三维适形放疗联合XELOX方案治疗胃癌术后腹腔淋巴结转移的疗效分析

Clinical Effect of Three-Dimensional Conformal Radiotherapy Combined with XELOX on Postoperative Abdominal Lymph-node Metastasis of Gastric Cancer

目的:探讨同步放化疗治疗胃癌术后腹腔淋巴结转移的临床疗效。方法:收集新疆医科大学第一附属医院肿瘤中心2007年1月至2009年11月收治胃癌根治术后出现腹腔淋巴结转移患者83例,随机分为治疗组和对照组。治疗组41例,给予三维适形放疗同步XELOX方案(奥沙利铂+希罗达)化疗;对照组42例,给予XELOX方案化疗。两组患者一般临床资料具有可比性结果:治疗组和对照组客观有效率分别为80.5%和57.1%,两者比较有显著性差异(P=0.01),治疗组和对照组患者的腹痛、腹胀、腰痛总的控制率分别为87.8%和52.4%,有显著性差异(P<0.001)。治疗组与对照组1、2年生存率分别为41.0%vs.19.5%、17.9%vs.4.9%,差异均具有统计学意义(P<0.001)。治疗组因腹腔淋巴结转移导致死亡的患者占25.0%,明显低于对照组的61.5%(P<0.001)。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<0.001),但不良反应主要为RTOG 1级和2级,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,同步放化疗可改善因腹腔淋巴结转移导致的症状,降低死亡率。

Objective： To investigate the effect of concurrent chemo-radiotherapy on patients with abdominal lymph node metas- tasis of gastric cancer after surgery. Methods： Eighty-three patients with abdominal lymph node metastasis were randomly divided into two groups, namely, the treatment group （ G1 ） and the control group （ G2 ）. Forty-one patients were included in G1, and the other 42 patients were included in G2. The patients in G1 tmderwent a simultaneous three-dimensional conformal radiation therapy combined with the regimen of XELOX （ Xeloda＋oxaliplatin ）. On the other hand, the patients in G2 received XELOX chemotherapy. The clinical data of the two groups were compared with each other. Results： The objective response rates of G1 and G2 were 80.5% and 57.1%, re- spectively, showing significant differences between the two groups （ P = 0.01 ）. The overall control rate of abdominal pain, bloating, low back pain was 87.8% in G1, which was significantly higher than that of G2 at 52.4% （ P 〈 0.001 ）. The 1- and 2-year survival rates of G1 and G2 were 41.0% vs. 19.5% and 17.9% vs. 4.9%, respectively. G1 and G2 had a median survival time of 11.4 and 4.8 months, respectively, showing statistically significant differences between the two groups （ P 〈 0.001 ）. The death rate caused by the abdominal lymph node metastasis of gastric cancer in G1 was 25.0%, which was significantly lower than that in G2 at 61.5% （ P 〈 0.001 ）. The in- cidence rates of bone marrow suppression and gastrointestinal reaction were significantly higher in G1 than in G2 （ Pp 〈 0.001 ）. How- ever, the main adverse reactions were Grades One and Two based on the Side Reaction Classification of Common Toxicity Standard, RTOG （ CTC2.0 ）, and the symptoms were found to improve after the treatment. Conclusion： Postoperative lymph-node metastasis of gastric cancer is sensitive to chemo-radiotherapy. The synchronal treatment plan can improve the symptoms of nodal metastasis, reduce the mortality rate, and prolong the survival of patients.