胃癌术后同步放化疗64例临床分析

Postoperative radiotherapy concurrent with paclitaxel and cisplatin in the adjuvant treatment of gastric cancer：An analysis of 64 cases

目的评价胃癌术后放疗同步紫杉醇顺铂方案治疗的临床疗效和毒性反应，比较适形放疗与常规放疗在放疗毒性反应方面的差异。方法采用常规4野或三维适形放疗技术DT60Gy和紫杉醇135mg／m^2第1天，顺铂20mg／m^2第1～3天同步化疗，4周1次共2周期。结果3年总生存率、3年无复发生存期分别为78．2％、70．9％，28．1％患者出现治疗失败。3级及以上毒性反应发生率为70．3％．主要毒性反应为消化道（28．1％）、血液学毒性（21．8％）和脱发（18．7％），1洌患者发生治疗相关死亡。结论胃癌术后的同步化疗方案效果较好，安全可行；适形放疗技术可以进一步减轻放疗相关毒性反应尤其是胃肠道反应。

Objective To evaluate the efficacy and toxicity of postoperative chemoradiation for D2 dissection gastric cancer,and to compare the difference of toxicity between confromal and traditional radiotherapy. Methods Sixty four patients with T3-4,N ＋ or R1 were enrolled. Radioation was given to a total dose of 46Gy delivered in 23 fractions by use of 3D-CRT or 4 fields traditional radiotherapy. Chemothrepy was administered with paclitaxel 135 mg/ m2 day 1 and 29,eisplantin 20 mg/m2 day 1 - 3 and day 29 -31 during radiotherapy. Results The median follow-up time was 40 months. The 3-year overall and relapse-free survival rates were 78.2% and 70. 9%, respectively. Eighteen patients had tumor relapse. Fifty-three patients completed chemoradiotheray. Toxicities on grade 3 or above included gastrointestinal toxicity （28.1% ） , eutropenia（ 21. 8% ） and alopecia（ 18.7% ）. One patient died of hemorrhage of upper digestion tract. Conclusion Adjuvant radiotherapy with paclitaxol and cisplatin yielded satisfactory overall survival and disease-free survival in gastric cancer patients. The toxicity was manageable. Conformal radiotherapy seems to decrease the gastrointestinal toxicities compared to that occurred in the traditional radiotherapy.