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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  ;  Woo Jin Hyung  ;  Ji Yeong An  ;  Yong Chan Lee  ;  Sun Young Rha  ;  Chang Geol Lee  ;  Woong Sub Koom 
 RADIOTHERAPY AND ONCOLOGY, Vol.104(3) : 367-373, 2012 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Node Excision* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology* ; Neoplasm Staging ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Stomach Neoplasms/mortality ; Stomach Neoplasms/pathology ; Stomach Neoplasms/therapy* ; Survival Rate
Gastric cancer ; Recurrence ; Pattern of failure ; Postoperative radiotherapy ; D2 dissection
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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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk Paul(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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