[Evaluation of tolerance and efficacy of postoperative combined radiotherapy and chemotherapy in locally advanced gastric cancer].
OBJECTIVE
To assess the toxicity and the efficacy of adjuvant radio-chemotherapy in patients with high-risk gastric cancer.


METHODS
Patients with adenocarcinoma of the stomach were enrolled into the study from April 1999 to December 2000. There were 15 females and 27 males, 33 to 69 years old (median 52). There were following inclusion criteria: tumor stages T1-2 N1-3 or T3-4 N0-3, no distant metastases (except resected metastases to sac or spleen). All patients had lymph node and/or serosal involvement. Radiation dose of 42.5 Gy in 1.7 Gy per fraction was delivered to the tumor bed and regional lymph nodes over 5 weeks. In 4 cases of nonradical surgery a boost dose of 8.5 Gy was given. Chemotherapy consisted of 5-Fu 325 mg/m2/day, given on day 1-3 and 29-31 of radiotherapy.


RESULTS
All patients completed radiotherapy as planned. Mild nausea/vomiting in 43% of pts., leucopenia WHO 1 and 2 in 43% of pts. as well as WHO 3 in 5% of pts. and diarrhea WHO 1 and 2 in 21% of pts. were the most frequent toxicities. Three year relapse-free survival and overall survival rates were 29% and 31%, respectively (median 12 and 18 months). Three year survival rates in stage II, III and IV were 67%, 24% and 17% respectively.


CONCLUSIONS
Postoperative radio-chemotherapy in patients with locally advanced gastric cancer was safe and well tolerated. The results obtained in this study and from literature suggest that adjuvant radio-chemotherapy may improve 3-year survival rates by 10-15% compared to historical controls treated with surgery alone.
Wydmański
Jerzy
J
Pracownia Radioterapii Konwencjonalnej i Sródoperacyjnej. wydmanski@neostrada.pl
Suwiński
Rafał
R
Miszczyk
Leszek
L
Maka
Bogusław
B
Maciejewski
Bogusław
B
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome