Efficacy of radiotherapy for patients with unresectable or recurrent locally advanced gastric carcinoma

Objective: To retrospectively analyze the efficacy of abdominal radiotherapy for unresectable or recurrent locally advanced gastric cancer and its influencing factors. Methods: A retrospective analysis was performed among 57 patients admitted to our hospital from 2009 to 2015. In those patients, 36 patients had unresectable locally advanced gastric cancer (19 patients with locally advanced gastric cancer and 17 patients with residual tumor after surgery) and 21 patients had postoperative recurrence; 17 patients received three-dimensional conformal radiotherapy and 40 patients received intensity-modulated radiotherapy with a median radiation dose of 50 Gy (42-60 Gy); 81% of all patients received concurrent chemotherapy by oral administration of fluorouracil. Results: In all patients, the median follow-up time was 16.0 months (3.9-77.5 months) and the response rate was 65% after radiotherapy. The median overall survival (OS) time was 13.9, 13.9, and 19.0 months in patients with locally advanced tumors, residual tumor after R₂ resection, and recurrence, respectively. The 2-year OS, progression-free survival, and local-regional recurrence-free survival rates in all patients were expected to be 50%, 37%, and 50%, respectively. The multivariate analysis showed that disease grouping was a prognostic factor and the third regional lymph node invasion was not a negative prognostic factor. Conclusions: Medium-dose radiotherapy combined with chemotherapy achieves satisfactory local control and improves survival in patients with unresectable or recurrent locally advanced gastric cancer. Postoperative recurrence and the third regional lymph node invasion should be considered as good indications for salvage chemoradiotherapy. (authors)