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The 30-year experience with combined and surgical treatment of gastric cancer gained at the Center is discussed. The results of surgery were improved due to use of intensive preoperative radiotherapy, metronidazole and dynamic fractionated treatment. There was no correlation between intensive preoperative radiotherapy and postoperative complication incidence or lethality, irrespective of extent of surgery or lymph node dissection. Moreover, radiotherapy was followed by a considerable decrease in postoperative incidence of pancreatitis due to inhibition of secretory function by the pancreas. Use of modern technology of radiotherapy planning and implementing left virtually no serious damage. Considering the recent changes introduced to standards for surgical treatment of gastric cancer, our findings point to a safe combination of preoperative radiotherapy with extended surgical and combined treatment.

Aim: Surgery remains the main treatment of stomach carcinoma. Poor long-term survival mandates the study of other techniques. An original treatment scheme with preoperative radiotherapy and metronidazole as a radiosensitizer is reported here., Methods: Between 1982 and 1988, MRRC RAMS carried out a prospective clinical trial of preoperative radiotherapy (20 Gy/5 days) in combination with metronidazole (given orally, 3 times, 5 gms per metre(2)). Of 91 patients who received preoperative radiotherapy, 67 patients were operated on with curative intent and were eligible for further analysis., Results: Acute gastro-intestinal toxicity was significant but manageable without surgery delay in most cases. There were 4 postoperative deaths. Overall 5-year, 10-year survival and median survival were 46%, 36% and 46 months. Serosal and nodal involvement were the most significant adverse prognostic factors. Tumours confined to the gastric wall, node negative cases, middle and distal location, differentiated tumours, female sex and age more than 50 years were associated with relatively good long-term results: overall 5-year survival was 50% or better, overall 10-year survival was 40% or better., Conclusion: The combined treatment showed significant but manageable acute toxicity. The long-term results seem encouraging and support further investigations in multimodal treatment of gastric cancer., (Copyright 2002 Elsevier Science Ltd.)

In 90 patients with malignant neoplasia of larynx, stomach and cervix uteri the functional state of hemostasis was investigated within the process of radiotherapy and in radiotherapy and radiosensitization by metronidazole. Aim of this work is to answer the question if metronidazole affects the state of organism besides its effect on radiosensitivity of tumor tissue, especially the system of hemostasis, the impairment of which can not seldom result in thrombohemorrhagic complications in oncologic patients as is known. It was pointed out that the thrombophilic status of the blood of patients with stomach carcinoma continues to be unchanged and the patients are endangered for thrombosis potentially. In consequences of radiotherapy and doses of metronidazole the capacity for adhesion is decreased in thrombocytes of patients with laryngeal and cervical carcinomas to a high degree, whereby the thrombogenic potential of blood is reduced and with that the risk for origin of intravascular thrombosis.

Altogether 70 patients received combined therapy for stomach cancer. A course of gamma-beam therapy (a summary focal dose of 20 Gy) combined with metronidazole was given at the first stage. Three-five days after the discontinuation of radiation therapy the patients were operated upon. Forty-nine (70%) patients were subjected to radical operation. The area of surgical intervention ranged from subtotal resection of the stomach to combined gastrectomy. Lethality after radical operations was 7.5%. Pronounced and extensive dystrophic changes were found in tumors at microscopic examination of resected specimens.

Indices of platelet function, plasmic coagulation and fibrinolysis were studied during gamma-beam therapy in patients with laryngeal, gastric and cervical tumors (potentially at risk for thrombosis) against a background of metronidazole administration. During the above therapy the thrombophilic status of gastric cancer patients was preserved. These patients were considered at risk for thrombosis. In patients with laryngeal and cervical cancer platelet capacity to adhesion was considerably reduced during radiotherapy with the use of metronidazole. As a result of it the thrombogenic blood potential and danger of intravascular thrombogenesis were decreased.