Radiotherapy has been an important component in the multidisciplinary treatment strategy of gastric cancer. INT0116 has showed the improvement of survival with adjuvant chemoradiation in resected gastric cancer. The benefit of adjuvant chemoradiation has been confirmed further in gastric cancer population. Recent reported ARTIST trial which all patients got D2 dissection has showed the benefit of adjuvant chemoradiation only seen in patients with lymph node positive. As the same observed in other two trail, ACT-GC and CLASSIC, extremely low local recurrence were reported in these trial. We should be very cautious when we interpret these results and treatment into our clinical practice due to the difference of local recurrence between trials and daily practice. Neoadjuvant radiation has been reported its effectiveness of cardiac gastric cancer in earlier randomized trial. Phase II( trials have shown the high pCR rate with neoadjuvant chemoradiation. However, concurrent chemoradiation was with more toxicity and limited it development. Even though, further investigation in neoadjuvant setting is worthy but with reduce of toxicity. New progress in high technique of radiation will help the application of radiotherapy in gastric cancer. The future of radiation in gastric cancer treatment will focus on the selection of patients which are of most benefit, detection of radiosensitivity and how to optimize combination of radiation with surgery and novel chemotherapy and target therapy.
Humans ; Perioperative Care ; Radiotherapy, Adjuvant ; Stomach Neoplasms ; radiotherapy ; surgery

OBJECTIVETo elucidate the application and the dosimetry characteristic of the simplified intensity modulated radiation therapy (sIMRT) for gastric cancer after operation, and to compare the dose distribution with intensity modulated radiation therapy (IMRT) and three-dimension conformal radiation therapy (3D-CRT).

METHODSTwelve patients with gastric cancer after operation were enrolled in this study. 3D-CRT plan, 5-field IMRT plans (20 degree, 80 degree, 180 degree, 280 degree, 340 degree) and 5-field sIMRT plans (20 degree, 80 degree, 180 degree, 280 degree, 340 degree) were performed for each patient. The conformal index (CI), heterogeneity index (HI) of the planning target volume (PTV) and the dose of normal organs were analyzed with the dose volume histogram (DVH). The total MU and treatment time were also compared.

RESULTSThe sIMRT and IMRT plans had comparable CI (sIMRT>IMRT>3D-CRT), and showed better dose conformity but worse homogeneity than 3D-CRT. The percentage of volume receiving 20 Gy, 25 Gy, 30 Gy and 40 Gy by liver were significantly lower in sIMRT than that in 3D-CRT, and comparable to IMRT. All the dose volumes to kidneys with sIMRT were still significantly lower as compared to 3D-CRT, and comparable to IMRT. The sIMRT plan was better than IMRT plan in total MU and treatment time.

CONCLUSIONSsIMRT has comparable dose distribution in patients with gastric cancer to IMRT, but is significantly better than 3D-CRT. Treatment time of sIMRT is the shortest. So sIMRT technique can be applied more simply.

Humans ; Postoperative Care ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Stomach Neoplasms ; radiotherapy ; surgery

Gastric cancer is the most prevalent cancer in Korea and comprises the second cause of cancer death. Surgery only can provide chance of cure, but most locally advanced cancers recur after a curative resection, even though important advances in the surgical and nonsurgical treatments of gastric cancer have taken place. Preoperative chemotherapy theoretically can provide the advantages of reducing the bulk of tumor, which might improve the R0 resection rate, and of treating micrometastases early. Also, preoperative chemotherapy is expected to render unresectable tumors resectable without increasing postoperative morbidity and mortality. There are many new chemotherapeutic agents available for the treatment of advanced gastric cancer, but still the most effective agent, the optimal time and number of cycle for administration are still not known. The addition of postoperative chemotherapy through an intraperitoneal route and/or radiotherapy might affect the outcome of surgery favorably, but that hasn't been proved yet. A multicenter prospective randomized phase III trial should be performed to answer for those questions and to improve the curability of gastric cancer treatment.
Drug Therapy* ; Korea ; Mortality ; Neoplasm Micrometastasis ; Radiotherapy ; Stomach Neoplasms*

Stomach cancer is the most popular tumor in Korea but the prognosis following extensive surgery and chemotherapy has not improved for many years. Conventional external radiotherapy also has some limitation, namely, a cancerocidal dose cannot be delivered to tumors because of low radiation tolerance of adjacent critical sensitive organs. In order to overcome these limitations of curative surgery and external radiotherapy, intraoperative radiotherapy was proposed in many centers and the results were excellent. We treated two cases of locally advanced gastric cancers with IORT by using NEC 18 MeV Linear Accelerator after standard subtotal resection of the stomach. After treatment, the patients are in good conditions so far, but in order to evaluate the effectiveness of IORT, a study will be performed on the survival rates between patients treated by IORT and those treated by surgery alone.
Drug Therapy ; Humans ; Korea ; Particle Accelerators ; Prognosis ; Radiation Tolerance ; Radiotherapy ; Stomach ; Stomach Neoplasms* ; Survival Rate

PURPOSE: To improve the therapeutic results of postoperative recurrent disease and inoperable disease of stomach cancer, we used the thermoradiotherapy. We conducted a retrospective analysis of the results and compared between the results of hyperthermia before radiotherapy and those of hyperthermia after radiotherapy. MATERIALS AND METHODS: From july 1994 to november 1996, we treated twenty patients of locally advanced stomach cancer and recurrent stomach cancer with thermoradiotherapy. We divided those patients into two groups : hyperthermia before radiotherapy group (PreRT group : 13 patients) and hyperthermia after radiotherapy group (PostRT group : 7 patients). We performed radiation therapy to the total tumor dose of 3000-5040cGy in fraction of 180-300cGy and 5 fractions per week. Hyperthermia was performed with 8 MHz radiofrequency apparatus. We treated those patients everyday for thirty minutes within ten minutes before radiation therapy in PreRT group, and 1-2 sessions per week for 40-60 minutes within ten minutes after radiation therapy in PostRT group. RESULTS: Overall response rate was 33.3%. This response rate was appeared same in both groups. Mean survival and 1 year survival rate were 10.3 months and 16.5%. In PreRT group, mean survival and 1 year survival rate were 6.8 months and 9.0%, and in PostRT group, mean survival and 1 year survival rate were 7.7 months and 34%. There were no statistical significant difference between the prognostic factors and therapeutic results. CONCLUSION: The thermoradiotherapy was safe treatment method in advanced and recurrent gastric cancer when compared with other treatment. Because the number of patients we treated was small and the follow up period was short, we were not able to draw any conclusions about therapeutic efficacy of sequence of radiation therapy and hyperthermia Therefore, further clinical trial of thermoradiotherapy for stomach cancer appear to be warranted.
Fever* ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Stomach Neoplasms* ; Stomach* ; Survival Rate

Cancers of the stomach rank first in cancer deaths in Korea with a high fatality rate. As for the adjuvant treatment of gastric cancer, a meta-analysis of adjuvant chemotherapy trials suggested a limited survival benefit for adjuvant chemotherapy compared with surgery alone. Most of the trials used combination chemotherapy, usually based on fluorouracil or cisplatin. Although the large intergroup trial 116, comparing surgery alone to surgery followed by postoperative fluorouracil, leucovorin, and radiotherapy, indicated a significant survival benefit for postoperative chemoradiotherapy, inadequate surgical resection of regional lymphnodes was an important issue of this trial. Future trials should address the extensive lymphnode dissection, the inclusion of newer chemotherapeutic agents, the use of preoperative chemotherapy, and the use of intraperitoneal therapy. Randomized trials are mandatory for the establishment of a satisfactory strategy.
Chemoradiotherapy ; Chemotherapy, Adjuvant* ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Fluorouracil ; Korea ; Leucovorin ; Radiotherapy ; Stomach ; Stomach Neoplasms*

In order to evaluate the role of radiation therapy in the management of low-grade mucosa-associated lymphoid tissue lymphoma of the stomach (MLS), in patients with no evidence of Helicobacter pylori (H. pylori) or who had not responded to H. pylori eradication treatment, we analyzed the treatment outcome of patients who had received radiotherapy alone. Between Jan 1995 and May 2001, 6 patients with low- grade MLS were treated with radiotherapy alone. The median radiation dose was 30.6 Gy (range; 30 - 39 Gy) in a daily fractions of 1.5 - 1.8 Gy. Each patient had an endoscopic esophago-gastro-duodenoscopy with biopsy, 4 weeks after the completion of radiotherapy and every 6 months thereafter. A complete response was obtained in all patients. All patients were followed-up without evidence of disease, and no patient suffered a relapse. There was neither perforation nor hemorrhage of the stomach in any of the patients. No renal or hepatic toxicity were noted, and no secondary malignancies developed. In conclusion, radiotherapy should be considered as the preferred treatment method for low-grade MLS, in patients with no evidence of H. pylori infection, or who do not respond to antibiotic therapy, due to the significant benefits in gastric preservation and low morbidity.
Adult ; Aged ; Female ; Human ; Lymphoma, Low-Grade/*radiotherapy ; Lymphoma, Mucosa-Associated Lymphoid Tissue/*radiotherapy ; Male ; Middle Age ; Radiotherapy/adverse effects ; Stomach Neoplasms/*radiotherapy

PURPOSE: We report the outcomes of patients treated with palliative radiotherapy (pRT) to the primary tumour in the context of well-controlled metastatic disease after initial chemotherapy. MATERIALS AND METHODS: Clinical records of 132 patients with metastatic esophago-gastric (OG) cancer treated with palliative chemotherapy (pCT) between January 2009 and June 2013 were reviewed. Ninetyseven patients had responding or stable disease after 3 months of chemotherapy, of whom 53 patients received pRT to the primary tumour after initial chemotherapy in the presence of well-controlled metastatic disease (group A, pCT-RT). The remaining 44 patients were treated with pCT alone (group B, pCT). Treatment-related outcomes were assessed in above groups including time to local progression (TTLP), progression-free and overall survival. RESULTS: The median overall survival for patients treated with pRT after initial chemotherapy (group A) was 23.3 months (95% confidence interval [CI], 17.70 to 28.89 months) and significantly higher than the 14 months (95% CI, 10.91 to 17.08 months) in patients treated with pCT alone (group B) (p < 0.001). The use of pCT-RT was an independent predictor of OS in multivariate analysis. Local recurrence was observed in 12/53 of patients (23%) in group A compared to 16/44 (36%) in group B. The median TTLP was significantly higher in patients after pCT-RT at 17.3 months (5.23 months to 44.50 months) compared to 8.3 months (range, 4.10 to 25.23 months) in patients treated with pCT alone (p=0.006). CONCLUSION: The possibility of pRT influencing systemic disease in advanced OG cancer has not been reported, and results from the present study present strong arguments for investigation of this therapeutic strategy in a randomized trial.
Drug Therapy* ; Esophageal Neoplasms ; Humans ; Multivariate Analysis ; Palliative Care ; Radiotherapy* ; Recurrence ; Stomach Neoplasms*

PURPOSE: In some patients who receive adjuvant radiotherapy (RT) for the left breast, the stomach is located inside the RT field. This study investigates the incidence of gastric complications following adjuvant RT for breast cancer using data of the Health Insurance Review and Assessment Service in South Korea. METHODS: We identified 37,966 women who underwent surgery and received adjuvant RT for breast cancer. The cumulative incidence rate of gastric hemorrhage and gastric cancer was calculated and compared for left and right breast cancers. RESULTS: Among 37,966 patients, 19,531 (51.4%) and 18,435 (48.6%) had right and left breast cancers, respectively. After a median follow-up duration of 6.3 years, the cumulative incidence of gastric cancer and gastric hemorrhage did not differ between right and left breast cancers (p = 0.414 and p = 0.166, respectively). The multivariable analysis revealed that old age was the only factor associated with the development of gastric cancer (p < 0.001) and gastric hemorrhage (p < 0.001). The incidence of gastric cancer and hemorrhage did not differ between patients who received adjuvant RT for right and left breast cancers. CONCLUSION: Irradiation-related chronic complications of the stomach in patients with breast cancer are minimal. A study with a longer follow-up duration might be needed to assess the risk of gastric cancer.
Breast Neoplasms ; Breast ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Insurance, Health ; Korea ; Radiotherapy ; Radiotherapy, Adjuvant ; Stomach ; Stomach Neoplasms

OBJECTIVETo study the clinical features and proper treatment of 38 elderly patients with early double primary cancers.

METHODSThirty-eight elderly patients with early double primary cancers treated from January 1980 to March 2003 were retrospectively reviewed for involved organs, treatment and prognosis.

RESULTSDigestive tract was the most frequently involved, followed by urogenital system and lung. Long-term results of endoscopic mucosal resection (EMR), operation and radiotherapy were superior to other methods. The prognosis of gastrointestinal carcinoma was better than that of prostate carcinoma and hematopoietic system. The operation rate decreased with increasing age. The 5-year survival rates of EMR, operation and radiotherapy were 85.7%, 71.1% and 75.0%, respectively. The medium survival time was 120 months in first cancer and 39 months in the second primary cancer. The 5-year survival rates of the first cancer and second primary cancer were 88.6% and 53.8%.

CONCLUSIONYearly follow-up for elderly patients with endoscopy, beta ultrasonic scan and X-ray contribute to finding of early double primary cancers. Operation is the best treatment of early double primary cancers. Endoscopic mucosal resection is especially suitable for old patients with digestive tract and bladder cancer.

Aged ; Aged, 80 and over ; Colorectal Neoplasms ; diagnosis ; radiotherapy ; surgery ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; radiotherapy ; surgery ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; Prostatic Neoplasms ; radiotherapy ; surgery ; Retrospective Studies ; Stomach Neoplasms ; radiotherapy ; surgery ; Survival Rate