{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:57:04Z","timestamp":1792180624148,"version":"4.4.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Despite advances in D2 gastrectomy (ie, gastrectomy with D2 lymphadenectomy) and adjuvant chemotherapy, the value of adding postoperative radiotherapy (RT) to adjuvant chemotherapy after D2 gastrectomy remains a topic of ongoing debate.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess whether the addition of RT to the S-1 plus oxaliplatin (SOX) chemotherapy regimen increases disease-free survival (DFS) in patients with T4 or node-positive gastric cancer after D2 gastrectomy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This open-label, phase 3 randomized clinical trial was conducted between December 1, 2012, and August 30, 2022, at 5 large tertiary hospitals in China. Eligible patients were aged 18 to 70 years with gastric adenocarcinoma who underwent R0 resection with D2 lymphadenectomy, had pathologic stage T4 or node-positive disease, and had no evidence of metastasis (M0). Intention-to-treat statistical analyses were conducted from January 14 to March 31, 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n \n Participants were assigned 1:1 to receive concurrent chemoradiotherapy (SOX RT) or chemotherapy alone (SOX). The SOX RT group received 1 cycle of induction SOX, followed by RT (50.4 Gy in 28 fractions) with concurrent S-1 (50 mg twice daily), and then 3 cycles of SOX. The SOX group received 6 cycles of SOX (S-1 30-40 mg\/m\n 2<\/jats:sup>\n twice daily on days 1-14; oxaliplatin 130 mg\/m\n 2<\/jats:sup>\n on day 1, every 3 weeks).\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary end point was 3-year DFS. Secondary end points included overall survival (OS) and adverse events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 620 patients were randomly assigned to the SOX group (n\u2009=\u2009311) or SOX RT group (n\u2009=\u2009309). Patients had a median (IQR) age of 55 (47-62) years and included 401 males (64.7%). Overall, 274 patients (44.2%) had T4 disease, and 590 (95.2%) had node-positive disease. In the primary analysis for the prespecified 3-year DFS end point, there was no evidence of a between-group difference in DFS (SOX RT vs SOX: HR, 0.98; 95% CI, 0.73-1.33). Similarly, there was no evidence of a between-group difference in OS (HR, 0.86; 95% CI, 0.60-1.23). The Kaplan-Meier\u2013estimated 3-year DFS rates were 70.5% in the SOX RT group and 69.3% in the SOX group (log-rank\n P<\/jats:italic>\n \u2009=\u2009.93), and the corresponding 3-year OS rates were 80.8% and 78.4%, respectively (log-rank\n P<\/jats:italic>\n \u2009=\u2009.41). At 5 years, the DFS rates were 60.0% and 57.3% (log-rank\n P<\/jats:italic>\n \u2009=\u2009.76) and the corresponding OS rates were 73.7% and 71.4% (log-rank\n P<\/jats:italic>\n \u2009=\u2009.55) in the SOX RT and SOX groups, respectively. Treatment-related adverse events were similar between groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of patients with T4 or node-positive gastric cancer who underwent D2 gastrectomy, SOX RT did not significantly improve DFS or OS. Accordingly, among patients with D2-resected gastric cancer, the findings do not support routine addition of adjuvant chemoradiotherapy to chemotherapy.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Chinese Clinical Trial Registry Identifier:\n ChiCTR-TRC-12002919<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.16154","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:30:45Z","timestamp":1781537445000},"page":"e2616154","source":"Crossref","is-referenced-by-count":1,"title":["Adjuvant Chemoradiotherapy or Chemotherapy After D2 Gastrectomy in Gastric Cancer"],"prefix":"10.1001","volume":"9","author":[{"given":"Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Abdominal Tumor Multimodality Treatment, West China Hospital, Sichuan University, Sichuan, China"},{"name":"State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, 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