45例局部晚期胃癌术后辅助同步放化疗临床研究

Clinical Study of Postoperative Concomitant Concurrent Chemora-diotherapy in 45 Cases with Locally Advanced Gastric Cancer

[目的]探讨局部晚期胃癌术后辅助同步放化疗的有效性和耐受性。[方法]2006年3月至2008年5月共86例患者入组。随机进入治疗组(术后同步放化疗组)或对照组(术后单纯化疗组)。治疗组45例,术后4周内开始放疗,常规外照射6MV-XDT46～50Gy/23～25f,4～5w。放疗第一周和最后一周各行CF方案化疗1个周期,之后继续行CF方案辅助化疗4个周期。对照组41例,术后4周内开始行辅助化疗,CF方案6个周期。[结果]治疗组1、2、3年总生存率分别是90.5%、78.2%、54.5%,中位生存时间38个月。对照组1、2、3年总生存率分别是78.3%、54.3%、28.8%,中位生存时间31个月。两组生存率差异有显著性意义(P=0.044)。毒副反应治疗组胃肠道反应有所增加,但均顺利完成治疗计划。[结论]局部晚期胃癌术后辅助同步放化疗能提高生存率,毒性反应有所增加,但能耐受,值得临床进一步研究。

[Purpose] To investigate the efficacy and tolerance of postoperative concomitant chemora- diotherapy for locally advanced gastric cancer. [Methods] From March 2006 to May 2008, 86 cases were enrolled and randomly divided into treatment group （postoperative concomitant chemoradiotherapy） or control group （postoperative chemotherapy alone）. Forty-five cases in treatment group received conventional external radiotherapy to a total dose of DT46~50Gy/23～25 fractions,4～5 weeks beginning on the 4 weeks after radical operation. Concomitant chemotherapy of fluorouracil and leucovorin were administered in the first and last week of radiotherapy. After the concomitant chemoradiotherapy, 4 cycles same chemotherapy were consecutively administered. Forty-one patients in control group received 6 cycles adjuvant chemotherapy of 5-fluorouracil and leucovorin beginning on the 4 weeks after operation. [Results] The overall survival at 1-year, 2-year,3-year and median survival was 90.5%, 78.2%, 54.5%, 38 months in the treatment group and 78.3%, 54.3%, 28.8%, 31 months in the control group respectively （P =0.044）. Gastrointestinal toxicity in treatment group was higher than that in control group, but all patients completed the treatment plan safely. [Conclusion] Postoperative concomitant chemoradiotherapy in patients with locally advanced gastric cancer improve overall survival and median survival as compared with chemotherapy alone. The toxicity is higher but well tolerable.