title: Adenocarcinoma of the stomach: autopsy observations with therapeutic implications for the radiation oncologist.
abstract: Autopsy and clinical records of 85 patients dying of stomach cancer were reviewed in order to study patterns of recurrence and dissemination. Loco-regional recurrence was observed in 15 of 16 patients who had undergone potentially curative surgical resection, and was the most common form of treatment failure. Peritoneal seeding, seen in 29% of the patients who died without treatment, was the most common manifestation of cancer dissemination (47%), and was associated with shorter average duration of survival. Among patients undergoing potentially curative resection, initial serosal involvement was predictive of subsequent peritoneal recurrence (7/10), whereas only 1 of 6 patients with initially uninvolved serosa developed this pattern of failure. Patients with primary cancers involving the gastro-esophageal junction were more likely to have extra-abdominal spread (9/13, 69%) than patients whose cancers involved more distal portions of the stomach (35/72, 49%). Potential implications for surgical staging, choice of radiation treatment volume, and design of clinical trials are discussed.
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000532:radiotherapy