title: A new suggestion for the radiation target volume after a subtotal gastrectomy in patients with stomach cancer.
abstract: OBJECTIVE
  To compare treatment results between the use of two different radiation fields including and excluding remnant stomach and suggest new target volumes excluding remnant stomach after subtotal gastrectomy (STG) in patients with stomach cancer.
  
  
  METHODS
  We retrospectively analyzed 291 patients treated with adjuvant chemoradiotherapy after STG and D2 dissection at the Samsung Medical Center, Seoul, South Korea. Eighty-three patients registered from 1995 to 1997 underwent irradiation according to the INT 0116 protocol that recommended the inclusion of remnant stomach within the target volume (Group A). After this period, we excluded remnant stomach from the target volume for 208 patients (Group B). Median follow-up was 67 months.
  
  
  RESULTS
  Treatment failure developed in 93 patients (32.0%). Local and regional recurrence rates for Group A vs. Group B were 10.8% vs. 5.3% (p = not significant) and 9.6% vs. 6.3% (p = not significant), and recurrence rates for remnant stomach were 7.2% vs. 1.4% (p = 0.018), respectively. Overall and disease-free survival rates were not different between the two groups. Grade 3 or 4 vomiting and diarrhea developed more frequently in Group A than Group B (4.8% vs. 1.4% and 6.0% vs. 1.9%, respectively; p = 0.012; p < 0.001).
  
  
  CONCLUSIONS
  Exclusion of remnant stomach from the radiation field had no effect on failure rates or survival, and a low complication rate occurred in patients treated excluding remnant stomach. We suggest that remnant stomach be excluded from the radiation target volume for patients with stomach cancer who undergo STG and D2 dissection.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Heerim
authors.initials: H
authors.lastname: Nam
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Lim
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
authors.forename: Won Ki
authors.initials: WK
authors.lastname: Kang
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Sohn
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Noh
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Chan Hyung
authors.initials: CH
authors.lastname: Park
authors.forename: Chul Keun
authors.initials: CK
authors.lastname: Park
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D018530:Gastric Stump; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017211:Treatment Failure