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How would you treat an early-stage gastric adenocarcinoma in a patient who is medically inoperable and not fit enough for chemotherapy?
Is there such thing a definitive radiotherapy in this setting, or would this be a purely palliative approach? If you would treat, what would your target and dose be to the intact tumor (and stomach).
Answer from: Radiation Oncologist at Community Practice
In my n=1 experience, I treated a medically inoperable patient with a T1N0M0 gastric body adenocarcinoma with "definitive" RT with mild Xeloda. I had the gastroenterologist place clips around the tumor. I treated the whole empty stomach and lymphatics to 45Gy and the gross disease to 54Gy. The patie...
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Answer from: Radiation Oncologist at Academic Institution
I agree in general with @Manuj Agarwal. I have treated a small number of patients with chemoradiation alone. While I would hesitate to call this definitive therapy, there are good prospective data, (e.g. Ajani et al. JCO 2005) that demonstrate a significant (20-30%) path CR rate in the neoadjuvant s...
Answer from: Radiation Oncologist at Academic Institution
One would need to make a judgment about whether a patient who cannot tolerate even an endoscopic resection can tolerate combined chemoradiation. The pCR rate for locally advanced gastric cancer with chemoRT is in the 20-30%. It is presumably higher with a T1a tumor, though I'm not aware of literatur...
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Radiation Oncologist at Christus St Vincent
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