Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer

Implications for postoperative radiotherapy

Jee Suk Chang, Joon Seok Lim, Sung Hoon Noh, WooJin Hyung, Ji Yeong An, Yongchan Lee, SunYoung Rha, Chang Geol Lee, Woong Sub Koom

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background and purpose: To analyze patterns of regional recurrence after curative gastrectomy and D2 lymph node dissection in patients with stage III (N3) gastric cancer. Materials and methods: Between 2004 and 2008, 2918 patients with primary gastric cancer underwent D2 resection at a single institution. A retrospective review was performed on 382 patients in stage III with N3 disease. Of these, 357 patients (93.5%) received adjuvant chemotherapy. None of the patients received pre- or postoperative radiotherapy. Results: Median follow-up was 56.3 months. The 5-year regional failure free-survival (RFFS) rate was 63.6%. Regional failure (RF) as any component of first recurrence occurred in 91 patients (23.8%), with isolated regional failure occurring in 49 (12.8%). The most commonly involved lymph nodes were the No. 16b, No. 16a, No. 12, No. 14, No. 13, and No. 9 nodes. RFFS was adversely affected by advanced nodal stage (N3b vs. N3a). The 5-year progression-free survival rate was 32.1% and overall survival was 41.5%. Conclusion: The most prevalent nodal recurrence in patients with advanced gastric cancer was in the nodal basin outside the D2 dissection field. Our findings may help physicians construct a lymph node target volume for radiation treatment of gastric cancer after D2 dissection.

Original languageEnglish
Pages (from-to)367-373
Number of pages7
JournalRadiotherapy and Oncology
Volume104
Issue number3
DOIs
Publication statusPublished - 2012 Sep 1

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Stomach Neoplasms
Radiotherapy
Recurrence
Dissection
Survival Rate
Lymph Nodes
Survival
Gastrectomy
Adjuvant Chemotherapy
Lymph Node Excision
Disease-Free Survival
Radiation
Physicians

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Chang, Jee Suk ; Lim, Joon Seok ; Noh, Sung Hoon ; Hyung, WooJin ; An, Ji Yeong ; Lee, Yongchan ; Rha, SunYoung ; Lee, Chang Geol ; Koom, Woong Sub. / Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer : Implications for postoperative radiotherapy. In: Radiotherapy and Oncology. 2012 ; Vol. 104, No. 3. pp. 367-373.
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Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer : Implications for postoperative radiotherapy. / Chang, Jee Suk; Lim, Joon Seok; Noh, Sung Hoon; Hyung, WooJin; An, Ji Yeong; Lee, Yongchan; Rha, SunYoung; Lee, Chang Geol; Koom, Woong Sub.

In: Radiotherapy and Oncology, Vol. 104, No. 3, 01.09.2012, p. 367-373.

Research output: Contribution to journalArticle

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AU - Chang, Jee Suk

AU - Lim, Joon Seok

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AU - Hyung, WooJin

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N2 - Background and purpose: To analyze patterns of regional recurrence after curative gastrectomy and D2 lymph node dissection in patients with stage III (N3) gastric cancer. Materials and methods: Between 2004 and 2008, 2918 patients with primary gastric cancer underwent D2 resection at a single institution. A retrospective review was performed on 382 patients in stage III with N3 disease. Of these, 357 patients (93.5%) received adjuvant chemotherapy. None of the patients received pre- or postoperative radiotherapy. Results: Median follow-up was 56.3 months. The 5-year regional failure free-survival (RFFS) rate was 63.6%. Regional failure (RF) as any component of first recurrence occurred in 91 patients (23.8%), with isolated regional failure occurring in 49 (12.8%). The most commonly involved lymph nodes were the No. 16b, No. 16a, No. 12, No. 14, No. 13, and No. 9 nodes. RFFS was adversely affected by advanced nodal stage (N3b vs. N3a). The 5-year progression-free survival rate was 32.1% and overall survival was 41.5%. Conclusion: The most prevalent nodal recurrence in patients with advanced gastric cancer was in the nodal basin outside the D2 dissection field. Our findings may help physicians construct a lymph node target volume for radiation treatment of gastric cancer after D2 dissection.

AB - Background and purpose: To analyze patterns of regional recurrence after curative gastrectomy and D2 lymph node dissection in patients with stage III (N3) gastric cancer. Materials and methods: Between 2004 and 2008, 2918 patients with primary gastric cancer underwent D2 resection at a single institution. A retrospective review was performed on 382 patients in stage III with N3 disease. Of these, 357 patients (93.5%) received adjuvant chemotherapy. None of the patients received pre- or postoperative radiotherapy. Results: Median follow-up was 56.3 months. The 5-year regional failure free-survival (RFFS) rate was 63.6%. Regional failure (RF) as any component of first recurrence occurred in 91 patients (23.8%), with isolated regional failure occurring in 49 (12.8%). The most commonly involved lymph nodes were the No. 16b, No. 16a, No. 12, No. 14, No. 13, and No. 9 nodes. RFFS was adversely affected by advanced nodal stage (N3b vs. N3a). The 5-year progression-free survival rate was 32.1% and overall survival was 41.5%. Conclusion: The most prevalent nodal recurrence in patients with advanced gastric cancer was in the nodal basin outside the D2 dissection field. Our findings may help physicians construct a lymph node target volume for radiation treatment of gastric cancer after D2 dissection.

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