Copyright ©2006 Baishideng Publishing Group Co.
World J Gastroenterol. Mar 14, 2006; 12(10): 1511-1520
Published online Mar 14, 2006. doi: 10.3748/wjg.v12.i10.1511
Table 1 Patterns of relapse based on University of Minnesota re-operation series and autopsy series
Univ. of MinnesotaAutopsy series[6-9]
series[10] (n=107)
Pattern of relapse%%
Gastric bed5552-68
Abdominal wound5-
Peritoneal seeding4230-43
Lymph nodes43152
Local-regional as any site6980-93
Local-regional only23-
Lymph Nodes only7-
Lymph nodes only in nodal3-
dissection sites
Distant metastases3650
Table 2 Randomized trials of adjuvant radiation therapy in gastric carcinoma
SurvivalLocal-regional relapse
ReferencenMedian (mo)5-year (%)P value%P value
Mayo Clinic[14]
Surgery alone231540.0554NS
Post-op EBRT + CT39242339
British stomach group[11,12]
Surgery alone1451520NS27<0.01 for
Post-op CT138131919
Post-op EBRT153171210EBRT
Surgery alone199NR200.009521<0.025
Pre-op EBRT171NR3039
Intergroup 0116[16]
Surgery alone2752741 (3 yr)0.00529NR
Postop EBRT + CT2813650 (3 yr)19
Walsh et al[15]
Surgery alone55116 (3 yr)0.01NR-
Preop EBRT + CT581632 (3 yr)
Table 3 Randomized trials of D1 versus D2 lymph node dissection in gastric cancer
MRC[18] (n=711)Dutch[17] (n=400)
EndpointD1D2P valueD1D2P value
5 year overall survival45%47%NS35%33%NS
Post-operative morbidity25%43%<0.00128%46%<0.001
Post-operative mortality4%10%0.0046.5%13%0.04
Table 4 Prospective trials of pre-operative chemoradiation in gastric cancer
RT dose Overall Median Complete Partial R0 % Distant
Reference Chemo (Gy) survival % survival time response (%) response (%) rate (%) metastases
(2 yr) (mo) during therapy
RTOG5FU/LV/cis×2 prior to RT;
99-04[46]5FU with RT45NRNR27NR77NR
(n = 49)
(n = 19)Cis/5FU38.4,71NR550NR0
(n = 23)5FU45NRNR1163NR17
Ajani 2004[43]
(n = 33)5FU/LV/cis×2 prior to RT; 5FU with RT455433.73024NR12
Ajani 2005[44]
(n = 41)5FU/cis/tax×2 prior to RT; 5FU/tax with RT45682Not reached20153780
(n = 42)5FU/cis4545.62314-81-
(n = 21)Cis/5FU or tax50.44218146253-
Table 5 Treatment results: Unresectable or residual gastric cancer
ReferencenTreatmentRadiation therapyChemotherapyResults
Mayo Clinic[51]48EBRT ± CT35-37.5 Gy in 4-5 wk5FU 1st wk of EBRTMedian survival 13 vs 6 mo and 5-year overall survival 12% vs 0% favoringEBRT+5FU
GITSG[53]90CT ± EBRT50 Gy split course in 8 wk5FU during EBRT, maintenance 5FU/MeCCNU4-year survival 18% vs 7%, favoring CT+EBRT
EORTC[52]90EBRT ± CT55.5 Gy in 6 wk5FU14% long-term survival (3 patients) with EBRT and 5FU
MGH[55]32EBRT ± CT45-55 Gy in 5-6 wk5FU during EBRT, maintenance 5FU/MeCCNUEBRT+CT: Unresectable disease 14 mo median survival; unresectable and residual disease 10% 4-year survival