title: Role of salvage radiotherapy for regional lymph node recurrence after radical surgery in advanced gastric cancer.
abstract: OBJECTIVE
  To evaluate the role of salvage radiotherapy (RT) for the treatment of regional lymph node recurrence (RLNR) after radical surgery in advanced gastric cancer.
  
  
  METHODS
  We retrospectively analyzed medical records of 26 patients who underwent salvage treatment after diagnosis of RLNR between 2006 and 2011. Patients with peritoneal seeding or distant metastasis were excluded. Eighteen patients received RT with or without chemotherapy and the other 8 did chemotherapy only without RT. A three-dimensional conformal RT was performed with median dose of 56 Gy (range, 44 to 60 Gy). Sixteen patients had fluoropyrimidine-based chemotherapy, 5 did taxane-based chemotherapy, and irinotecan was applied in 4.
  
  
  RESULTS
  With a median follow-up of 20 months (range, 5 to 57 months), median overall survival (OS) and progression-free survival (PFS) after diagnosis of RLNR were 29 months and 12 months in the entire patients, respectively. Radiotherapy (p = 0.007) and disease-free interval (p = 0.033) were statistically significant factors for OS in multivariate analysis. Median OS was 36 months in patients who received RT and 16 months in those who did not. Furthermore, delivery of RT (p < 0.001), complete remission after salvage treatment (p = 0.040) and performance status (p = 0.023) were associated with a significantly better PFS. Gastrointestinal toxicities from RT were mild in most patients.
  
  
  CONCLUSIONS
  Salvage RT combined with systemic chemotherapy may be an effective treatment managing RLNR from advanced gastric cancer.
authors.affiliation: Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Byoung Hyuck
authors.initials: BH
authors.lastname: Kim
authors.forename: Keun-Yong
authors.initials: KY
authors.lastname: Eom
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyung-Ho
authors.initials: HH
authors.lastname: Kim
authors.forename: Do Joong
authors.initials: DJ
authors.lastname: Park
keywords: Lymph nodes; Radiotherapy; Recurrence; Stomach neoplasms