Table 4. Randomized trials comparing preoperative RT vs. surgery alone—study characteristics.
| Author | Year | Site | Eligibility | Characteristics | N |
Surgery | Study arm |
|||
|---|---|---|---|---|---|---|---|---|---|---|
| Preoperative RT | Surgery alone | RT dose | RT volume | Technique | ||||||
| Skoropad (27) | 2002 | Russia | Stomach Ca | Esophagus involvement 22 preoperative RT, 16 surgery | 77 [51]§ | 75 [51]§ | D1 dissection* | 20 Gy in 5 fractions | Whole stomach, regional nodes along curvatures, celiac axis and branches 20×20 cm2 field size with no shielding | APPA |
| Adenocarcinoma | Diffuse NA | |||||||||
| SII/IV: 31 preoperative RT, 33 surgery | ||||||||||
| R0 not stated, R1 preoperative RT 3, surgery 4 | ||||||||||
| D1 100% | ||||||||||
| Total gastrectomy 27 preoperative RT, 20 surgery | ||||||||||
| No. nodes removed: NA | ||||||||||
| No. nodes involved: NA | ||||||||||
| Skoropad (28) | 2000 | Russia | Stomach Ca (esophageal involvement <3 cm included) | Esophagus involvement not stated | 59 [40]§ | 53 [38]§ | D1* | Preoperative RT 20 Gy in 5 fractions and IORT 20 Gy in 1 fraction | Preoperative RT: primary tumor and regional nodes (10×12 to 14-16 cm fields) | APPA (Co60) |
| Adenocarcinoma | Diffuse NA | IORT: tumor bed and celiac axis approximate 6-10 cm field | IORT: direction electron beam (8-22 MeV) | |||||||
| T3-4 20 preoperative RT, 21 surgery | ||||||||||
| N+ 17 preoperative RT, 13 surgery | ||||||||||
| R0 not stated R1 3 preoperative RT, 3 surgery | ||||||||||
| D1 100% | ||||||||||
| Total gastrectomy 19 preoperative RT, 16 surgery | ||||||||||
| No. nodes removed: NA | ||||||||||
| No. nodes involved: NA | ||||||||||
| Zhang (21) | 1998 | China | Stomach Ca (cardia) | Esophagus involvement not stated | 171 | 199 | NA | 40 Gy in 20 fractions | Cardia, lower segment of esophagus, fundus, lesser curve, hepatogastric ligament, superior border at 4-5 cm from cranial extent of tumor | APPA |
| Diffuse NA (one case SCC) | ||||||||||
| SIII/IV preoperative RT 71.2% surgery 89.4% | ||||||||||
| R0 not stated | ||||||||||
| D2 not stated | ||||||||||
| Total gastrectomy: NA | ||||||||||
| No. nodes removed: NA | ||||||||||
| No. nodes involved: NA | ||||||||||
| Shchepotin (29) | 1994 | Ukraine | Stomach Ca | Esophagus involvement not stated | 98 preoperative RT | 100 | NA | 20 Gy in 5 fractions | Not specified | APPA |
| Diffuse NA | 96 preoperative RTHT | HT: tumor temperature to 42 °C daily ×4 days, 2 hours postoperative RT | ||||||||
| T2,3,4: 3%, 65%, 32% | ||||||||||
| N+: 65% | ||||||||||
| R0 not stated | ||||||||||
| D1 not stated | ||||||||||
| Total gastrectomy: 51% | ||||||||||
| No. nodes removed: NA | ||||||||||
| No. nodes involved: NA | ||||||||||
§, patients were randomized to be explored, and if curative resection possible, to receive protocol treatment. Numbers in square brackets are patients eligible after exploration; *D1, complete dissection of perigastric nodes in all patients; RT, radiotherapy; Ca, cancer; NA, not available; R1, positive resection margins; APPA, anterior posterior vs. posterior anterior beam arrangement; IORT, intraoperative radiotherapy; SCC, squamous cell carcinoma; RTHT, radiotherapy and hyperthermia.