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Gastric IORT With or Without EBRT

  • Chapter
Intraoperative Irradiation

Part of the book series: Current Clinical Oncology ((CCO))

Abstract

Gastric cancer has experienced a marked change in prevalence during the last decades. Although in some countries, as in the Far East, gastric cancer continues to be a national health problem, the incidence in most Western countries is decreasing. Most importantly, whereas the overall incidence of gastric cancer has decreased in Europe and the United States, there has been an increase in the relative percentage of proximal gastric adenocarcinomas and adenocarcinomas arising in the gastroesophageal junction. With the exception of Japan, where mass screening programs have increased the number of patients diagnosed of early gastric cancer, diagnosis at an advanced stage is the rule. Approximately 50–75% of the patients who have gastric resection for cancer have serosal invasion and/or lymph node involvement. This helps to explain why cure rates have remained unchanged for decades in spite of improvements in oncologic therapy. Investigators should consider that both accrual and design of future trials in gastric cancer will probably be affected by these epidemiological trends.

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References

  1. Abe M, Nishimura Y, and Shibamoto Y. Intraoperative radiation therapy for gastric cancer, World J. Surg., 19 (1995) 544–547.

    PubMed  CAS  Google Scholar 

  2. Ogata T, Araki K, Matsuura K, et al. A 10-year experience of intraoperative radiotherapy for gastric carcinoma and a new surgical method of creating a wider irradiation field for cases of total gastrectomy patients, Int. J. Radiat. Oncol. Phys., 32 (1995) 341–347.

    Article  CAS  Google Scholar 

  3. Nishi M, Nakayima T, and Kajitani T. The JapaneHse Research Society for gastric cancer—the general rules for the gastric cancer study and an analysis of treatment results based on the rules. In Preece PE, Cuschieri A, Wellwood JM, (eds.) Cancer of the Stomach, Grune & Straton, New York, 1986, pp. 107–121.

    Google Scholar 

  4. American Joint Committee on Cancer. Manual for Staging of Cancer, 4th ed. JB Lippincott, Philadelphia, 1992.

    Google Scholar 

  5. Kodama Y, Sugimachi K, Soejima K, et al. Evaluation of extensive lymph node resection for carcinoma of the stomach, World J. Surg., 11 (1981) 127–145.

    Google Scholar 

  6. Dent DM, Madden MV, and Price SK. Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma, Br. J. Surg., 75 (1988) 110–112.

    Article  PubMed  CAS  Google Scholar 

  7. Sasako M, Maruyama K, Kinoshita T, et al. Quality control of surgical technique in a multicenter, prospective, randomized, controlled study on the surgical treatment of gastric cancer, Jap. J. Clin. Oncol., 22 (1992) 41–48.

    CAS  Google Scholar 

  8. Van de Veide CJH. Surgery of gastric carcinoma R1 versus R2 resection. Second International Conference on Biology, Prevention and Treatment of Gastrointestinal Malignancies, Köln, Germany. Symposium Abstracts, p. 21, 1995.

    Google Scholar 

  9. Landry J, Tepper JE, Wood WC, Orlow E, Koerner F, and Sullinger J. Patterns of failure following curative resection of gastric carcinoma, Int. J. Radiat. Oncol. Biol. Phys., 19 (1990) 1357–1362.

    Article  PubMed  CAS  Google Scholar 

  10. Noguchi Y, Imada T, Matsumoto A, Coit DG, and Brennan MF. Radical surgery for gastric cancer. A review of the Japanese experience, Cancer, 64 (1989) 2053–2062.

    Google Scholar 

  11. Gunderson LL and Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) Clinico-pathologiccorrelation and implications for adjuvant therapy, Int. J. Radiat. Oncol. Biol. Phys., 8 (1982) 1–11.

    Article  PubMed  CAS  Google Scholar 

  12. Wisbeek WM, Becher EM, and Russell AH. Adenocarcinoma of the stomach: autopsy observations with therapeutic implications for the radiation oncologist, Radiother. Oncol., 7 (1986) 13–18.

    Article  Google Scholar 

  13. Allum WH, Hallissey MT, Ward LC, et al. A controlled, prospective, randomised trial of adjuvant chemotherapy or radiotherapy in resectable gastric cancer. Interim report. British Stomach Cancer Group, Br. J. Cancer, 60 (1989) 739–744.

    Article  PubMed  CAS  Google Scholar 

  14. Klaasen DJ, Manlntyre JM, Catton GE, Engstrom PF, and Moertel CG. Treatment of locally unresectable cancer of the stomach and pancreas: a randomised comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil-An Eastern Cooperative Oncology Group Study, J. Clin. Oncol., 3 (1985) 373–378.

    Google Scholar 

  15. Martinez-Monge R, Calvo FA, Azinovic I, et al. Patterns of failure and long-term results in high-risk resected gastric cancer treated with postoperative radiotherapy ± intraoperative electron boost, J. Surg. Oncol., 66 (1997) 24–29.

    Article  PubMed  CAS  Google Scholar 

  16. Moertel CG, Childs DS, O’Fallon JR, Holbrook MA, Schutt AI, and Reitemeier RJ. Combined 5-fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma, J. Clin. Oncol., 2 (1984) 1249–1254.

    PubMed  CAS  Google Scholar 

  17. Regine WF and Mohiuddin M. Impact of adjuvant therapy on locally advanced adenocarcinoma of the stomach, Int. J. Radiat. Oncol. Biol. Phys., 24 (1992) 921–927.

    Article  PubMed  CAS  Google Scholar 

  18. Haas CD, Mansfield CM, Leichman LP, Considine B, and Bukowski RM. Combined nonsimultaneous radiation therapy and chemotherapy with 5-FU, doxorubicin and mitomycin C for residual localized gastric adenocarcinoma; a Southwest Oncology Group Pilot Study, Cancer Treat. Rep., 76 (1983) 421–424.

    Google Scholar 

  19. O’Connell MJ, Gunderson LL, Moertel CG, and Kvols LK. A pilot study to determine clinical tolerability of intensive combined modality therapy for locally unresectable gastric cancer, Int. J. Radiat. Oncol. Biol. Phys., 11 (1985) 1827–1831.

    Article  PubMed  Google Scholar 

  20. Slot A, Meerwaldt JH, Van Putten WLJ, and Treurniet-Donker AD. Adjuvant postoperative radiotherapy for gastric carcinoma with poor prognostic signs, Radiother. Oncol., 16 (1989) 269–274.

    Article  PubMed  CAS  Google Scholar 

  21. Sindelar WF, Kinsella TJ, Tepper JE, et al. Randomized trial of intraoperative radiotherapy in carcinoma of the stomach, Am. J. Surg., 165 (1993) 178–86.

    Article  PubMed  CAS  Google Scholar 

  22. MacDonald JS, Steele G, and Gunderson LL. Carcinoma of the stomach. In DeVita VT Jr, Hellman S, and Rosenberg SA (eds.), Cancer-Principles and Practice of Oncology, 2nd ed. Lippincott, Philadelphia, 1989, pp. 765–799.

    Google Scholar 

  23. Hermans J, Bonenkamp JJ, Boon MC, et al. Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J. Clin. Oncol.,118 (1993) 1441–1447.

    Google Scholar 

  24. Childs DS, Moertel CG, Holbrook MA, Reitemeier RJ, and Colby Jr M. Treatment of unresectable adenocarcinomas of the stomach with a combination of 5-fluorouracil and radiation, AJR, 102 (1968) 541–544.

    Article  Google Scholar 

  25. Moertel CG, Childs DS, Reitemeier RJ, Colby Jr M, and Holbrook MA. Combined 5-flourouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer, Lancet, 1 (1969) 865–870.

    Article  Google Scholar 

  26. Holbrook MA. Current concepts in cancer-radiation therapy for gastric cancer: treatment principles, JAMA, 228 (1974) 1289–1290.

    Article  PubMed  CAS  Google Scholar 

  27. Schein PS and Novak J. Gastrointestinal Tumor Study Group: a comparison of combination chemotherapy and combined modality therapy for locally advanced gastric carcinoma, Cancer, 49 (1982) 1771–1777.

    Article  Google Scholar 

  28. Chevalier TL, Smith FP, Harter WK, and Schein PS. Chemotherapy and combined modality therapy for locally advanced and metastatic gastric carcinoma, Semin. Oncol., 12 (1985) 46–53.

    PubMed  Google Scholar 

  29. Gastrointestinal Tumor Study Group. The concept of locally advanced gastric cancer. Effect of treatment on outcome, Cancer, 66 (1990) 2324–2330.

    Google Scholar 

  30. Dent DM, Werner ID, Novis B, Cheverton P, and Brice P. Prospective randomized trial of combined oncological therapy for gastric carcinoma, Cancer, 44 (1979) 385–392.

    Article  PubMed  CAS  Google Scholar 

  31. Gunderson LL, Burch PA, and Donohue JH. The role of irradiation as a component of combined modality treatment for gastric cancer, J. Infusion Chemo., 5 (1995) 117–124.

    CAS  Google Scholar 

  32. Abe M, Takahashi M, Yabumoto E, Adachi H, Yoshii M, and Mori K. Clinical experiences with intraoperative radiotherapy for locally advanced cancers, Cancer, 45 (1980) 40–48.

    Article  PubMed  CAS  Google Scholar 

  33. Abe M, Takahashi M, Ono K, Tobe T, and Inamoto T. Japan gastric trials in intraoperative radiation therapy, Int. J. Radiat. Oncol. Biol. Phys., 15 (1988) 1431–1433.

    Article  PubMed  CAS  Google Scholar 

  34. Farthmann EH, Kirchner R, Salm R, Strasser C, Frommhold, and Nilles A. Usefulness and limitations of preoperative radiotherapy in association with curative resection in the treatment of gastric cancer, Chirurgie,119 (1993–1994) 565–568.

    Google Scholar 

  35. Kramling HJ, Willich N, Cramer C, Wilkowski R, Duhmke E, and Schildberg FW. Early results of IORT in the treatment of gastric cancer. In Vaeth JM (ed.), Intraoperative Radiation Therapy in the Treatment of Cancer, Front. Radiat. Ther. Oncol., 31 (1997) 157–160.

    Chapter  Google Scholar 

  36. Avizonis VN, Buzydlowski J, Lanciano R, Owens JC, Noyes D, and Hanks GE. Treatment of adenocarcinoma of the stomach with resection, intraoperative radiotherapy and adjuvant external beam radiation: a phase II study from Radiation Therapy Oncology Group 85–04, Ann. Surg. Oncol., 2 (1995) 295–302.

    Article  PubMed  CAS  Google Scholar 

  37. Calvo FA, Aristu JJ, Azinovic I, et al. Intraoperative and external radiotherapy in resected gastric cancer: updated report of a Phase II trial, Int. J. Radiat. Oncol. Biol. Phys., 24 (1992) 729–36.

    Article  PubMed  CAS  Google Scholar 

  38. Chabert M, Schmitt T, Soglu M, et al. Intraoperative radiation therapy (IORT) for locally advanced gastric cancer. Proceedings of the 6th International IORT Symposium and 31st San Francisco Cancer Symposium, San Francisco, September 23–25, 1996.

    Google Scholar 

  39. Dulce MC, Kaiser J, Boese-Landgraf J, Scheffler A, Haring R, and Ernst H. Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method), Strahlenther, Onkol., 167 (1991) 581–591.

    CAS  Google Scholar 

  40. Coquard R, Ayzac L, Gilly FN, et al. Intraoperative radiation therapy combined with limited lymph node resection in gastric cancer: an alternative to extended dissection? Int. J. Radiat. Oncol. Biol. Phys., 39 (5) (1997) 1093–1098.

    Article  PubMed  CAS  Google Scholar 

  41. Caudry M, Escarmant P, Maire JP, Demeaux H, Guichard F, and Azaloux H. Radiotherapy of gastric cancer with a three field combination: feasibility, tolerance and survival, Int. J. Radiat. Oncol. Biol. Phys., 13 (1987) 1821–1827.

    Article  PubMed  CAS  Google Scholar 

  42. Chen G and Song S. Intraoperative Radiation Therapy. Evaluation of intraoperative radiotherapy for gastric carcinoma-analysis of 247 patients. In Abe M and Takayashi M (eds.), Pergamon, New York, 1991, p. 190.

    Google Scholar 

  43. Kramling HJ, Grab J, Zaspel J, et al. Experimental study of vascular sequelae of combined upper abdominal intraoperative and external radiation therapy. In Vaeth JM (ed.), Intraoperative Radiation Therapy in the Treatment of Cancer, Front. Radiat. Ther. Oncol., 31 (1997) 36–40.

    Chapter  Google Scholar 

  44. Ahmadu-Suka F, Gillette EL, Withrow SJ, Husted PW, Nelson AW, and Whiteman CE. Exocrine pancreatic function following intraoperative irradiation of the canine pancreas, Cancer,62 (1988)10911095.

    Google Scholar 

  45. Ahmadu-Suka F, Gillette EL, Withrow SJ, Husted PW, Nelson AW, and Whiteman CE. Pathological response of the pancreas and duodenum to experimental intraoperative irradiation, Int. J. Radiat. Oncol. Biol. Phys., 14 (1988) 1197–1204.

    Article  PubMed  CAS  Google Scholar 

  46. Heijmans HJ, Mehta DM, Kleibeuker JH, Sluiter WJ, Oldhoff J, and Hoekstra HJ. Intraoperative irradiation of the canine pancreas: short-term effects, Radiother. Oncol., 29 (1993) 347–51.

    Article  PubMed  CAS  Google Scholar 

  47. Johnstone PA, Sprague M, DeLuca AM, et al. Effects of intraoperative radiotherapy on vascular grafts in a canine model, Int. J. Radiat. Oncol. Biol. Phys., 29 (1994) 1015–1025.

    Article  PubMed  CAS  Google Scholar 

  48. Tepper JE, Sindelar WF, Travis EL, Terrill R, and Padikal T. Tolerance of canine anastomoses to intraoperative radiation therapy, Int. J. Radiat. Oncol. Biol. Phys., 9 (1983) 987–992.

    Article  PubMed  CAS  Google Scholar 

  49. Gillette EL, Powers BE, McChesney SL, Park RD, and Withrow SJ. Response of aorta and branch arteries to experimental intraoperative irradiation, Int. J. Radiat. Oncol. Biol. Phys.,17 (1989) 12471255.

    Google Scholar 

  50. Grab J, Zaspel J, Kallfass E, et al. Reactions of the gastric wall following IORT ± ERT to the upper abdomen in rabbits. In Vaeth IM (ed.), Intraoperative Radiation in the Treatment of Cancer, Front. Radiat. Ther. Oncol., 31 (1997) 36–40.

    Google Scholar 

  51. Aristu JJ, Azinovic I, Martinez-Monge R, Tangco E, Yoldi A, and Calvo FA. Pancreatic function following upper abdominal intraoperative and external irradiation. A long-termk clinical analysis. In Schildberg FW, Willich N, and Krämling H-J (eds.), Intraoperative Radiation Therapy, Proceedings 4th International Symposium IORT, Munich 1992. Verlag Die Blaue Eule, Essen, 1993.

    Google Scholar 

  52. De Villa VH, Calvo FA, and Bilbao JI. Arteriodigestive fistula: a complication associated with intra-operative and external beam radiotherapy following surgery for gastric cancer, J. Surg. Oncol., 49 (1992) 52–7.

    Article  PubMed  Google Scholar 

  53. Kim MS, Kim SK, Song SK, Kim HJ, Kwon KB, and Kim HD. Complication of intraoperative radiation therapy (IORT) in gastric cancer. International Congress of Radiation Oncology 1993. Kyoto, Japan, 1993, p. 357.

    Google Scholar 

  54. Aristu JJ, Bilbao JI, Azinovic I, Martinez-Monge R, Tangco E, and Calvo FA. Abdominal vascular changes following gastrectomy, intraoperative and external irradiation: a long-term analysis. In Schildberg FW, Willich N, and Krämling H-J (eds.), Intraoperative Radiation Therapy, Proceedings 4th International Symposium IORT, Munich 1992. Verlag Die Blaue Eule, Essen, 1993.

    Google Scholar 

  55. Sindelar WF, Hoekstra H, Restrepo C, and Kinsella TJ. Pathological tissue changes following intra-operative radiotherapy, Am. J. Clin. Oncol., 9 (1986) 504–509.

    Article  PubMed  CAS  Google Scholar 

  56. Perez CA and Brady LW. Overview. In Perez CA and Brady LW (eds.), Principles and Practice of Radiation Oncology, 2nd ed. JB Lippincott, Philadelphia, 1992, pp. 1–63.

    Google Scholar 

  57. Sindelar WF, Kinsella TJ, Chen PW, et al. Intraooperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial, Arch. Surg., 128 (1993) 402–410.

    Article  PubMed  CAS  Google Scholar 

  58. Noyes RD, Weiss SM, and Krall JM. Surgical complications of intraoperative radiation therapy: the Radiation Therapy Oncology Group experience, J. Surg. Oncol., 50 (1992) 209–215.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Rafael Martinez-Monge
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  2. Jean P. Gerard
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  3. H. J. Kramling
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  4. F. Guillemin
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  5. Felipe A. Calvo
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Editor information

Editors and Affiliations

  1. Mayo Clinic and Mayo Medical School, Rochester, MN, USA

    Leonard L. Gunderson MD, MS (Professor and Chair of Oncology) (Professor and Chair of Oncology)

  2. Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Christopher G. Willet MD

  3. Albert Einstein College of Medicine and Beth Israel Cancer Center, New York, NY, USA

    Louis B. Harrison MD

  4. University Hospital Gregorio Marañón, Madrid, Spain

    Felipe A. Calvo MD (Chair of Oncology) (Chair of Oncology)

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© 1999 Springer Science+Business Media New York

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Martinez-Monge, R., Gerard, J.P., Kramling, H.J., Guillemin, F., Calvo, F.A. (1999). Gastric IORT With or Without EBRT. In: Gunderson, L.L., Willet, C.G., Harrison, L.B., Calvo, F.A. (eds) Intraoperative Irradiation. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-696-6_11

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  • DOI: https://doi.org/10.1007/978-1-59259-696-6_11

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-5576-3

  • Online ISBN: 978-1-59259-696-6

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