Postoperative concomitant chemoradiotherapy for gastric cancer at out patient clinic (The preliminary results of protocol)
İlknur B. GÖRKEN,1 Evrim BAYMAN,1 Seymen BORA,2 İlhan ÖZTOP,3 Uğur YILMAZ,3 Hilmi ALANYALI,1 Münir KINAY1
1Dokuz Eylül Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi Anabilim Dalı, İzmir, Turkey
2Dokuz Eylül Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, İzmir, Turkey
3Dokuz Eylül Üniversitesi Tıp Fakültesi, Medikal Onkoloji Bilim Dalı, İzmir, Turkey
Adjuvant concomitant chemoradiotherapy has been used at our clinic since February 2000 in the patients with gastric carcinoma.

Thirty-one gastric carcinoma patients (7 females, 24 males; median age 56 years; range 24 to 77 years) have been evaluated between March 2000-August 2003. The most frequent symptom was dispepsy (42%); and the most frequent tumour localisations were cardia, antrum and small curvature as an equal rates (29%). Operation types were total gastrectomy+ lymph node dissection (LND)+splenectomy (29%), distal subtotal gastrectomy+LND (36%), and total gastrectomy+LND (29%). The most frequent histopathological type was adenocarcinoma (58%). Median 21 (0-71) LND removed, and median metastatic lymph node was 5 (0-49). AJCC 1997 staging system was used for clinical staging, and the dispertion: stage II 9 (29%), IIIA 10 (33%), IIIB 5 (16%), stage IV 7 (22%) patients. Total 45 Gy radiotherapy (1.8 Gy/ fraction, 25 fraction) was delivered to the tumour and regional nodes. All patients have been treated with two opposed fields (anteroposterior/ posteroanterior) and with individual blocs. Concomitant chemoradiotherapy was administered as an intravenous continous infusion (225 mg/m2/day 5Fluorourasil (5-FU)) has been given to 20 (65%) patients.

Median follow up was 19 (4-50) months. All of the living patients were under follow up except one. Early side effects were classified as to RTOG, and late toxicity was evaluated according to EORTC / RTOG toxicity criteria. Six patients in only RT group (n=11), and 12 patients in concomitant chemoradiotherapy group (n=20) had grade I early gastrointestinal symptoms (nausea, vomiting, diarrhoea). Gradeı (n=13) and grade II (n=1) early skin reaction have been observed in RT fields. None of the patients had treatment interruption due to the side effects, and no severe late side effect had been detected. Overall, disease free, locoregional recurrence free, and distant metastasis free survival rates for two years were 64%, 67%, 90%, 79% in respectively.

Concomitant chemoradiotherapy is a tolerable and safe treatment under out patient clinic conditions for gastric carcinoma patients after gross radical resection. New trials including wide case series and long follow up are required for survival, local control and distant metastasis evaluation. Keywords : Adjuvant chemoradiotherapy; stomach neoplasms/drug therapy/mortality/radiotherapy/surgery; survival rate