***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background For patients who undergo gastrectomy for gastric cancer , systematic follow-up evaluation to detect recurrent lesions is recommended , although the benefits of a surveillance program using short-term imaging studies have not been evaluated . Methods This study review ed the clinical data of patients who underwent curative surgery for gastric cancer using a prospect i ve data base . Patients with recurrence were classified according to surveillance interval as follows : ≤3 , 3–6 , and 6–12 months . Results Of the 2785 patients who underwent curative surgery for gastric cancer , 376 ( 13.5 % ) had intraabdominal recurrences , excluding the stomach . Multivariable analysis showed that a short surveillance interval did not increase the post-recurrence survival duration ( with 6–12 months as the reference : ≤3 months : hazard ratio [ HR ] 0.954 ; 95 % confidence interval [ CI ] 0.689–1.323 ; 3–6 months : HR 0.994 , 95 % CI 0.743–1.330 ) . In addition , short surveillance intervals did not increase overall survival ( with 6–12 months as the reference : ≤3 months : HR 0.969 ; 95 % CI 0.699–1.342 ; 3–6 months : HR 0.955 ; 95 % CI 0.711–1.285 ) . In contrast to the surveillance interval , age , cancer stage , symptoms at recurrence , and recurrence time after gastrectomy were factors associated with both post-recurrence survival and overall survival . Conclusions Although the detection of recurrence before symptoms helped to prolong both post-recurrence survival and overall survival , shortening the surveillance interval to less than 6 months did not improve either the patient ’s post-recurrence survival or overall survival . Hence , it is not recommended that asymptomatic patients  undergo surveillance involving imaging studies more often than once a year Purpose In a retrospective analysis , adjuvant intensity-modulated radiation therapy ( IMRT ) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination of three-dimensional conformal radiation therapy ( 3D-CRT ) and conventional chemotherapy . We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy , or 3D-CRT and conventional chemotherapy .  Patients and methods Between 2001 and 2008 , 65 consecutive gastric cancer patients received either 3D-CRT  ( n = 27 ) or IMRT ( n = 38 ) following tumor resection . Chemotherapy comprised predominantly 5-fluorouracil/folinic acid ( 5-FU/FA ) in the earlier cohort and capecitabine plus oxaliplatin ( XELOX ) in the latter . The primary endpoints were overall survival ( OS ) and disease-free survival ( DFS ) . Results Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups , respectively ( p = 0.0602 ) . Actuarial 5-year OS rates were 26 and 47 % , respectively . Within the IMRT group , XELOX gave better results than 5-FU/FA in terms of OS , but this difference was not statistically significant . The primary cause of death in both groups was distant metastasis . Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups , respectively ( p = 0.0693 ) . Actuarial 5-year DFS rates were 22 and 44 % , respectively . Among patients receiving 5-FU/FA , DFS tended to be better in the IMRT group , but this was not statistically significant . A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients . No late toxicity exceeding grade 3 or secondary tumors were observed . Conclusion After a median follow-up period of over 5 years , OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group . Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity . ZusammenfassungZielsetzungIn einer retrospektiven Analyse verbesserte die adjuvante Radiochemotherapie mit intensitätsmodulierter Strahlentherapie ( IMRT ) und moderner Chemotherapie das Überleben von Patienten mit lokal fortgeschrittenem Magenkarzinom gegenüber der Kombination aus 3-dimensionaler konformaler Strahlentherapie ( 3D-CRT ) und konventioneller Chemotherapie . Wir berichten nun über die Langzeitergebnisse von zwei aufein and er folgenden Patientenkohorten , die entweder mit IMRT  in Kombination mit einer intensivierten Chemotherapie [ Capecitabin/Oxaliplatin ( XELOX ) , spätere Kohorte ] oder mit 3D-CRT und konventioneller Chemotherapie [ 5-Fluorouracil/Folinsäure ( 5-FU/FA ) , frühere Kohorte ] beh and elt worden waren . Patienten und Method enIn den Jahren 2001–2008 wurden 65 Patienten konsekutiv wegen eines Magenkarzinoms entweder mit 3D-CRT ( n = 27 ) oder IMRT ( n = 38 ) beh and elt . Die Chemotherapie beinhaltete überwiegend 5-FU/FA in der früheren Kohorte und XELOX in der späteren Kohorte . Primäre Endpunkte waren das Gesamtüberleben ( OS ) und krankheitsfreie Überleben (DFS).ErgebnisseDas mediane OS betrug in der 3D-CRT-Gruppe 18 Monate und in der IMRT-Gruppe 43 Monate ( p = 0,0602 ) . Das aktuarische 5-Jahres-OS lag nach 3D-CRT bei 26 % und nach IMRT bei 47 % . Innerhalb der IMRT-Gruppe war die intensivierte Chemotherapie der konventionellen hinsichtlich des OS überlegen , der Unterschied erreichte aber keine statistische Signifikanz . Zum Tode führten in beiden Gruppen vorwiegend Fernmetastasen außerhalb des Bestrahlungsfelds . Das mediane DFS betrug 14 Monate in der 3D-CRT-Gruppe und 35 Monate in der IMRT-Gruppe ( p = 0,0693 ) . Das aktuarische 5-Jahres-DFS lag bei 22 % in der 3D-CRT und 44 % in der IMRT-Gruppe . Innerhalb der Patientengruppe , die lediglich 5-FU/FA erhalten hatte , zeigte sich ein statistisch nicht signifikanter Vorteil für die IMRT . Eine entsprechende Analyse in der XELOX-Gruppe war nicht möglich , da die Radiotherapie nahezu nie als 3D-CRT durchgeführt worden war . Eine Spättoxizität > Grad 3 und Sekundärtumoren wurden nicht beobachtet . SchlussfolgerungNach einer medianen Beobachtungsdauer von > 5 Jahren war sowohl das OS als auch das DFS in der Patientengruppe mit IMRT/XELOX-Beh and lung deutlich verbessert . Die Langzeitbeobachtung erbrachte keine klinischen Hinweise auf Nephrotoxizität oder therapiebedingte Sekundärtumoren PURPOSE Surgical resection of gastric cancer has produced suboptimal survival despite multiple r and omized trials that used postoperative chemotherapy or more aggressive surgical procedures . We performed a r and omized phase III trial of postoperative radiochemotherapy in those at moderate risk of locoregional failure ( LRF ) following surgery . We originally reported results with 4-year median follow-up . This up date , with a more than 10-year median follow-up , presents data on failure patterns and second malignancies and explores selected subset analyses . PATIENTS AND METHODS In all , 559 patients with primaries ≥ T3 and /or node-positive gastric cancer were r and omly assigned to observation versus radiochemotherapy after R0 resection . Fluorouracil and leucovorin were administered before , during , and after radiotherapy . Radiotherapy was given to all LRF sites to a dose of 45 Gy . RESULTS Overall survival ( OS ) and relapse-free survival ( RFS ) data demonstrate continued strong benefit from postoperative radiochemotherapy . The hazard ratio ( HR ) for OS is 1.32 ( 95 % CI , 1.10 to 1.60 ; P = .0046 ) . The HR for RFS is 1.51 ( 95 % CI , 1.25 to 1.83 ; P < .001 ) . Adjuvant radiochemotherapy produced substantial reduction in both overall relapse and locoregional relapse . Second malignancies were observed in 21 patients with radiotherapy versus eight with observation ( P = .21 ) . Subset analyses show robust treatment benefit in most subsets , with the exception of patients with diffuse histology who exhibited minimal nonsignificant treatment effect . CONCLUSION Intergroup 0116 ( INT-0116 ) demonstrates strong persistent benefit from adjuvant radiochemotherapy . Toxicities , including second malignancies , appear acceptable , given the magnitude of RFS and OS improvement . LRF reduction may account for the majority of overall relapse reduction . Adjuvant radiochemotherapy remains a rational st and ard therapy for curatively resected gastric cancer with primaries T3 or greater and /or positive nodes BACKGROUND Surgical resection of adenocarcinoma of the stomach is curative in less than 40 percent of cases . We investigated the effect of surgery plus postoperative ( adjuvant ) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction . METHODS A total of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction were r and omly assigned to surgery plus postoperative chemoradiotherapy or surgery alone . The adjuvant treatment consisted of 425 mg of fluorouracil per square meter of body-surface area per day , plus 20 mg of leucovorin per square meter per day , for five days , followed by 4500 cGy of radiation at 180 cGy per day , given five days per week for five weeks , with modified doses of fluorouracil and leucovorin on the first four and the last three days of radiotherapy . One month after the completion of radiotherapy , two five-day cycles of fluorouracil ( 425 mg per square meter per day ) plus leucovorin ( 20 mg per square meter per day ) were given one month apart . RESULTS The median overall survival in the surgery-only group was 27 months , as compared with 36 months in the chemoradiotherapy group ; the hazard ratio for death was 1.35 ( 95 percent confidence interval , 1.09 to 1.66 ; P=0.005 ) . The hazard ratio for relapse was 1.52 ( 95 percent confidence interval , 1.23 to 1.86 ; P<0.001 ) . Three patients ( 1 percent ) died from toxic effects of the chemoradiotherapy ; grade 3 toxic effects occurred in 41 percent of the patients in the chemoradiotherapy group , and grade 4 toxic effects occurred in 32 percent . CONCLUSIONS Postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection Abstract Background To evaluate the safety and efficacy of a concurrent three-dimensional conformal radiotherapy ( 3D-CRT ) or intensity-modulated radiotherapy ( IMRT ) plus oxaliplatin , 5-fluorouracil and leucovorin ( FOLFOX ) regimen in completely resected gastric cancer patients with D2 lymph node dissection . Material s and methods Patients with stage IB – IIIC gastric cancer ( per the AJCC , 7th edition ) who had undergone R0 and D2 gastrectomy were recruited . Two cycles of FOLFOX with concurrent 3D-CRT or IMRT ( 50.4 Gy/28f ) were administered . One and an additional five cycles of FOLFOX were delivered before and after concurrent chemoradiotherapy , respectively . Primary endpoints were relapse-free survival ( RFS ) and overall survival ( OS ) , with adverse events as secondary endpoints . Results From 2008 to 2011 , 110 patients were evaluable . The 1- , 2- and 3-year RFS and OS were 86.2 , 72.2 , 67.8 and 94.7 , 87.2 , 77.6 % , respectively . On multivariate analysis , stage ( ≤IIIA vs. > IIIA ) was a statistically significant factor affecting both RFS and OS . Additionally , the T-category ( ≤T4a vs. = T4b ) was a statistically significant factor affecting only the RFS . The most commonly observed grade 3 or 4 adverse events were nausea and vomiting , decreased appetite , leukopenia/neutropenia and fatigue , each of which occurred in 14.5 , 11.8 , 9.1 and 6.4 % patients , respectively . Conclusions Adjuvant 3D-CRT/IMRT to a dose of 50.4 Gy/28f with concurrent FOLFOX is safe and effective in patients following radical gastrectomy 
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No significant difference in the 3-year DFS rate was found between the IMRT and 3D-CRT groups .
Grade 2–4 toxicities were similar between the IMRT and 3D-CRT groups .
Conclusion The findings suggested that IMRT might be superior to 3D-CRT in treating patients with gastric cancer in terms of local control rates without increasing toxicity