Adjuvant Radiotherapy for Gastric Carcinoma: 10 years Follow-up of 244 cases from a Single Institution

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among highriskpatients. This study was undertaken to analyse long-term survival probability and the impact of certaincovariates on the survival outcome in affected individuals. Materials and
Methods: Between January 2000 andDecember 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Datawere retrieved retrospectively from patient files and analysed with SPSS version 21.0.
Results: A total of 244cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years(range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperativeadjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range,2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probabilityfor 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS)probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotalgastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses.Surgical margin status or lymph node dissection type were not prognostic for survival.
Conclusions: PostoperativeCRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-knownprognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy wasan important prognostic factor in our series. With our findings we add to the discussion on the definition ofrequired surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patientsin our clinic can be useful in the future randomised trials to point the way to improved outcomes.