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Annals of Surgical Oncology

, Volume 2, Issue 4, pp 295–302 | Cite as

Treatment of adenocarcinoma of the stomach with resection, intraoperative radiotherapy, and adjuvant external beam radiation: A phase II study from radiation therapy oncology group 85-04

  • Vilija N. Avizonis
  • Jan Buzydlowski
  • Rachelle Lanciano
  • Jay C. Owens
  • R. Dirk Noyes
  • Gerald E. Hanks
Original Articles

Abstract

Background: Fewer than 10% of patients presenting with adenocarcinoma of the stomach in the United States can expect to be cured. These discouraging results have led to trials of various adjuvant therapies. Some studies suggest a role for radiation in improving regional control. Radiation doses, however, are limited by the tolerance of abdominal organs.

Methods: Between 1985 and 1989, the Radiation Therapy Oncology Group conducted a phase II study to determine the feasibility of using intraoperative radiotherapy (IORT) in the treatment of adenocarcinoma of the stomach. Forty-three patients were entered into the study. Patients underwent maximal surgical resection (subtotal or total gastrectomy and regional node dissection) and IORT doses of 12.5–16.5 Gy were delivered in 27 patients. Adjuvant external beam radiation was given to 23 of the 27 patients with total doses ranging from 24 to 50 Gy.

Results: Two-year actuarial survival in the 27 patients receiving IORT was 47% and median survival was 19.3 months. Disease-free survival was 27%. Fifteen percent failed locally only, 26% with distant metastases only and 22% with both. Acute postoperative complications occurred in 14% with one fatality. Severe late complications occurred in 7% with one fatality.

Conclusions: Intraoperative radiotherapy combined with surgical resection and postoperative radiotherapy appears to be feasible without excessive morbidity in a multiinstitutional study. Its ultimate value requires further study.

Key Words

Radiotherapy Stomach cancer Gastrectomy Intraoperative radiotherapy 

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References

  1. 1.
    American Cancer Society. Cancer statistics.Ca 1989;39:3–39.Google Scholar
  2. 2.
    Gunderson LL, Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operative series (second on symptomatic look) clinicopathologic correlation and implications for adjuvant therapy.Int J Radiat Oncol Biol Phys 1982;3:1–11.Google Scholar
  3. 3.
    Landry J, Tepper JE, Wood WC, Moulton EO, Koefner F, Sallinger J. Patterns of failure following curative resection of gastric carcinoma.Int J Radiat Oncol Biol Phys 1990;19:1357–62.PubMedGoogle Scholar
  4. 4.
    Regine WF, Mohiuddin M. Impact of adjuvant therapy on locally advanced adenocarcinoma of the stomach.Int J Radiat Oncol Biol Phys 1992;24:921–7.PubMedGoogle Scholar
  5. 5.
    Gunderson LL, Hoskins B, Cohen AC, Kaufman S, Wood WC, Corey RW. Combined modality treatment of gastric cancer.Int J Radiat Oncol Biol Phys 1983;9:965–75.PubMedGoogle Scholar
  6. 6.
    Klaassen DJ, MacIntyre JM, Catton GE, Engstrom PF, Moertel CG. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil, an Eastern Cooperative Oncology Group study.J Clin Oncol 1985;3:373–8.PubMedGoogle Scholar
  7. 7.
    Gastrointestinal Tumor Study Group. A comparison of combination chemotherapy and combined modality therapy for locally advanced gastric carcinoma.Cancer 1982;49:1771–7.Google Scholar
  8. 8.
    Abe M, Takahashi M, Ono K, Tobe T, Iramoto T. Japan gastric trials in intraoperative radiation therapy.Int J Radiat Oncol Biol Phys 1988;15:1431–3.PubMedGoogle Scholar
  9. 9.
    Calvo FA, Henriquez I, Santos M, et al. Intraoperative and external beam radiotherapy in advanced resectable gastric cancer: technical description and preliminary results.Int J Radiat Oncol Biol Phys 1989;17:183–9.PubMedGoogle Scholar
  10. 10.
    Calvo FA, Aristu JJ, Azinovic I, et al. Intraoperative and external radiotherapy in resected gastric cancer: updated report of a phase II trial.Int J Radiat Oncol Biol Phys 1992;24:729–36.PubMedGoogle Scholar
  11. 11.
    Sindelar WF, Kinsella TJ, Hoekstra HS, et al. Treatment complications in intraoperative radiotherapy.Int J Radiat Oncol Biol Phys 1985;11:117–8.Google Scholar
  12. 12.
    American Joint Committee on Cancer.Manual for staging of cancer, 3rd ed. Philadelphia: JB Lippincott, 1988.Google Scholar
  13. 13.
    Abe M, Yabumoto E, Takahashi M, et al. Intraoperative radiotherapy of gastric cancer.Cancer 1974;34:2034–41.PubMedGoogle Scholar
  14. 14.
    Dupont JB, Lee JR, Burton GR, et al. Adenocarcinoma of the stomach: review of 1497 cases.Cancer 1978;41:941.PubMedGoogle Scholar
  15. 15.
    Dupont JB, Cohn I. Gastric adenocarcinoma.Curr Prob Cancer 1980;4:25.Google Scholar
  16. 16.
    Landry J, Tepper JE, Wood WC, Moulton EO. Analysis of survival and local control following surgery for gastric cancer.Int J Radiat Oncol Biol Phys 1986;12:119.Google Scholar
  17. 17.
    Tsukiyama I, Yasuyuki A, Kjiura Y, et al. Radiation therapy for advanced gastric cancer.Int J Radiat Oncol Biol Phys 1988;15:123–7.PubMedGoogle Scholar
  18. 18.
    Chen G, Song S. Evaluation of intraoperative radiotherapy for gastric carcinoma—analysis of 247 patients. In: Abe M, Takahashi M, eds.Intraoperative radiotherapy. New York: Pergamon Press, 1991;190–1.Google Scholar
  19. 19.
    Kramling HT, Willich N, Denecke H, Grab J, Schildberg FW. Prospective randomized study on IORT for resectable gastric carcinoma. In: Abe M, Takahashi M, eds.Intraoperative radiotherapy. New York: Pergamon Press, 1991:192–3.Google Scholar
  20. 20.
    Gerard JP, Sentenac I, Gilly F, et al. Intraoperative radio-therapy for carcinoma of the stomach with the Lyon Intraoperative System. In: Abe M, Takahashi M, eds.Intraoperative radiotherapy. New York: Pergamon Press, 1991:195–6.Google Scholar
  21. 21.
    Guillemin F, Malissard L, Aletti P, Bey P, Verhaeghe JL, Godfrin PY. Intraoperative radiation therapy for carcinoma of the stomach. A five year experience pilot study. In: Abe M, Takahashi M, eds.Intraoperative radiotherapy. New York: Pergamon Press, 1991;199–200.Google Scholar
  22. 22.
    Noyes R, Weiss S, Krall J, et al. Surgical complications of intraoperative radiotherapy — the Radiation Therapy Oncology Group experience. In: Abe M, Takahashi M, (eds),Intraoperative Radiotherapy. New York: Pergamon Press, 1991;393–395.Google Scholar
  23. 23.
    Avizonis VN, Sause WT, Noyes RD. Morbidity and mortality associated with intraoperative radiotherapy.J Surg Oncol 1989;41:240–5.PubMedGoogle Scholar
  24. 24.
    Cromack DT, Maher MM, Hoestra H, Kinsella TJ, Sindelar WF. Are complications in intraoperative radiation therapy more frequent than in conventional treatment?Arch Surg 1989;124:229–34.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 1995

Authors and Affiliations

  • Vilija N. Avizonis
    • 1
  • Jan Buzydlowski
    • 2
  • Rachelle Lanciano
    • 3
  • Jay C. Owens
    • 4
  • R. Dirk Noyes
    • 1
  • Gerald E. Hanks
    • 3
  1. 1.LDS Hospital, Radiation TherapySalt Lake CityUSA
  2. 2.RTOG HeadquartersPhiladelphia
  3. 3.Fox Chase Cancer CenterPhiladelphia
  4. 4.Sutter Community HospitalSacramento

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