| セッション情報 | JDDW International Debate Session（Featured Lecture）5(JDDW)JDDW International Debate Session 「How to use irradiation in potentially curable gastric cancer? 」 |
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| タイトル | IS1-5-1：A Japanese viewpoint. |
| 演者 | T. Sano（Cancer Institute Hospital） |
| 共同演者 | |
| 抄録 | Japanese surgeons developed extended surgery for gastric cancer in the strong belief that thorough, systematic lymphadenectomy brings complete local tumor control. In fact, local failure has never been a leading pattern of recurrence in Japan over the past 50 years. Although “super-extended gastrectomy” such as para-aortic lymphadenectomy was once performed widely, the surgical extent has now settled down on the gold standard D2 in consequence of randomized trials and observational studies. In this history of Japanese gastric cancer surgery, radiation therapy has almost never been employed as a primary or an adjuvant treatment. It is considered only in palliative settings for chronic tumor bleeding or symptomatic metastasis. Even when the American RCT INT0116 showed clear survival benefit of adjuvant chemoradiotherapy, very few Japanese physicians including radiation oncologists were inclined to consider this as a standard treatment. It is believed that radiation therapy adds little benefit after D2 lymphadenectomy, and that the peritoneal metastasis which is the most common recurrence in Japan cannot controlled by radiation therapy. The recent trend toward neoadjuvant therapy for resectable gastric cancer may change such an attitude. Relatively high rates of complete tumor response and consequent prolonged survival have been reported after chemoradiotherapy. Recent introduction of staging laparoscopy enables exclusion of peritoneal disease, which helps selection of patients with locally advanced gastric cancer who may benefit from neoadjuvant radiotherapy. |
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