摘要
Metastatic gastric cancer remains a non-curative disease. Palliative chemotherapy has been demonstrated to prolong survival without quality of life compromise. Many single-agents and combinations have been confirmed to be active in the treatment of metastatic disease. Objective response rates ranged from 10-30% for single-agent therapy and 30-60% for polychemotherapy. Results of phase Ⅱ and Ⅲ studies are reviewed in this paper as well as the potential efficacy of new drugs. For patients with localized disease, the role of adjuvant and neoadjuvant chemotherapy and radiation therapy is discussed. Most studies on adjuvant chemotherapy failed to demonstrate a survival advantage, and therefore, it is not considerecl as standard treatment in most centres. Adjuvant immunochemotherapy has been developed fundamentally in Korea and Japan. A meta-analysis of phase Ⅲ trials with OK-432 suggested that immunochemotherapy may improve survival of patients with curatively resected gastric cancer. Based on the results of US Intergroup 0116 study, postoperative chemoradiation has been accepted as standard care in patients with resected gastric cancer in North America. However, the results are somewhat confounded by the fact that patients underwent less than a recommended D1 lymph node dissection and the pattern of recurrence suggested a positive effect derived from local radiotherapy without any effect on micrometastatic disease. Neoadjuvant chemotherapy or chemoradiation therapy remains experimental, but several phase Ⅱ studies are showing promising results. Phase Ⅲ trials are needed.
变形胃的癌症仍然是非药品疾病。没有生活妥协的质量，辩解的化疗被表明了延长幸存。单个代理人的许多和联合被证实了在变形疾病的治疗活跃。客观反应率为综合化学疗法为单个代理人的治疗和 30-60% 从 10-30%。阶段 II 和 III 研究的结果在这篇论文以及新药的潜在的功效被考察。为有局部性的疾病的病人，助手和 neoadjuvant 化疗和放射治疗的角色被讨论。辅助化疗上的大多数研究没能表明一个幸存优点，因此，它没在大多数中心被看作标准疗法。辅助免疫化疗在朝鲜和日本根本上被开发了。有 OK-432 的阶段 III 试用的元分析建议那免疫化疗可以改进病人的幸存与 curatively resected 胃的癌症。基于美国的结果团体之间 0116 学习，手术后的 chemoradiation 与 resected 在病人作为标准照顾被接受了在北美洲的胃的癌症。然而，结果被病人们经历了的事实有点惊讶不到推荐 D1 淋巴节点解剖和复发的模式建议没有任何效果，积极效果在微变形疾病上源于本地放射疗法。Neoadjuvant 化疗或 chemoradiation 治疗仍然保持试验性，但是几阶段 II 学习正在显示出有希望的结果。阶段 III 试用被需要。
