Which regimen is better for gastric adenocarcinoma- neoadjuvant chemotherapy or adjuvant chemoradiation?

There are common criticisms of both the MAGIC and INT-0116 trial results.

In the MAGIC trial consisting of preoperative (3 cycles ECF) and postoperative (3 cycles of ECF) vs surgery alone, there was inconsistent preoperative staging.. Lymph node dissections were left to the discretion of the surgeon with a variety of D0-D2 dissections. Curative gastric surgery was performed in about 65-70% of cases in both arms, possibly speaking to the variety of staging approaches. About 40% of patients completed all of the protocol treatment. Although patients were significantly downstaged from a T and N standpoint, there were ZERO pathological complete responses out of 250 cases who received chemotherapy. 5Y survival was 36% (chemo+ surgery) vs 23% (surg...

The differences in the design of these trials make it impossible to compare the results. Both are viable options. People, and institutions, certainly have preferences for one approach vs. the other, but I would not say there is a consensus.

My personal preference is for pre-operative chemoradiation, but that is not standard of care. If the TOPGEAR trial is positive, however, pre-operative chemoradiation for gastric cancer may become a third option in addition to the MAGIC and MacDonald approaches.