• chemoradiotherapy
• gastric cancer
• surgery

The randomised controlled trial reported by MacDonald et al documents an impressive increase in overall survival with postoperative chemoradiotherapy compared with surgical resection of gastric cancer alone (36 months v 27 months). Of equal importance is the finding of a significant reduction in the hazard ratio for relapse (1.52, 95% CI 1.23–1.86; p<0.001). Although not the first randomised controlled trial to document a survival benefit from postoperative adjuvant therapy,¹ it is the first to demonstrate a substantial survival advantage due to reduction of locally recurrent disease from postoperative adjuvant orthodox chemoradiation (425 mg fluorouracil/m² plus 20 mg leucovorin/m² for five days, followed by 45 000 cGy of radiation over a five week period) and brings hope to a depressing cancer with an unfavourable prognosis unless diagnosed at the T1 stage. Thus this North American randomised controlled trial merits close scrutiny.

The trial has adequate power …