Analysis of therapeutic effects of radiochemotherapy and chemotherapy alone in patients with advanced gastric cancer after gastrectomy

Objective: To investigate the therapeutic effects and toxic effects of radiochemotherapy versus chemotherapy alone in patients with advanced gastric cancer after gastrectomy. Methods: A total of 183 patients with stage II-IV(M₀) gastric cancer, who received treatment after gastrectomy from 2004 to 2010, were included in the study. Of the 183 patients, 64 received radiochemotherapy after gastrectomy, and 119 received chemotherapy alone after gastrectomy. The survival rates and hematological and gastrointestinal toxic effects were compared between the two groups; survival difference was also analyzed after the patients were stratified by TNM stage, number of metastatic lymph nodes, and extent of lymph node dissection (D₀, D₁, and D₂). The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis; the chi-square test was used for comparing toxic effects between the two groups. Results: The follow-up rate was 87.8%; 72 patients were followed up for at least 3 years, and 29 patients for at least 5 years. The 1-, 3-, and 5-year survival rates for the radiochemotherapy group were 86%, 62%, and 55%, respectively, as compared with 11%, 53%, and 43% for the chemotherapy group (P = 0.079). There were no significant differences in grade 3-4 hematological and gastrointestinal toxic effects between the two groups (P = 0.363 and 0.617). The univariate analysis showed that radiochemotherapy had a significantly better survival benefit than chemotherapy alone in patients with stage III_B-IV (M₀) gastric cancer, patients who underwent D₀ lymph node dissection, and patients with more than 6 metastatic lymph nodes (P = 0.022, 0.025, and 0.021). Conclusions: Compared with chemotherapy alone, radiochemotherapy tends to improve survival in patients with gastric cancer after gastrectomy, and its toxic effects are tolerable. The patients with stage III_B-IV (M₀) gastric cancer, patients who undergo D₀ lymph node dissection, and patients with more than 6 metastatic lymph nodes can benefit from radiochemotherapy. (authors)