Usefulness of chemoradiotherapy for inoperable gastric cancer

Abstract

Introduction Radiotherapy is not commonly used for the treatment of gastric cancer in Japan, where surgery is the standard local treatment. We report the results of chemoradiotherapy in patients with advanced or recurrent gastric cancer which was deemed difficult to treat surgically. Methods Twenty-one patients with gastric cancer (including sixteen with advanced/recurrent gastric cancer and five with poor general condition) underwent chemo-radiotherapy, for whom the therapeutic efficacy, toxicity and survival period were analysed. Results The tumour response to chemoradiotherapy was categorised as complete, partial, stable or progressive in 5, 9, 3, and 4 patients, respectively, with an overall response rate of 67%. No serious complications such as gastrointestinal perforation or bleeding occurred, and no cardiac, hepatic or renal dysfunction developed during the follow-up period. The mean survival time was 19.8 months (range, 3-51 months). One patient died of another disease, 18 died of primary cancer and the cause of death was unknown in 2 patients. Conclusions Chemoradiotherapy appears to be an effective treatment for localised gastric cancer without distant metastases, but further studies are needed to determine the indications for chemoradiotherapy and late adverse effects, as well as the chemotherapy regimens to be used.

Keywords: Advanced gastric cancer; Chemo-radiation therapy; Non-curative resection; Recurrent gastric cancer.

Figure 1

Target volume of primary and lymph node and dose-volume histogram of patient with local advanced gastric cancer

Figure 2(a, b)

A type 3 lesion involving 4/5 of the circumference on the lesser curvature side of the gastric antrum; (c, d): the tumour has disappeared, with only mild residual erosions

Figure 3

Overall survival of patients with gastric cancer who underwent chemoradiotherapy (n = 21)