Boosting Preoperative Response Rates in Gastric Cancer: Chemotherapy Plus Radiotherapy

ContributorsProf. Dr. Mustafa ÖzdoğanAuthor · Medical review · Editorial approval

PublishedJan 13, 2026

UpdatedOct 17, 2026

3 min read

Boosting Preoperative Response Rates in Gastric Cancer: Chemotherapy Plus Radiotherapy

In this article

Intensified Treatment Before Surgery

Why Do We Need a New Approach?

Our standard approach to gastric cancer generally involves chemotherapy before and after surgery (perioperative treatment). However, we frequently encounter a major problem in clinical practice: Patients undergoing gastric surgery (gastrectomy) struggle to recover after the operation and cannot complete the planned ‘postoperative’ part of treatment.

The Phase 2 trial from the Netherlands, CRITICS-II, focuses precisely on this problem: ‘Would outcomes be better if we gave all or the most intensive part of treatment while the patient is still strong — before surgery?’

Results presented at ASCO GI 2026 show that combining chemotherapy and radiotherapy before surgery (a total neoadjuvant approach) may markedly improve survival rates.

Clinical Glossary: Understanding the Study

Neoadjuvant Treatment: Treatment intended to shrink the tumor and improve surgical success, given before surgery.

Chemoradiotherapy (CRT): The concurrent administration of chemotherapy drugs and radiotherapy (radiation treatment) to increase the effect on the tumor.

Event-Free Survival (EFS): The length of time after treatment that a patient experiences no adverse event, such as cancer recurrence or progression.

Study Design: Three Different Strategies Compete

Patients with Stage IB–IIIC resectable (operable) gastric cancer were assigned to three different preoperative treatment arms:

1. Chemotherapy Alone

4 cycles of Docetaxel, Oxaliplatin and Capecitabine.

Conventional Approach

2. Combination (TNT)

2 cycles of chemotherapy, followed by chemoradiotherapy (45 Gy radiotherapy + Paclitaxel/Carboplatin).

The Most Successful Arm

3. Chemoradiotherapy Alone

Concurrent radiotherapy and chemotherapy alone.

Results: Combination Treatment Comes Out on Top

The study’s most striking result was that the group receiving both chemotherapy and chemoradiotherapy before surgery (Combination) had markedly superior outcomes to the others.

Event-Free Survival (EFS) Rates at Year 1

Combination (Chemotherapy + CRT) 84%

Chemoradiotherapy Alone (CRT) 78%

Chemotherapy Alone 68%

Overall Survival Difference: Overall survival at year 1 in the combination group was 89% , compared with 74% in the chemotherapy-alone group.

DROZDOGAN Academy Commentary

CRITICS-II provides important evidence strengthening the concept of ‘Total Neoadjuvant Treatment’ (TNT) in gastric cancer management. Its most important message is: Leaving treatment until after surgery is risky.

Looking at the data, only 81% of patients in the chemotherapy-alone group and 65% in the combination group completed preoperative treatment. However, adherence to postoperative chemotherapy (adjuvant treatment) is always lower because of surgical complications or patient debility. This study shows that using our most effective weapons — both potent chemotherapy and radiotherapy — before patients experience the toll of surgery is superior for controlling disease.

These results suggest that we should reconsider the role of radiotherapy in gastric cancer and that intensified preoperative treatment may become standard for appropriate patients.

Source:

Verheij M, et al. Neoadjuvant chemotherapy plus chemoradiotherapy may be superior to neoadjuvant chemotherapy or chemoradiotherapy alone in patients with resectable gastric cancer. ASCO Gastrointestinal Cancers Symposium. 2026; Abstract 283.
Leong T, et al. Preoperative chemoradiotherapy for resectable gastric cancer. N Engl J Med. 2024;391(19):1810-1821.

Reader comments

Share your comment

Your name and comment are published only after administrator approval. Your email address is never shown to visitors.

Be the first to comment.

DROZDOGAN AI

Explore this article together

Ask about the article and read answers alongside published sources from our site.

Menu

Boosting Preoperative Response Rates in Gastric Cancer: Chemotherapy Plus Radiotherapy