Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method)

: The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week). For intraoperative and percutaneous radiotherapy the target absorbed dose was selected in a way that their combined effect on the tumor was approximately equivalent to that of a total dose of 60 Gy in the usual fractionating. Up to now, the median survival time for stage III patients (UICC 1987) has been twelve months. In five patients who died of a relapse or of peritoneal carcinosis, histologic evaluation revealed in every case a diffuse tumor type according to Lauren-classification. All relapses occurred within the first eight months. The two-year survival rate according to Kaplan-Meier is 67% for stage III. Advanced resectable gastric cancer of the intestinal tumor type seems to profit from adjuvant intraoperative radiotherapy. The results warrant further research within the framework of a prospective randomized multicenter study.