Clinical and Translational Oncology

, Volume 19, Issue 10, pp 1268–1275 | Cite as

Integration of radiotherapy and chemotherapy for abdominal lymph node recurrence in gastric cancer

  • J. Lee
  • H. I. Yoon
  • S. Y. Rha
  • W. J. Hyung
  • Y. C. Lee
  • J. S. Lim
  • H. S. KimEmail author
  • W. S. KoomEmail author
Research Article



Abdominal lymph node (ALN) recurrence in gastric cancer (GC) is rare and usually unresectable. We investigated the effects of integration of radiotherapy (RT) and chemotherapy against ALN recurrence in GC.


We retrospectively categorized GC patients with ALN recurrence treated between 2005 and 2013 into two groups: those treated with integration of RT and chemotherapy (RCT) and those who received systemic chemotherapy only (CT). The median follow-up period after ALN recurrence for all patients was 20 months.


Of 53 patients, 31 and 22 were in the RCT and CT groups, respectively. Isolated distant failure (DF; 35.5%) without local progression (LP) was the dominant pattern of failure (POF) in the RCT group (median DF-free period, 26 months). LP followed by DF (31.8%) was the dominant POF in the CT group; LP (median LP-free period, 8 months) occurred 10 months earlier than DF (median DF-free period, 18 months). RCT patients had significantly longer median progression-free survival (PFS) compared to CT patients (25 vs. 8 months; P = 0.021). On multivariate analysis, treatment (CT vs. RCT) was an independent prognostic factor for PFS (hazard ratio 2.085; 95% confidence interval 1.073–4.050; P = 0.013).


Integration of RT and chemotherapy achieved long-term local control and prolonged PFS in GC patients with ALN recurrence. Local RT is feasible for treating isolated ALN recurrences.


Gastric cancer Lymph node recurrence Radiotherapy Chemotherapy 



This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (2015R1C1A2A01055617, Hyo Song Kim).

Compliance with ethical standards

Conflict of interest

The authors indicate no potential conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

12094_2017_1665_MOESM1_ESM.docx (171 kb)
Supplementary material 1 (DOCX 171 kb)


  1. 1.
    Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol. 2004;22:2069–77.CrossRefPubMedGoogle Scholar
  2. 2.
    Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Yoo CH, Noh SH, Shin DW, et al. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000;87:236–42.CrossRefPubMedGoogle Scholar
  4. 4.
    Roukos DH, Kappas AM. Perspectives in the treatment of gastric cancer. Nat Clin Pract Oncol. 2005;2:98–107.CrossRefPubMedGoogle Scholar
  5. 5.
    Choi YY, Noh SH, Cheong JH. Evolution of gastric cancer treatment: from the golden age of surgery to an era of precision medicine. Yonsei Med J. 2015;56:1177–85.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Schwarz RE, Zagala-Nevarez K. Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy. Ann Surg Oncol. 2002;9:394–400.CrossRefPubMedGoogle Scholar
  7. 7.
    Tey J, Choo BA, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine (Baltimore). 2014;93:e118.CrossRefGoogle Scholar
  8. 8.
    Chang JS, Lim JS, Noh SH, et al. Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer: implications for postoperative radiotherapy. Radiother Oncol. 2012;104:367–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Yi Y, Yu J, Li B, et al. Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume delineation of regional lymph node in patients with gastric carcinoma. Radiother Oncol. 2010;96:223–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Lehnert T, Rudek B, Buhl K, et al. Surgical therapy for loco-regional recurrence and distant metastasis of gastric cancer. Eur J Surg Oncol. 2002;28:455–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Badgwell B, Cormier JN, Xing Y, et al. Attempted salvage resection for recurrent gastric or gastroesophageal cancer. Ann Surg Oncol. 2009;16:42–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Ajani JA. Optimizing docetaxel chemotherapy in patients with cancer of the gastric and gastroesophageal junction: evolution of the docetaxel, cisplatin, and 5-fluorouracil regimen. Cancer. 2008;113:945–55.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee J, Chang JS, Shin SJ, et al. Incorporation of radiotherapy in the multidisciplinary treatment of isolated retroperitoneal lymph node recurrence from colorectal cancer. Ann Surg Oncol. 2015;22:1520–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Sun J, Sun YH, Zeng ZC, et al. Consideration of the role of radiotherapy for abdominal lymph node metastases in patients with recurrent gastric cancer. Int J Radiat Oncol Biol Phys. 2010;77:384–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim BH, Eom KY, Kim JS, et al. Role of salvage radiotherapy for regional lymph node recurrence after radical surgery in advanced gastric cancer. Radiat Oncol J. 2013;31:147–54.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kim MS, Yoo SY, Cho CK, et al. Stereotactic body radiotherapy for isolated para-aortic lymph node recurrence after curative resection in gastric cancer. J Korean Med Sci. 2009;24:488–92.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Choi HJ, Roh JW, Seo SS, et al. Comparison of the accuracy of magnetic resonance imaging and positron emission tomography/computed tomography in the presurgical detection of lymph node metastases in patients with uterine cervical carcinoma: a prospective study. Cancer. 2006;106:914–22.CrossRefPubMedGoogle Scholar
  18. 18.
    National Institutes of Health NCI. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03. 2010. US Government Publishing Office, Washington, DC. 2010.Google Scholar
  19. 19.
    Hebert G, Netzer F, Ferrua M, et al. Evaluating iatrogenic prescribing: development of an oncology-focused trigger tool. Eur J Cancer. 2015;51:427–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Vigano L, Ferrero A, Lo Tesoriere R, et al. Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol. 2008;15:2458–64.CrossRefPubMedGoogle Scholar
  21. 21.
    Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Jones RP, Stattner S, Sutton P, et al. Controversies in the oncosurgical management of liver limited stage IV colorectal cancer. Surg Oncol. 2014;23:53–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget. 2015;6:8491–524.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Liakakos T, Roukos DH. More controversy than ever—challenges and promises towards personalized treatment of gastric cancer. Ann Surg Oncol. 2008;15:956–60.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Punglia RS, Morrow M, Winer EP, et al. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMedGoogle Scholar
  26. 26.
    Conde Moreno AJ, Ferrer Albiach C, Muelas Soria R, et al. Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options. Radiat Oncol. 2014;9:258.CrossRefPubMedGoogle Scholar
  27. 27.
    Loh J, Davis ID, Martin JM, et al. Extracranial oligometastatic renal cell carcinoma: current management and future directions. Future Oncol. 2014;10:761–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Hajj C, Goodman KA. Role of radiotherapy and newer techniques in the treatment of gi cancers. J Clin Oncol. 2015;33:1737–44.CrossRefPubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  • J. Lee
    • 1
    • 2
  • H. I. Yoon
    • 1
  • S. Y. Rha
    • 3
  • W. J. Hyung
    • 4
  • Y. C. Lee
    • 3
  • J. S. Lim
    • 5
  • H. S. Kim
    • 3
    Email author
  • W. S. Koom
    • 1
    Email author
  1. 1.Department of Radiation OncologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiation OncologyInha University HospitalIncheonRepublic of Korea
  3. 3.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  4. 4.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  5. 5.Department of RadiologyYonsei University College of MedicineSeoulRepublic of Korea

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