Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of gastric cardia (AGC) - Report on 370 patients

Purpose: An attempt was made to define the role of radiotherapy before oper ation for AGC. Methods and Materials: From January 1978 to May 1989, a prospective randomi zed trial on preoperative radiotherapy (R+S) vs. surgery alone (S) for AGC was carried out in 370 patients. Patients were randomized into a combined g roup (R+S, 171 patients) or a surgery alone group (S, 199 patients) by the envelope method. 8-MV photon or telecobalt was used for the preoperative ra diation therapy, using anterior-posterior opposing parallel fields to deliv er 40 Gy to the cardia, lower segment of the esophagus,fundus, lesser curva ture, and hepatogastric ligament. Surgery was performed after 2 to 4 weeks rest. Results: The 5- and 10-year survival rates of the R+S Group and the S Alone Group were 30.10% and 19.75%, 20.26% and 13.30%, respectively. The surviva l curves of these two groups diverged right from the beginning after the op eration over the ninth year. Statistics by Kaplan-Meier log rank test prove s that the difference is significant (chi(2) = 6.74, p = 0.0094). The immed iate results were: resection rate 89.5% and 79.4% (p < 0.01); pathologic st age after resection T2 12.9% and 4.5% (p < 0.01), T4 40.3% and 51.3% (p < 0 .05), lymph node metastasis rates 64.3% and 84.9% (p < 0.001); operative mo rtality rates 0.6% and 2.5%; intrathoracic leak rates 1.8% and 4.0%, repect ively. The causes of failure were: local uncontrol and recurrence 38.6% vs. 51.7% (p < 0.025), regional lymph node metastasis 38.6% vs. 54.6% (p < 0.0 05), distant metastasis 24.3% vs. 24.7%. Conclusion: Preoperative radiation therapy is able to improve the results o f surgery for adenocarcinoma of the gastric cardia. (C) 1998 Elsevier Scien ce Inc.