[Intraoperative radiotherapy of stomach cancer]

Clinical results of intraoperative radiotherapy for gastric cancer were reported. One hundred and five cases of gastric cancer were treated by intraoperative radiotherapy. Indications for the intraoperative radiotherapy were determined as follows: 1) The primary lesion (tumor) located at the level of gastric corpus or antrum (M, A); 2) At least, the primary tumor should be resected; 3) Neither liver metastasis nor peritoneal dissemination was noticed; 4) Lymph node metastasis were limited to the second group (less than N3); 5) Cases of which tumor-infiltration-depth reached to the serosal surface (S3) of the posterior gastric wall and infiltrated to the pancreatic capsule were included. However, infiltrations to the serosal surface of the anterior gastric wall were not subjected to the treatment, because of having peritoneal disseminations. Irradiation of 2800-4000 rad of electron beam from betatron was performed after resection of the stomach and the regional lymph node as possible. Five-year survival rate was studied on 58 cases (consisting 5 cases of stage I, 27 cases of stage II, 12 cases of stage III and 14 cases of stage IV). Comparisons were done with the cases receiving surgical operation only.

Whatever the stage of the patient was, 3-year survival rate was found to be better in the radiotherapy group than that of the control group (treated surgical resection only). Five year survival rate of the stages III and IV in the radiotherapy group was better than the control group. Unfavorable side effects were observed in 4 cases out of 105 cases. In one case, penetration of postoperative peptic ulcer into the irradiated aortic wall was found by autopsy. Two cases of bile duct stenosis and one case of ileus due to acutely developed peritonitis carcinomatosa were experienced. In conclusion, intraoperative radiotherapy immediately after surgical resection for the treatment of gastric cancer was found to be an effective method. The most effective application of the method appears to be to cases of stage II and III without liver metastasis and peritoneal disseminations (H0P0, M, A).