进展期胃癌术后化疗联合调强适形放疗的临床观察

Clinical Observation of Chemotherapy Combined with Intensity Modulated Radiation Therapy for Advanced zastric Cancer Postoperation

目的观察进展期胃癌术后化疗联合调强适形放疗技术对进展期胃癌的疗效和安全性。方法行胃全切或胃次全切除加淋巴结扩大清扫术(D2)的临床分期为Ⅱ-Ⅲ期胃腺癌37例,采用直线加速器6MV-X线调强适形放疗外照射,处方剂量45Gy/25次,同时在放疗的第1天和第1-14天给予奥沙利铂(艾恒)(120mg/m2)和卡培他滨(希罗达)(1650mg/m2)方案化疗,每3周重复,共2疗程。休息2-4周,再予全身化疗2-4周期。结果 2年总生存率为89.8%,2年无瘤生存率84.2%;肝转移3例(8.1%),腹膜转移2例(5.4%),吻合口复发1例(2.7%),腹膜后淋巴结转移1例(2.7%);根据剂量体积直方图(DVH)评价,95%临床靶区接受了45Gy的照射剂量,OAR受量均在耐受剂量以下。结论进展期胃癌术后化疗联合调强适形放疗是有效的治疗方法,局部控制率较好,无严重毒副反应,病人耐受良好。

Objective To evaluate the safety and efficacy of the chemotherapy combined with intensity modulated radiation therapy（IMRT） for advanced gastric cancer.Methods Thirty-seven patients of advanced gastric cancer with total or subtotal gastrectomy and D2 dissection were irradiated with a total dose of 45Gy of IMRT in 25 fractions by linac with 6-MV photons.All patients received concomitant chemotherapy with two cycles of oxaliplatin（120mg/m^2） d1 and capecitabine（1650mg/m^2） d1-14.Results The overall survival and the disease free survival of two years of all patients was 89.8% and 84.2%,respectively.7 patients with treatment failure had recurrent disease,3（8.1%） in the liver,2（5.4%） in the peritoneum,1（2.7%） in the anastomotic stoma,1（2.7%） in the retroperitoneal lymph node,respectively.The plan was evaluated by dose-volume histogram of three-dimensional therapy plan system,with 95% of PTV receiving the prescribed dose,and the dose of organ at risk was under the tolerance dose.Conclusion Chemotherapy combined with the IMRT is one of the safe and effective treatment for gastric cancer postoperation,and is well tolerated with no severe side effects.