The association of surgical resection and intraoperative radiotherapy (IORT) permits combining the removal of the primary tumor with the direct aggression of high-dose radiant therapy on the gastric bed, a preferental site for loco-regional recurrences. A pilot study on total gastrectomy (TG) + IORT was initiated in January 1990 in the II Department of Surgery of the Regina Elena National Cancer Institute. Of the 68 patients submitted to elective surgery during the course of 1990, 39 submitted to TG with N2 lymphadenectomy (according to the 1988 TNM UICC classification) were considered. The survey was divided into two arms: the first included 22 patients treated with only TG and the second included 17 patients treated with TG + IORT. There were more patients with advanced disease in the first arm than in the second: 1 vs. 2 patients at stage I, 4 vs. 4 at stage II, while at stage III, 11 patients were submitted to TG and 5 to TG + IORT and 5 vs. 5 at stage IV. With regard to the postoperative course, no alterations of the principle hematochemical tests were observed in 37 out of the 39 patients, while hyperamylasemia and transitory hyperglycemia were observed in 2 patients submitted to TG + IORT. Regarding complications and mortality in the first arm, 4 deaths from 4 serious complications occurred: a pancreatitis, a diffused sepsis, a dehiscence of the esophago-jejunal anastomosis and one case of irreversible cardiorespiratory insufficiency. In the second IORT-treated group, only two serious and fatal complications occurred: an esophageal hemorrhage in a patient submitted to gastro-esophageal resection for a carcinoma of the cardia and serious sepsis leading to a complete renal block and renal insufficiency and death on the 45th day. The studies conducted in Japan and those currently in progress in Europe and the United States recommend the use of IORT as an interesting complementary therapy, able to limit the progression of the disease at a loco-regional level. In its preliminary phase, the results of the present study permit affirm that the treatment does not cause harmful effects nor does it interfere negatively on the immediate prognosis of patients affected with stage II and III gastric cancer.
|Translated title of the contribution||Intraoperative radiotherapy in stomach cancer. Rationale and preliminary experiences|
|Number of pages||7|
|Issue number||4 SUPPL.|
|Publication status||Published - 1991|
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