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Purpose We report the outcomes of patients treated with palliative radiotherapy (pRT) to the primarytumour in the context of well-controlled metastatic disease after initial chemotherapy. Materials and MethodsClinical records of 132 patients with metastatic esophago-gastric (OG) cancer treated withpalliative chemotherapy (pCT) between January 2009 and June 2013 were reviewed. Ninetysevenpatients had responding or stable disease after 3 months of chemotherapy, of whom53 patients received pRT to the primary tumour after initial chemotherapy in the presenceof well-controlled metastatic disease (group A, pCT-RT). The remaining 44 patients weretreated with pCT alone (group B, pCT). Treatment-related outcomes were assessed in abovegroups including time to local progression (TTLP), progression-free and overall survival. ResultsThe median overall survival for patients treated with pRT after initial chemotherapy (groupA) was 23.3 months (95% confidence interval [CI], 17.70 to 28.89 months) and significantlyhigher than the 14 months (95% CI, 10.91 to 17.08 months) in patients treated with pCTalone (group B) (p < 0.001). The use of pCT-RT was an independent predictor of OS in multivariateanalysis. Local recurrence was observed in 12/53 of patients (23%) in group Acompared to 16/44 (36%) in group B. The median TTLP was significantly higher in patientsafter pCT-RT at 17.3 months (5.23 months to 44.50 months) compared to 8.3 months(range, 4.10 to 25.23 months) in patients treated with pCT alone (p=0.006). ConclusionThe possibility of pRT influencing systemic disease in advanced OG cancer has not beenreported, and results from the present study present strong arguments for investigation ofthis therapeutic strategy in a randomized trial.

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