Multimodal Treatment of Resectable Gastric Cancer with Intensive Neoadjuvant Radiation Therapy: Obninsk Radiological Center Experience

Introduction: We performed a retrospective analysis to clarify the role of neoadjuvant radiation therapy in the management of resectable gastric cancer. Methods and Methodology: All patients underwent R0 gastrectomy between 1974 and 2008 were retrospectively evaluated. Among them 597 patients underwent multimodal treatment with various schemes of intensive preoperative radiation therapy (total dose of 20-27 Gy) and 433 patients were treated with surgery alone. Results: Radiation therapy was completed in 98% of the patients without the delay of the surgery and any increase in postoperative morbidity or mortality including cases with D2 lymphadenectomy. Subgroup analysis showed that neoadjuvant radiotherapy provided statistically significant survival improvement comparing with surgery alone in pN+ cases (p=0.035); Borrmann 3 and 4 types (p=0.029); poorly differentiated, undifferentiated and signet ring cell carcinomas (p=0.005). Multivariate analysis in the latter group confirmed that neoadjuvant radiation therapy was an independent factor of the favorable prognosis (p=0.001). Conclusions: Intensive neoadjuvant radiotherapy is safe, feasible and could improve survival in selected groups of patients. Patients with poorly differentiated, undifferentiated and signet ring cell carcinomas should be considered as the target group for the multimodal treatment including radiation therapy.