Adjuvant radiochemotherapy in the treatment of completely resected, locally advanced gastric cancer

Purpose: To analyze the efficacy and toxicity of adjuvant whole abdomen irr adiation (WAI) and concomitant chemotherapy in the treatment of completely resected, high-risk gastric cancer. Methods and Materials: Between October 1990 and September 1997, 52 patients with completely resected gastric cancer, with lymph node and/or serosal in volvement, were treated. Ages were 16-78 (median, 53.5) years, Treatment wa s either total- or sub-total gastrectomy, followed by WAI, 2100 cGy/21 frac tions plus a 2400 cGy/16 fractions boost to the tumor bed. Chemotherapy con sisted of either 5-fluorouracil (5-FU) 450 -500 mg/m(2) i.v. for 5 days fir st and 5th week or 200-300 mg/m(2) continuous infusion during irradiation. No further chemotherapy was given. Results: With a minimum follow-up of 30 months and a median follow-up of 43 .5 months, 25 of the 52 patients have died. Overall 5-year survival rate is 54%. Three patients sustained Grade 3-5 complications. Two patients with G rade 5 complications (malabsorption syndrome) died 31 and 56 months after t he beginning of the treatment, respectively, with no evidence of recurrent tumor. For patients with involvement of the lymph nodes alone (n = 19) the 5-year survival was 69%, which was significantly better than the 36% 5-year survival observed for those patients with both serosal and lymph node invo lvement (n = 26, p = 0,004). Conclusion: Adjuvant radiochemotherapy, WAI, and concomitant 5-FU, is a fea sible and a fairly well-tolerated treatment for patients with locally advan ced (involvement of the lymph nodes or serosa) gastric carcinoma who underg o complete resection, The 54% overall 5-year survival compares favorably wi th the survival reported after surgery alone for those patients. (C) 2001 E lsevier Science Inc.