Results of irradiation or chemoirradiation for primary unresectable, locally recurrent, or grossly incomplete resection of gastric adenocarcinoma

Objective: To evaluate the results of irradiation +/- chemotherapy for pati ents with unresectable gastric carcinoma, Materials and Methods: The records of 60 patients with a gastric or gastroe sophageal junction adenocarcinoma and a locally advanced unresectable prima ry (n = 28), a local or regional recurrence (n = 21), or gross residual dis ease following incomplete resection (n = 11) were retrospectively reviewed. Patients were treated with external beam irradiation (EBRT) alone or exter nal beam plus intraoperative irradiation (IOERT), and 55 of the 60 (92%) pa tients received 5-FU based chemotherapy. Results: The median survival for the entire cohort was 11.6 months. There w as no significant difference in median survival between each of the three t reatment groups. In examining the extent of disease there was a significant difference in survival based on the number of sites involved, Nine patient s with disease limited to a single non-nodal site appeared to represent a f avorable subgroup compared to the rest of the patients (median survival of 21.8 months vs. 10.2 months,p = 0.03), In the patients with recurrent disea se, the number of sites involved (p = 0.05), and total dose adding external beam dose to IOERT dose (> 54 Gy vs. less than or equal to 54 Gy, p = 0.06 ) were of borderline significance in regard to survival. Conclusions: In patients with either primary unresectable, locally or regio nally recurrent, or incompletely resected gastric carcinoma, the overall su rvival is similar, and related to the extent of disease based on the number of regional sites involved. The patients with a single non-nodal site of d isease represent a favorable subgroup and patients with recurrent disease m ay benefit from total irradiation doses > 54 Gy, (C) 2000 Elsevier Science Inc.