Recurrence and metastasis patterns of gastric cancer after curative resection and its value in target definition for radiotherapy / 中华放射肿瘤学杂志

ABSTRACT

Objective To investigate the recurrence and metastasis patterns of gastric cancer after curative resection and to guide target definition of prophylactic radiotherapy.Methods In the past 8 years,130 gastric cancer patients with treatment failure after radical resection were retrospectively analyzed.The failure sites were confirmed by B ultrasonography, CT or MRI imaging.Ten of 28 patients with ascites were found to have adenocarcinoma cells in the ascites.All superficial node and abdominal wall metastases were diagnosed pathologically by biopsy.And 27 patients with gastric remnant and/or anastomotic recurrence were diagnosed pathologically by biopsy.Results Of 130 patients, 53 were presented with multiple recurrences or metastases, 27 with gastric remnant and/or anastomostic recurrence, 28 with peritoneal metastases, 22 with liver metastases, 9 with pancreatic metastases, 60 with abdominal lymph node (LN) metastases, 8 with abdominal wall metastases, 5 with pelvic implantations, 6 with lung metastases, 5 with brain metastases, 5 with bone metastases, 8 with cervical lymph node metastases, 9 with mediastinal lymph node metastases and 8 with other metastases.Of 60 patients with abdominal LN metastases, 35, 16 and 9 had peri-gastric LNs,peri-pancreatic LNs and para-aortic LNs metastases.Abdominal LN metastases were found in 33 from 77 patients with primary gastric fundus or cardiac carcinoma, 20 from 40 patients with gastric body carcinoma,and 7 from 13 patients with pyloric carcinoma, respectively.Conclusions The failure sites of gastric cancer after radical resection are mainly the gastric stump/stoma, peritoneum, liver and abdominal LN.The perigastric, peri-pancreatic and/or para-aortic LN metastases are the most common failure of LNs.Thus, the peri-gastric, peri-pancreatic and para-aortic LN regions and gastric stump/stoma should be included in postoperative radiotherapy, and current chemotherapy is recommended.