Unresectable Locoregional Disease
The addition of radiation therapy to chemotherapy in patients with locally advanced disease has been studied in a number of trials, which have shown that concurrent 5-fluorouracil-based chemotherapy and radiation therapy at a dose of 35 to 50 Gy is feasible. Chemoradiation therapy provides a survival advantage similar to that seen with chemotherapy alone.
At M. D. Anderson, we have found concurrent 5-fluorouracil, paclitaxel, and radiation therapy at a dose of 45 to 50 Gy to be feasible (Table 14-3). Aggressive nutritional support is important with a combined-modality approach. Gastrostomy feeding tubes are suboptimal in the setting of gastric irradiation. The use of a feeding jejunostomy and a 3-dimensional conformal technique can greatly enhance tolerance.
Table 14-3. Treatment with 5-Fluorouracil, Paclitaxel, and Radiation Therapy for Locally Advanced Gastric Cancer
5-fluorouracil 300 mg/m2/day continuous intravenous infusion 5 days per week for 5 weeks
Paclitaxel 45 mg/m2 IV 1 day per week for 5 weeks
External-beam radiation therapy 1.8 Gy/day 5 days per week to 45-50 Gy
Abbreviation: IV, intravenously.
In patients with disseminated disease, the role of radiation therapy is limited to palliation of symptoms. The role of radiation therapy for brain and spinal cord metastases is well established. Irradiation of areas of painful soft-tissue disease may enhance pain control. Gastric irradiation helps to treat bleeding from primary tumor and gastric outlet obstruction.
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