Preoperative radiotherapy in combination with metronidazole for resectable gastric cancer: long-term results of a phase 2 study.
OBJECTIVE
Surgery remains the main treatment of stomach carcinoma. Poor long-term survival mandates the study of other techniques. An original treatment scheme with preoperative radiotherapy and metronidazole as a radiosensitizer is reported here.


METHODS
Between 1982 and 1988, MRRC RAMS carried out a prospective clinical trial of preoperative radiotherapy (20 Gy/5 days) in combination with metronidazole (given orally, 3 times, 5 gms per metre(2)). Of 91 patients who received preoperative radiotherapy, 67 patients were operated on with curative intent and were eligible for further analysis.


RESULTS
Acute gastro-intestinal toxicity was significant but manageable without surgery delay in most cases. There were 4 postoperative deaths. Overall 5-year, 10-year survival and median survival were 46%, 36% and 46 months. Serosal and nodal involvement were the most significant adverse prognostic factors. Tumours confined to the gastric wall, node negative cases, middle and distal location, differentiated tumours, female sex and age more than 50 years were associated with relatively good long-term results: overall 5-year survival was 50% or better, overall 10-year survival was 40% or better.


CONCLUSIONS
The combined treatment showed significant but manageable acute toxicity. The long-term results seem encouraging and support further investigations in multimodal treatment of gastric cancer.
Skoropad
V Y
VY
Department of Surgical and Combined Treatment of Abdominal Tumors, Medical Radiological Research Center of Russian Academy of Medical Sciences, Koroliova Street 4 249036, Obninsk, Russia. skoropad@mrrc.obninsk.ru
Berdov
B A
BA
Zagrebin
V M
VM
D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*; D011878:Radiotherapy / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome
D011838:Radiation-Sensitizing Agents; D008795:Metronidazole