Radiation therapy in locally distributed inoperable cancer of the stomach without the symptoms of obstruction

Introduction: To assess the overall survival (OS) of patients with "asymptomatic" LAIGC in the groups of CRT and CT according to a randomized study. Methods: Patients with LAIGC without signs and threats of dysphagia were selected from a randomized study aimed at comparing chemoradiation (CRT) and chemotherapy (СT), from 2015 to 2017 on the basis of the Department of Oncology and Radiology of the Tashkent Medical Academy. Twenty-nine patients with LAIGC with tumors localized in the body and antrum sections of the stomach were selected: 15 of them received CRT, 14 - HT. In the CRT group, treatment was started with a remote radiation therapy, which was carried out from two counter figured fields in the traditional fractionation mode to a total dose of 50-64 Gy. Chemotherapy included cisplatin 100 mg/m 2 per day + 5-fluorouracil 1000 mg/m 2 24-hour infusion from 1 to 5 days, every 28 days, 4-6 courses. Overall survival was assessed by the Kaplan-Mayer method using a log-rank test. The relationship between the risk of death in a single-factor and multivariate analysis was calculated using Cox's regression. All calculations were carried out using the statistical software package Stata 13.0 (College Station, Texas 77845 USA). Results: Treatment groups were well balanced by baseline characteristics. In the distribution by sex, age, ECOG status, the severity of the concomitant pathology, trial laparotomy, gastroenteroanastomosis, the size of the primary tumor, lymph node involvement, stage of the process, tumor localization, histological variant, no statistically significant differences were found. At the time of analysis, the median time of follow-up was 52.0 (standard deviation, SD 6.9) months, 25 patients died. All four living patients - from the group of CRT (3 with localization of the tumor in the body of the stomach). Median OS, 1-and 3-year OS were 13 (95% confidence interval (CI) 4-20) vs. 20 (95% CI 7-43) months, 57% (95% CI 28-78%) vs. 80% (95% CI 50-93%) and 0% vs. 33% (95% CI 12-56%), log rank χ2 = 4.7, p = 0.029 in the CT and CRT groups, respectively. The ratio of the risk (RR) of death from any cause with the use of CRT was reduced to 0.39 (95% CI 0.17-0.94). Conclusion: Adding RT to the standard used for LAIGC of chemotherapy leads to an improvement in the overall survival of patients in the absence of symptoms of dysphagia. A small number of observations, however, does not allow to consider the advantage of CRT as proven and requires more observations in phase III of the randomized trial. The reserves of improving the effectiveness of treatment are conformal irradiation techniques and simultaneous CRT.

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