晚期胃癌治疗进展

Progress in Treatment for Advanced Gastric Cancer

胃癌在全球最常见恶性肿瘤中排名第四位,是恶性肿瘤第二大死因;其发现多在晚期,已经失去了根治性手术机会。晚期胃癌治疗手段主要包括姑息性手术治疗、放疗、化疗、生物免疫治疗、中医药治疗。姑息性手术治疗主要用于减轻患者肿瘤负荷,或减少并发症的发生;放疗在局部晚期胃癌的治疗中具有一定的效用。化疗在晚期胃癌治疗中可发挥主导作用,对有症状的患者有始息性治疗效果。由FAX方案到ECF/DCF方案,再到REAL-2试验、ML17032、SPIRITS试验等几项里程碑式的随机性Ⅲ期临床研究结果的公布,关于晚期或转移性胃癌化疗的研究一直是关注的焦点,随着EOX、XP、S-1/CDDP、IF、FOLFOX、XELOX等化疗方案相继提出,晚期胃癌的临床疗效有了进一步提高,但目前尚未得到优势明显的标准治疗方案。胃癌的生物免疫治疗也逐渐成为研究热点,它是对手术和化、放疗的有益补充,但还不能作为主干性疗法。无论手术、放疗,或是化疗、生物免疫治疗,其在发挥疗效的同时,均具有明显的副作用。因此,采用中药内服外用、针灸推拿、心理干预等多种综合治疗手段,发挥中西医结合在缓解临床症状、对化、放疗减毒与增效、提高患者生存质量、预防肿瘤复发与转移、逆转肿瘤细胞多药耐药、治疗癌性腹水及癌性疼痛等方面的特色与优势,同样具有重要临床价值。

Gastric cancer is the fourth most common cancer and is the second leading cause of cancer death worldwide. Gastric cancer is usually in advanced stage at diagnosis, without opportunity for curative resection. Chemotherapy is the major treatment for advanced gastric cancer （AGC）, and other treatments include palliative surgery, radiotherapy, chemotherapy, biologic and immunologic therapy as well as Chinese medicine. Palliative therapy is used to reduce tumor load or complication occurrence, while radiotherapy is effective for Iocoregionally advanced gastric cancer. At present, chemotherapy plays a leading role in AGC treatment and has a palliative effect on symptomatic patients. For advanced or metastatic gastric cancer, chemotherapy has always been the focus of studies. Results of studies of FAX, ECF/DCF regimens and Phrase Ⅲ clinical trials of REAL-2, ML17032 and SPIRITS have been released. With the application of EOX, XP, S-1/CDDP, IF, FOLFOX and XELOX regimens, the outcomes of advanced gastric cancer are improved. However, there is no standard regimen accepted as superior over others. Biologic and immunologic therapy are beneficial supplements to surgery, chemotherapy and radiotherapy, but are not yet the mainstream. All of these treatments have obvious side effects. Other comprehensive methods are of equal importance, such as Chinese herbal medicine, acupuncture and moxibustion, and psychological intervention. Combined with western medicine, the above methods have certain merits in relieving clinical symptoms, reducing toxicity, increasing effectiveness, improving quality of life, preventing metastasis and recurrence, reversing multidrug resistance of tumor cells, and curing ascites and managing cancer pain.