Randomized clinical trial on the combination of preoperative irradiation and surgery in the treatment of adenocarcinoma of gastric cardia (AGC) — report on 370 patients

• Published in: International journal of radiation oncology, biology, physics Vol. 42; no. 5; pp. 929 - 934
• Main Authors: Zhang, Zhi-Xian, Gu, Xian-Zhi, Yin, Wei-Bo, Huang, Guo-Jun, Zhang, Da-Wei, Zhang, Ru-Gang
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1998; Elsevier
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Cardia; Cardiac adenocarcinoma; Combined Modality Therapy; Combined treatment; Diseases of the digestive system; Double-Blind Method; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Preoperative radiotherapy; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stomach Neoplasms - mortality; Stomach Neoplasms - radiotherapy; Stomach Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Survival Rate; Treatment Failure; Tumors; Preoperative radiotherapy; Combined treatment; Cardiac adenocarcinoma; Surgery; Adenocarcinoma; Human; Stomach; Cardia; Digestive diseases; Clinical trial; Preoperative; Malignant tumor; Radiotherapy; Survival curve; Gastric disease
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(98)00280-6

Purpose: An attempt was made to define the role of radiotherapy before operation for AGC. Methods and Materials: From January 1978 to May 1989, a prospective randomized trial on preoperative radiotherapy (R+S) vs. surgery alone (S) for AGC was carried out in 370 patients. Patients were randomized into a combined group (R+S, 171 patients) or a surgery alone group (S, 199 patients) by the envelope method. 8-MV photon or telecobalt was used for the preoperative radiation therapy, using anterior-posterior opposing parallel fields to deliver 40 Gy to the cardia, lower segment of the esophagus, fundus, lesser curvature, and hepatogastric ligament. Surgery was performed after 2 to 4 weeks rest. Results: The 5- and 10-year survival rates of the R+S Group and the S Alone Group were 30.10% and 19.75%, 20.26% and 13.30%, respectively. The survival curves of these two groups diverged right from the beginning after the operation over the ninth year. Statistics by Kaplan–Meier log rank test proves that the difference is significant (χ2 = 6.74, p = 0.0094). The immediate results were: resection rate 89.5% and 79.4% (p < 0.01); pathologic stage after resection T2 12.9% and 4.5% (p < 0.01), T4 40.3% and 51.3% (p < 0.05), lymph node metastasis rates 64.3% and 84.9% (p < 0.001); operative mortality rates 0.6% and 2.5%; intrathoracic leak rates 1.8% and 4.0%, repectively. The causes of failure were: local uncontrol and recurrence 38.6% vs. 51.7% (p < 0.025), regional lymph node metastasis 38.6% vs. 54.6% (p < 0.005), distant metastasis 24.3% vs. 24.7%. Conclusion: Preoperative radiation therapy is able to improve the results of surgery for adenocarcinoma of the gastric cardia.