Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view.

The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed.

Postoperative chemoradiotherapy for gastric cancer.

BACKGROUND: We report the results of postoperative chemoradiotherapy after curative resection in gastric cancer patients. PATIENTS AND METHODS: Patients with gastric cancer staged IB to IV(M0) were treated with chemoradiotherapy after curative resection with extensive (D2) lymph node dissection. Nodal metastases were observed in 261 (90%) patients. The chemotherapy consisted of fluorouracil 400 mg/m(2) plus leucovorin 20 mg/m(2) for 5 days, followed by 4500 cGy of radiotherapy for 5 weeks with fluorouracil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two 5-day cycles of chemotherapy were given 4 weeks after the completion of radiotherapy. RESULTS: Of 290 patients accrued, 229 (79%) patients completed chemoradiotherapy as planned. With a median follow-up of 49 months, 114 (34%) patients have relapsed: 33 (29%) locoregional relapses, 76 (67%) peritoneal relapses and 41 (36%) distant metastases. The 5-year overall and relapse-free survivals were 60% and 57%, respectively. Tolerance was acceptable, the main toxicity being neutropenia. CONCLUSIONS: This postoperative chemoradiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities. Whether this adjuvant therapy in gastric cancer patients that have undergone a D2 lymph node dissection impacts on survival or reduces the incidence of relapses remains to be studied.

Lipiodol accumulation in focal peliosis hepatis with sinusoidal dilatation.

Peliosis hepatis is a rare benign condition that is histologically characterized by multiple cystic blood-filled spaces in the liver. Although the cause is unknown, the condition occurs in association with several diseases or medications. We report a patient who was found to have a lesion with lipiodol accumulation in the liver 2 months after its intraarterial injection. The lesion was diagnosed and treated as a small hepatocellular carcinoma. However, subsequent right hepatic lobectomy and histologic examination confirmed the diagnosis of focal peliosis hepatis.

Inhibition of ethanol absorption byRhodiola sachalinensis in rats.

We used a herbal medicine, roots ofRhodiola sachalinensis (RS) to assess whether RS extract can decrease blood ethanol concentrations in rats fed ethanol and if so, to elucidate the mechanism by which RS extract reduces blood ethanol levels. Rats were fed ethanol orally 1 hr after the oral administration of various doses of RS extract. In another experiment, rats were injected intraperitoneally with ethanol following the intake of RS extract via gastric catheter to eliminate possible inhibition of ethanol absorption in the gastrointestine by RS extract. The administration of RS extract remarkably lowered blood ethanol levels in a dose-dependent manner in rats given ethanol orally. However, the intake of RS extract did not reduce ethanol levels in rats injected with ethanol intraperitoneally. The activities of two main hepatic enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), involved in ethanol metabolism, were not affected by the administration of RS extract in rats fed ethanol. In addition, the intake of RS extract reduced serum triglyceride levels elevated by ethanol to the normal level. We conclude that the administration of RS extract lowers blood ethanol concentrations by inhibition of ethanol absorption in the gastrointestinal tracts of ethanol-fed animals.