三维适形放疗同步XELOX方案化疗治疗胃癌术后腹腔淋巴结转移的临床研究

Clinical study of three-dimensional conformal radiotherapy combined with XELOX programchemotherapy for postoperative abdominal lymph nodes metastasis of gastric cancer

目的：探讨三维适形放疗同步XELOX方案化疗治疗胃癌术后腹腔淋巴结转移的临床疗效。方法将71例胃癌术后出现腹腔淋巴结转移患者按随机数字表法分为治疗组和对照组。治疗组36例，给予三维适形放疗同步XELOX方案化疗；对照组35例，给予XELOX方案化疗。观察两组患者的近期疗效、症状控制率、远期生存率及不良反应。结果治疗组和对照组患者完全缓解率和客观有效率分别为36．1％（13／36）、20．0％（7，35）和77．8％（28~6）、60．0％（21/35），两组比较差异有统计学意义（P＜0．05）。治疗组和对照组患者腹痛、腹胀、腰背酸痛总的症状控制率分别为80．6％（29/6）和51．4％（18/35），两组比较差异有统计学意义（P＜0．01）。随访2年，随访率为97．2％（69/71）。治疗组和对照组1、2年生存率分别为42．9％（15，35）、22．9％（8，35）和20．6％（7/34）、5．9％（2／34），中位生存期分别为11．6个月和4．9个月，两组比较差异有统计学意义（P＜0．01）。治疗组骨髓抑制和胃肠道反应的发生率明显高于对照组（P＜0．01），经对症治疗后均好转。结论胃癌术后腹腔淋巴结转移对同步放化疗较敏感，同步放化疗可提高近期疗效，并延长生存期，但不良反应有所增加。

Objective To investigate the clinical effect of three-dimensional conformal radiotherapy Combined with XELOX program chemotherapy for postoperative abdominal lymph nodes metastasis of gastric cancer. Methods Seventy-one patients with postoperative abdominal lymph nodes metastasis were divided by random digits table method into treatment group （36 cases） who treated with three-dimensional conformal radiotherapy combined with XELOX program chemotherapy and control group （35 cases） who treated with XELOX program chemotherapy. The short-term efficacy, the control rate of symptoms, the long-term survival rate and adverse reaction were observed in two groups. Results The complete remission rate and objective response rate in treatment group and control group were 36.1% （13/36）, 20.0% （7/35） and 77.8% （28/36）, 60.0% （21/35）, respectively, there were significant differences between two groups （P 〈 0.05）. The overall control rate of abdominal pain, bloating, low back pain in treatment group was 80.6% （29/36）, significantly higher than that in control group [ 51.4% （ 18/35 ） ] （P 〈 0.01 ）. Followed up for 2 years, the followed up rate was 97.2% （69/71 ）. The 1,2-year survival rates in treatment group and control group were 42.9% （15/35）, 22.9% （8/35） and 20.6% （7/34）, 5.9% （2/34）, respectively, and the median survival time was 11.6 months and 4.9 months, there were significant differences between two groups （P 〈 0.01 ）. The incidence rates of bone marrow suppression and gastrointestinal tract in treatment group were obviously higher than those in controlgroup （P 〈 0.01 ）, and the symptoms all were improved after treatment. Conclusions Postoperative lymph nodes metastasis of gastric cancer is sensitive to concurrent chemoradiotherapy. Concurrent chemoradiotherapy can improve the short-term et^cacy and prolong survival time, but the adverse reactions increase.