Exploring the Interplay Between Surgery and Radiation in Gastric Cancer

At the 2026 ASCO Gastrointestinal Cancers Symposium, Marcel Verheij, MD, PhD, presented findings from the phase 2 CRITICS-II trial (NCT02931890) demonstrating effective event-free survival (EFS) outcomes with preoperative chemoradiotherapy (CRT) alone or in combination with chemotherapy among those with resectable gastric cancer. Data from the trial supported “total neoadjuvant” chemotherapy plus CRT as a preferred preoperative regimen in this patient population.

In a conversation with CancerNetwork^®, Verheij, from the Department of Radiation Oncology at Radboud University Medical Center, discussed key considerations for collaborating with colleagues in surgical oncology to optimize outcomes for patients undergoing radiotherapy followed by resection for gastric cancer. He noted that radiation oncologists and surgeons can form strategies during multidisciplinary tumor boards, touching upon topics like the expected toxicity associated with radiation as well as ideas for surgical techniques.

In the CRITICS-II trial, the EFS rate at 1 year was 68% (95% CI, 58%-80%) among patients who received chemotherapy alone in arm 1, 84% (95% CI, 75%-84%) for patients who received chemotherapy plus CRT in arm 2, and 78% (95% CI, 69%-88%) for those who received CRT alone in arm 3. Additionally, the rates of pathologic complete response were 8%, 20%, and 13% in each respective treatment arm. Across all patient groups, adverse effects of grade 0 to 2 occurred in 49% of patients, and grade 3/4 toxicities were reported in 49%.

Transcript:

There is an overlap in the way we treat patients in surgical and radiation oncology because we both treat locally. What is important in the interplay between surgeons and radiation oncologists is that surgeons know where we deposit our radiation dose because that may affect the technique and the complications of surgical intervention. In that respect, radiation oncologists and surgeons do discuss the patients, of course, in a multidisciplinary board with an emphasis on expected toxicity from radiation in terms of surgical techniques and outcomes.

Reference

Verheij M, van Grieken NCT, Slagter AE, et al. CRITICS-II: a multicenter randomized phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. J Clin Oncol. 2026;44(suppl 2):283. doi:10.1200/JCO.2026.44.2_suppl.283