胃癌术后三维适形或调强放疗加化疗的毒性及初步疗效分析

Toxicity and efficacy of post-operative chemoradiotherapy for gastric cancer

目的评价胃癌患者接受术后同期放化疗的毒性和近期疗效。方法回顾分析45例胃癌术后放疗患者，其中38例为同期放化疗，男31例，女14例，中位年龄54岁，IB～IV（M0）期。采用三维适形或调强放疗技术，靶区包括瘤床和区域淋巴引流区，放疗剂量45～55Gy分25～30次。化疗药物为氟尿嘧啶（21例）或希罗达（17例）。毒性分级标准采用CTCAE3．0。结果仅2例因无法耐受治疗而中止放疗，其中1例为术后肠粘连，1例为3级胃肠道反应。其余毒性表现为1＋2、3级白细胞减少发生率分别为71％、7％；1＋2、3级胃肠道反应发生率分别为56％、16％；1＋2级乏力、食欲不振发生率为38％。1年总生存率、无复发生存率和局部控制率分别为87％、82％、95％。结论局部进展期胃癌患者可耐受术后放化疗毒性，术后放化疗可提高局部控制率，是否可提高总生存率尚需更长时间随访和更多前瞻性随机试验证实。

Objective To evaluate the toxicity and efficacy of post-operative chemoradiotherapy for gastric cancer. Methods Forty-five gastric cancer patients treated with post-operative radiation ± concur- rent chemotherapy were retrospectively analyzed. Among them, 14 were female and 31 were male. The median age was 54 （30-72） years. Pathology stages were IB-IV. Radiotherapy of doses from 45 Gy/25fx to 55 Gy/30fx was delivered to the tumor bed and regional lymph nodes with 3D conformal or IMRT technology. Concurrent chemotherapy agent was fluorouracil or capacitabine. Results All patients except 2 （4%）completed radiotherapy as planned. The most common acute toxicities were hematologic and gastrointestinal effects. The incidence of the patients was 56% with mild nausea/vomiting,71% and 7% with grade Ⅰ / Ⅱ and IU leucopenia,and 38% with grade Ⅰ /Ⅱ hypodynamia and anepithymia. The 1-year overall survival, relapse-free survival and local control rates were 87%, 82% and 95% ,respectively. Conclusions Post- operative chemoradiation for patients with locally advanced gastric cancer is tolerable. Our study shows the advantage of post-operative chemoradiation for local control. However,further prospective randomized trial is needed to validate the efficacy.