摘要
目的:评价D1/D2手术后胃癌同步放化疗疗效及并发症。方法:68例(T3/T4和(或)N+)胃癌初治患者,手术清扫范围均达到D1/D2标准,手术切缘均为R0,术后随机分两组,放化组参照INT 0116(Intergroup0116)研究过程:化疗采用5氟尿嘧啶(5-FU)+四氢叶酸(LV),连续5天为1个周期,同步放化疗始于第1周期化疗后的第28天,放疗的前4天和后3天合并5-FU与LV(此相当于单化组第2、3周期化疗),放疗剂量45Gy/25f,每次1.8Gy,每周5次,放疗后1月再行2个周期化疗,化疗方案同放疗前,放疗采用X线调强外照射DT45Gy/25f。单化组采用5个周期的5-FU+LV。结果:放化组与单化组的1、2、3年生存率分别为85.9%、73.4%、67.7%和68.0%、50.0%、44.1%(P<0.05);1、2、3年无瘤生存率分别为73.5%、64.7%、55.8%和61.8%、38.2%、29.4%(P<0.05)。主要不良反应为消化道反应和中性粒细胞减少,两组Ⅰ、Ⅱ级厌食反应分别为73.5%(25/34)和44.1%(15/34)(P<0.05),Ⅰ、Ⅱ级恶心呕吐反应分别是82.35%(28/34)和73.5%(25/34)(P>0.05),Ⅰ、Ⅱ级中性粒细胞减少分别为70.6%(24/34)和44.1%(15/34)(P<0.05),其余所观察各反应指标均无显著性差异。结论:对于(T3/T4和(或)N+)D1/D2手术后胃癌患者,同步放化疗能提高患者的1、2、3年总生存率和1、2、3年无病生存率,主要不良反应为恶心呕吐及骨髓抑制,但以Ⅰ、Ⅱ级为主,患者耐受性良好。
Objective：To evaluate the efficacy and complications of concurrent chemoradiotherapy（CCRT） for the treatment of gastric cancer patients after D1/D2 surgery.Methods： Sixty-eight untreated gastric cancer patients（T3/T4 and/or N＋） were enrolled.They were first treated with surgery,and the clearing scope reached D1/D2 standards with an incisal margin of R0.The patients were randomized into two groups： CCRT group and single chemotherapy group.The CCRT group was treated according to INT 0116（Intergroup 0116）.One cycle of chemotherapy consisted of 5-fluorouracil（5-FU） and tetrahydrogolic acid（LV） administered continuously.CCRT began 28 days after the first cycle of chemotherapy,and the combination of 5-FU and LV was given in the first four and last three days（corresponding to the second and third cycles of chemotherapy in the single chemotherapy group） during the CCRT period with the radiation dosage of 45Gy/25f,i.e.1.8Gy five times per week.Two cycles of the same chemotherapy were administrated one month after radiotherapy-X-ray intensity-modulated external radiation,DT 45Gy/25f.Five cycles of 5-FU and LV were applied in the single chemotherapy group.Results： One,two and three-year survival rates were 85.9%,73.4% and 67.7% in the CCRT group and 68.0%,50.0% and 44.1% in the single chemotherapy group respectively（P 0.05）;and corresponding disease-free survival rates were 73.5%,64.7% and 55.8% in the CCRT group and 61.8%,38.2% and 29.4% in the single chemotherapy group respectively（P 0.05）.The major side effects were gastrointestinal reactions and neutrocytopenia.In the CCRT and single chemotherapy groups,the incidences were 73.5%（25/34） and 44.1%（15/34）（P〈0.05） for grade I and II anorexia,82.35%（28/34） and 73.5%（25/34）（P〈0.05） for nausea and vomiting and 70.6%（24/34） and 44.1%（15/34）（P〈0.05） for neutrocytopenia.Other indices showed no significant differences.Conclusion： CCRT can increase one,two and three-year total and disease-free survival rates of gastric cancer patients（T3/T4 and/or N＋） who have been treated with surgery.The major adverse reactions were grade Ⅰ and Ⅱ nausea and vomiting,as well as myelosuppression.CCRT is well tolerated.
出处
《现代肿瘤医学》
CAS
2012年第11期2341-2344,共4页
Journal of Modern Oncology
关键词
胃癌
化疗
调强放射治疗
gastric cancer
chemotherapy
intensity modulated radiotherapy
