IS THERE A ROOM IN BULGARIA FOR RADIOTHERAPY OF GASTRIC CANCER?

Gastric cancer is the fourth most common cancer worldwide with one million new casesyearly and the second most frequent cause of cancer death. Although surgery is the leading treatment modality of gastric cancer the survival remains low (5- year survival is reported to be 25% in Europe and 60% in the Eastern world). The risk of locoregional recurrence grows with the increase of the tumor stage. In order to improve locoregional control a number of clinical studies in the last four decades have examined different strategies of adjuvant therapy, including chemotherapy, radiotherapy, chemoradiation with ambiguous results. Various regimens of radiotherapy alone, applied preand postoperatively or in combination with chemotherapy in pre- and postoperative settings have been studied. With the present article, the authors present the world experience of radiotherapy application in gastric carcinoma, supporting its introduction in to Bulgarian clinical practice. The study results concerning this topic have been discussed. SWOG/Intergroup 0116 study showed that postoperative chemoradiation leads to increased 5-year overall survival compared with surgery alone. A recent metaanalysis on randomized trials in operable gastric cancer, found that adjuvant radiotherapy leads to 20 % improvement in disease free survival and overall survival and found no subgroup of patients who do not benefit from adjuvant radiotherapy. The available data from the published studies and metaanalysis completely supports the introduction of chemoradiation for gastric cancer and in Bulgarian radiotherapy practice with the opportunity of gaining own experience.

Radiotherapy in the multimodality management of esophageal cancer.

Squamous cell carcinoma and adenocarcinoma of the esophagus represent more than 90% of all cases of esophageal carcinoma. Although the incidence of squamous cell carcinoma has decreased, a continues increase in the incidence of adenocarcinoma has been observed, due to the increasing rate of obesity and gastroesophageal reflux disease. Treatment of carcinoma of the esophagus is complex and include surgery, chemotherapy and radiotherapy. The authors investigate the role of radiotherapy in the modern multimodality treatment of esophageal carcinomain order to derive recommendations for its implementation. The results of clinical trials and meta-analysis dealing with the radiotherapy application alone or as chemoradiation in preoperative, postoperative or definitive settings are summarized. When summarizing the data from the clinical trials and the meta-analyzes in esophageal carcinoma radiotherapy recommendations are drawn up. As a single modality radiotherapy is recommended only in palliative setting. Current data indicates that the neoadjuvant chemoradiation followed by the surgery is accepted as a standard treatment achieving 3-year overall survival rateraging between 30% and 60%. No improvement in local control or survival is observed when total irradiation dose is increased over 50.4Gy. Neoadjuvant or definitive chemoradiation became a standard treatmentin locally advanced tumors of the esophagus. Preoperative chemoradiation has proven contribution to improving treatment results when compared to surgery alone in both squamous cell and adenocarcinoma of esophagus. There is also a trend towards improved survival when neoadjuvant chemoradiation is applied compared to neoadjuvant chemotherapy alone. Data in favor of definitive radiotherapy as radical treatment are limited and its use is recommended only in case of palliation.

[Manometry of the upper gastrointestinal tract in esophageal reflux disease]. / Manometriia na gorniia otdel na stomashno-chrevniia trakt pri refluksna bolest na khranoprovoda.

Infusion manometry of the esophagus and the stomach after the permanent dynamic method of Winans [correction of Wynas] and Harris was carried out on 52 patients (30 women and 22 men) with hiatal hernia, volvulus of the stomach or peptic ulcer disease. Altogether 75 examinations were performed--35 preoperative and 40--postoperative. The mean preoperative pressure of the inferior esophageal sphincter was 9.1 (from 0 to 15) mmHg and the mean postoperative pressure was 18 (from 12 to 211 mmHg). The mean preoperative length of the inferior esophageal sphincter was 1.4 (from 0 to 4) cm and the mean postoperative length was 2.5 (from 1 to 6) cm. In 12 patients motor disturbances of the tubular esophagus were found: symmetric, hyperpersistaltic waves (Richter's nutcracker symptom)--in 3 patients, hypomotility--in 5 patients, diffuse esophageal spasm--in 4 patients. Esophageal manometry is a valuable noninvasive method for the functional diagnostic of the reflux disease and the motor esophageal disturbances as well as for the assessment of the postoperative function of the inferior esophageal sphincter.