A 10-YEAR EXPERIENCE OF INTRAOPERATIVE RADIOTHERAPY FOR GASTRIC-CARCINOMA AND A NEW SURGICAL METHOD OF CREATING A WIDER IRRADIATION FIELD FOR CASES OF TOTAL GASTRECTOMY PATIENTS

Purpose: To improve the prognosis of gastric cancer, radical surgical resection with extensive lymph node dissection plus intraoperative rad iation therapy (IORT) was tried in our clinic. In addition, a new oper ative procedure was created to obtain wider irradiation field for tota l gastrectomy patients. Methods and Materials: A total of 183 gastric cancer patients who underwent radical gastrectomy with or without IORT from August 1983 to July 1992 were retrospectively evaluated, The pat ients were divided into two groups: group 1 consisted of 58 patients w ho underwent radical operation plus IORT. A single dose of 28 to 30 Gy was delivered around the celiac axis with an electron beam of 12 MeV. Group 2, our historical control group, which showed no difference in age, sex and stage, consisted of 120 patients who underwent only radic al surgery. Tn addition, a new method of total gastrectomy with IORT a fter mobilization of the tail and body of the pancreas was devised to get wider irradiation field for advanced gastric cancer. Results: Of t he Stage II gastric cancer patients, all the 11 patients of group 1 ar e alive, whereas in group 2,the 4-year and the 8-year survival rates w ere 60% and 48%, respectively. In Stage III patients, the 8-year survi val rate of group 1 was 55% vs. 35% in group 2. As for Stage IV patien ts, the 5-year survival rate of group 1 was 12% and that of group 2 wa s 13%. Conclusion: Using this combined treatment modality of radical s urgical operation + IORT, improved survival rates were obtained for St age II and III gastric cancer patients. However, the method was ineffe ctive for more advanced, Stage IV, patients. The wider irradiation fie ld method used for total gastrectomy patients was safe and no complica tions were encountered.