title: Results of irradiation or chemoirradiation following resection of gastric adenocarcinoma.
abstract: OBJECTIVE
  To evaluate the results of postoperative irradiation +/- chemotherapy for carcinoma of the stomach and gastroesophageal junction.
  
  
  METHODS
  The records of 63 patients who underwent resection for stomach cancer were retrospectively reviewed. Twenty-five patients had complete resection with no residual disease but with high-risk factors for relapse. Twenty-eight had microscopic residual and 10 had gross residual disease. Doses of irradiation ranged from 39.6 to 59.4 Gy with a median dose of 50.4 Gy in 1.8 Gy fractions. Fifty-three of the 63 (84%) patients received 5-fluorouracil (5-FU)-based chemotherapy.
  
  
  RESULTS
  The median duration of survival was 19.3 months for patients with no residual disease, 16.7 months for those with microscopic residual disease, and 9.2 months for those with gross residual disease (p = 0.01). The amount of residual disease also significantly impacted locoregional control (p = 0.04). Patients with linitis plastica did significantly worse in terms of survival, locoregional control, and distant control than those without linitis plastica. The use of 4 or more irradiation fields was associated with a significant decrease in the rate of Grade 4 or 5 toxicity when compared to the patients treated with 2 fields (p = 0.05).
  
  
  CONCLUSIONS
  There was a significant association between survival and extent of residual disease after resection as well as the presence of linitis plastica. Distant failures are common and effective systemic therapy will be necessary to improve outcome. The toxicity of combined modality treatment appears to be reduced by using greater than 2 irradiation fields.
authors.affiliation: Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, Rochester, MN 55901, USA.
authors.forename: G T
authors.initials: GT
authors.lastname: Henning
authors.forename: S E
authors.initials: SE
authors.lastname: Schild
authors.forename: S L
authors.initials: SL
authors.lastname: Stafford
authors.forename: J H
authors.initials: JH
authors.lastname: Donohue
authors.forename: P A
authors.initials: PA
authors.lastname: Burch
authors.forename: M G
authors.initials: MG
authors.lastname: Haddock
authors.forename: V F
authors.initials: VF
authors.lastname: Trastek
authors.forename: L L
authors.initials: LL
authors.lastname: Gunderson
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011379:Prognosis; D011832:Radiation Injuries / Q000473:pathology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis