Postoperative radiotherapy in gastric cancer

Surgeons in Poland are very skeptical about the positive role of adjuvant irradiation in patients with gastric cancer. A retrospective study of 21 patients with operable gastric cancer referred for irradiation to Cancer Centre in Warsaw between December 1984 and December 1991 was performed. Patients were qualified to receive adjuvant treatment because of bad prognostic factors--nonradical surgery (10 patients), infiltration of entire thickness of gastric wall (13 patients), and metastases in regional lymph nodes (9 patients). All patients were in good condition. They were treated by either telecobalt 60 unit or linear accelerator using 9-15 MeV photons. The total dose to the gastric bed and lymphatic was 46-50 Gy in 25 to 28 fractions, 5 days a week. The tolerance of treatment was good. None of these patients received 5-FU either during irradiation or as maintenance therapy. We have obtained more than 50% overall survival rate at 3 years. Median survival was 27 months and median recurrent-free interval 27 months. Local recurrence was found in four patients, distant metastases in five patients. In the group of 10 patients with nonradical surgery, 5 are alive without evidence of disease from 2 up to 7 years after treatment. Our preliminary results and good tolerance of treatment seem to support the beneficial role of adjuvant radiotherapy after gastrectomy in patients with risk factors of locoregional cancer recurrence.