术中白芨顺铂微粒联合^(125)I近距离放化疗在进展期胃癌治疗中的应用

Application of Cisplatin in Bletilla Hyacinthine Particle Chemotherapy Combined with ^(125)Iodine Brachytherapy in Advanced Gastric Cancer

目的观察术中白芨顺铂微粒和125I近距离放化疗治疗进展期胃癌的近、远期疗效和毒副反应。方法纳入接收根治性手术的Ⅱ、Ⅲ期胃癌患者176例,随机分为近距离放化疗组(n=48)、腹腔化疗组(n=32)和静脉化疗组(n=48),并将术后自动放弃放、化疗的患者,在签署知情同意书后,选择作为对照组(n=48),观察各组患者近、远期随访结果和毒副反应,并通过Kaplan-Meier法和Log-Rank检验分析各组患者的生存情况。结果近期随访结果:近距离放化疗组总有效率为95.83%,腹腔化疗组总有效率为71.88%,静脉化疗组总有效率为64.58%,对照组总有效率为52.08%。4组间总有效率的差异有统计学意义(P<0.05),其中对照组与近距离放化疗组比较,差异有统计学意义(P<0.01)。远期随访结果:近距离放化疗组3年和5年死亡率为37.50%和56.32%,5年中位生存期为(14±4.51)个月(95%CI:14.419～4.512);腹腔化疗组3年和5年死亡率为78.12%和93.75%,5年中位总体生存期为(10.6±1.13)个月(95%CI:10.620～1.163);静脉化疗组3年和5年死亡率为79.21%和95.80%,5年中位总体生存期为(11±3.10)个月(95%CI:11.130～3.162);对照组3年和5年死亡率为87.50%和95.83%,5年中位总体生存期为(9±2.30)个月(95%CI:10.024～1.18)。与静脉化疗组相比较,近距离放化疗组恶心、呕吐、骨髓抑制、肝功能损害及肾功损害的发生率明显降低(P<0.05)。结论对进展期胃癌术中进行白芨顺铂微粒和125I近距离放化疗治疗可减少药物的毒副反应,延长患者生存期。

Objective To observe the effect of cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy on short-and long-term outcomes and the toxic and side effects in advanced gastric cancer.Methods One hundred seventy-six patients with stage Ⅱ or stage Ⅲ advanced gastric cancer underwent curative surgical resection were included in this study.They were randomly divided into brachytherapy and chemotherapy group（n=48）,intraperitoneal chemotherapy group（n=32） and intravenous chemotherapy group（n=48）,and other patients who abandoned radiotherapy and chemotherapy and signed informed consent form by themselves were considered as control group（n=48）.The short-and long-term outcomes and the toxic and side effects were observed and the survival of all patients was analyzed by Kaplan-Meier method and Log-Rank test.Results For short-term outcomes,the total effective rate in 4 groups were 95.83%,71.88%,64.58% and 52.08% respectively,and the difference was significant（P0.05）.For long-term outcomes,the 3-and 5-year mortality rate was 37.50% and 56.30%,and 5-year median survival time was（14±4.51） months（95%CI： 14.419-4.512） in brachytherapy and chemotherapy group patients.The 3-and 5-year mortality rate was 78.12%and 93.75%and 5-year median survival time was（10.6±1.13） months（95%CI： 10.620-1.163） in intraperitoneal chemotherapy group patients.The 3-and 5-year mortality rate was 79.21%and 95.80%and 5-year median survival time was（11±3.10） months（95%CI： 11.130-3.162） in intravenous chemotherapy group patients.The 3-and 5-year mortality rate was 87.50%and 95.83% and 5-year median survival time was（9±2.30） months（95%CI： 10.024-1.180） in control group patients.Compared with the vein chemotherapy group,the short distance puts the chemotherapy group disgusting vomit,the marrow to suppress,the liver function harm,the kidney function harm formation rate to reduce obviously（P0.05）.Conclusion Cisplatin in bletilla hyacinthine particle chemotherapy combined with 125I brachytherapy can reduce the toxic and side effects of drugs and prolong survival time of patients with advanced gastric cancer.