INTRAOPERATIVE RADIATION-THERAPY COMBINED WITH LIMITED LYMPH-NODE RESECTION IN GASTRIC-CANCER - AN ALTERNATIVE TO EXTENDED DISSECTION

Purpose: To describe the results of a series of 63 Western patients pr esenting with gastric adenocarcinoma and treated with surgery and intr aoperative radiation therapy (IORT) over a 8-year period and to discus s the role of IORT when combined with limited lymph node dissection. M ethods and Materials: From 1986 to 1993, 63 patients with gastric aden ocarcinoma have been operated in the department of radiation oncology of the Hospices Civils de Lyon. The stage was: I in 17, II in 11, IIIA in 9, IIIB in 20, and IV in 6. The lymph node dissection was consider ed to be limited in 56 patients and extended in 7. The IORT dose range d from 12 to 23 Gy (median: 15). Thirty patients also underwent a post operative external beam irradiation with a standard dose of 44-36 Gy. Results: The postoperative mortality rate was 4.8 %. The 5-year overal l survival in the entire series was 47 % and was 82, 55, 78, 20, and 0 % in Stages I, II, IIIA, IIIB, and IV, respectively. Loco-regional rel apse occurred in 15 of 63 patients and metastases in 15 of 63. Conclus ion: In Western patients treated by gastrectomy for adenocarcinoma of the stomach, IORT combined with limited lymph node dissection may prov ide overall survival similar to that observed after gastrectomy with e xtended lymph node dissection but with less postoperative mortality. ( C) 1997 Elsevier Science Inc.