Intraoperative radiotherapy and external beam radiation therapy in gastricadenocarcinoma with R0-R1 surgical resection

Introduction: The aims of this study were to evaluate the results of intrao perative radiotherapy (IORT) and external beam therapy (EBRT) in the treatm ent of gastric adenocarcinoma. Methods: From 1986 to 1999, 87 patients who underwent surgical resection fo r gastric adenocarcinoma combined with IORT were reviewed. A RO surgical re section was performed in 82 patients and five underwent R1 resection. The s tage was: pT1 in 12, pT2 in 19, pT3 in 44 and pT3 in seven. Thirteen patien ts were pN1 and 43 were pN2. The IORT dose ranged from 12 to 23 Gy. Patient s with pT3 and/or pN(+) tumours underwent EBRT with a standard dose of 44-4 6 Gy. Results: The post-operative mortality and morbidity rates were 2.3 and 6.8% , respectively. The 5-year survival rate for RO patients was 60%, for R0-pN 0 was 90%, and for R0-pN(+) patients was 55%. The local failure rate in the 19 pN(+) patients was 21%. Conclusion: IORT and EBRT combined with surgical resection may provide over all survival, improving the local control after gastrectomy.