EFFICIENCY OF COMBINED NEOADJUVANT REMOTE GAMMA THERAPY IN DISTAL CANCER OF THE STOMACH

Dumansky U.V., Vlasenko D.L.

The paper estimates the efficiency of combined treatment of distal cancer of the stomach in comparison with surgery. Overall, 345 patients with distal stomach cancer were involved. Patients with disseminated process (Т3N+M0 and Т4NXM0) were subjected to neoadjuvant remote gamma therapy (nRGT) using an average fractioning procedure (up to a Summary Local Doze of 40–43 Gy) with subsequent operative intervention. The remaining patients were subjected to surgical treatment only. Due to nRGT, it became possible to increase the number of radical operative interventions (71.5% against 67.0% in the control group). The number of gastrectomies increased in the main group (26.4% against 15.4%; р = 0.04) as well as in patients at stages I and II stages (22.2% against 7.9%; р = 0.05). Therapeutic pathomorphism (TP) of degrees III to IV was observed in 47.7% patients after nRGT. TP of degrees III to IV was mostly observed in moderately differentiated tumors (61.1%) and, to a smaller extent, in non-differentiated tumors (50.1%). Among patients with poorly differentiated tumors, TP of degrees II to IV was observed in 69.4% cases. In the main group of G3 patients, 24.0% had a less than 1-year survival as compared to 34.6% in the control group; for G2 patients these numbers were 5.9% and 14.7% respectively. These findings suggest that the nRGT procedure presented here decreases the severity of the clinical signs of neoplastic process, improves the resectability and reduces the 1-year lethality of patients with locally disseminated gastric tumors, especially in cases of moderately and poorly differentiated neoplastic processes (G2 and G3 tumors).