiation: Before surgery to shrink tumors.

• Definitive radiotherapy: For patients who cannot undergo surgery.

• Palliative radiotherapy: To relieve symptoms like bleeding, pain, or obstruction in advanced cancer.

• Local recurrence or residual disease: When surgery is not possible.

Treatment Details

Radiation therapy uses high-energy X-rays or particles to destroy cancer cells. For gastric cancer, it is often delivered using advanced techniques like:

1. External Beam Radiation Therapy (EBRT)

• The most common form.

• Uses a linear accelerator to target the tumor from outside the body.

2. Intensity-Modulated Radiation Therapy (IMRT)

• Allows precise targeting of the tumor with minimal damage to nearby organs like the liver or kidneys.

3. Image-Guided Radiation Therapy (IGRT)

• Uses imaging before each session to improve accuracy and minimize side effects.

4. 3D Conformal Radiation Therapy (3D-CRT)

• Shapes radiation beams to match the tumor.

Dosage:

• Typically 45–50.4 Gray (Gy) in 25–28 fractions over 5–6 weeks.

• May be combined with concurrent chemotherapy (e.g., 5-FU or capecitabine).

Medicines Used During Radiotherapy

When radiotherapy is combined with chemotherapy (chemoradiation), certain drugs may be used to enhance radiation’s effectiveness:

Radiosensitizers:

• 5-Fluorouracil (5-FU) – Standard concurrent agent.

• Capecitabine – Oral alternative to 5-FU.

• Cisplatin or Oxaliplatin – In some protocols.

Supportive Medications:

• Anti-nausea drugs (ondansetron, domperidone)

• Antacids or proton pump inhibitors

• Pain relievers

• Appetite stimulants

• Nutritional supplements

These help the patient tolerate the full course of radiotherapy with minimal interruptions.

Effectiveness of Gastric Cancer Radiotherapy

Radiotherapy offers several benefits when integrated with other treatments:

• Improves local control in high-risk patients post-surgery

• Shrinks tumors to make inoperable cancers resectable

• Increases survival when used with chemotherapy

• Relieves symptoms like bleeding, pain, or gastric outlet obstruction

Studies such as the INT-0116 trial have demonstrated improved disease-free and overall survival with adjuvant chemoradiotherapy after surgery.

Risks and Side Effects

Although modern radiation therapy is safer and more precise, side effects can still occur due to the stomach’s location near vital organs.

Common Side Effects:

• Nausea and vomiting

• Diarrhea

• Fatigue

• Abdominal cramps

• Skin redness or irritation at the treatment site

• Loss of appetite

• Temporary low blood counts

Long-Term Effects (Rare):

• Kidney or liver damage

• Ulcers or scarring of the stomach lining

• Secondary cancers (very rare)

Side effects are usually managed with supportive care, and most resolve after treatment ends.

Recovery and Aftercare

Recovery from gastric cancer radiotherapy depends on the patient’s overall health, tumor stage, and treatment plan.

During Radiotherapy:

• Weekly checkups with the radiation oncologist

• Blood tests to monitor organ function and blood counts

• Nutritional guidance and support

Post-Radiotherapy:

• Follow-up imaging (CT or PET scans) to evaluate treatment response

• PSA monitoring if applicable

• Dietary modifications: low-fat, high-protein, easily digestible foods

• Psychosocial support to manage fatigue and emotional stress

Most patients resume normal activities within 4–6 weeks after treatment.

Cost and Availability

Radiotherapy for gastric cancer is available in all major cancer centers worldwide. Costs vary depending on the type of radiotherapy used and the region.

In India:

• 3D-CRT: ₹50,000 – ₹80,000 ($600 – $1,000)

• IMRT: ₹1 – ₹2 lakhs ($1,200 – $2,400)

• Chemoradiation: ₹2.5 – ₹4 lakhs ($3,000 – $4,800)

In China:

• 3D-CRT: ¥20,000 – ¥35,000 ($2,800 – $5,000)

• IMRT/IGRT: ¥40,000 – ¥80,000 ($5,600 – $11,000)

• Additional costs for chemotherapy and imaging

Many patients qualify for financial support via government insurance or public health schemes.

Patient Experiences

Patients who receive radiotherapy often express gratitude for its symptom relief and tumor control, especially when other treatments were not effective or feasible.

Real stories:

• “After chemoradiation, my tumor shrank enough for surgery.”

• “Radiation relieved my pain and bleeding within a few days.”

• “I felt tired, but the team supported me through recovery.”

Multidisciplinary care and emotional support greatly enhance the overall experience and outcome.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey, and USA

These figures cover radiation planning, delivery, labs, chemo, and follow-up imaging.

List of Ongoing Clinical Trials in China

China continues to invest in radiotherapy innovations, especially in combination with chemotherapy and immunotherapy. Notable ongoing trials include:

1. Neoadjuvant Chemoradiation vs Chemotherapy Alone

   • Aim: Improve resection rates in locally advanced cases

   • Phase: III

2. IMRT + Immunotherapy in MSI-High Gastric Cancer

   • Focus: Boost immune response and local tumor control

   • Phase: II

3. Stereotactic Body Radiation Therapy (SBRT) for Oligometastatic Disease

   • Aim: Target limited metastases with high-dose precision radiation

   • Phase: I/II

4. AI-Guided Radiation Planning Algorithms

   • Improve accuracy and reduce planning time

   • Phase: Pilot Study

5. Chinese Herbal Medicine + Radiation Therapy

   • Explore reduction in side effects and immune enhancement

   • Phase: II

Top research centers: Fudan University Shanghai Cancer Center, Peking University Cancer Hospital, Sun Yat-sen University Cancer Center.

FAQ

Is radiation therapy a cure for gastric cancer?

Alone, it usually isn’t curative but is highly effective when combined with surgery and chemotherapy.

How many sessions are needed?

Typically, 25–28 sessions over 5–6 weeks.

Is radiation painful?

No. Radiation sessions are painless. Side effects may appear gradually.

Can radiotherapy be repeated?

Generally not in the same location due to tissue sensitivity, but may be possible in select cases.

Can I eat normally during radiation?

Yes, but soft, non-irritating foods are recommended. A dietitian can help manage nausea or appetite issues.

Is radiotherapy available in India and China?

Yes, at most public and private cancer hospitals, often at affordable or subsidized costs.