进展期胃癌术后替吉奥联合奥沙利铂化疗后序贯三维适形放疗的疗效及安全性观察

Observation on curative effect and safety of sequential three-dimensional conformal radiotherapy after postoperative chemotherapy of S-1 combined oxaliplatin for advanced gastric cancer

目的探讨进展期胃癌术后辅助化疗后序贯三维适形放疗后能否提高局部区域控制率,减少局部复发并延长生存期,并探讨进展期胃癌术后辅助化疗后序贯三维适形放疗的安全性及耐受性。方法选取我院60例进展期胃癌术后的患者,随机分为A、B两组,A组为对照组,其为单纯术后化疗患者,共30例,给予术后辅助化疗6个周期,化疗方案：奥沙利铂130 mg/m2 d1＋替吉奥60 mg bid d1~28。B组为观察组,其为上述方案6周期化疗后给予瘤床区三维适形放疗患者,共30例。观察胃肠反应、血常规、肿瘤指标、肿瘤影像评价结果。采用SPSS 18.0软件包进行统计处理。结果经过治疗后,观察组白细胞、血红蛋白减少、胃肠道反应的发生要比对照组明显,差异有统计学意义（P〈0.05）,但其不良反应轻,以Ⅰ~Ⅱ级居多,Ⅲ~Ⅳ级发生率极低;观察组和对照组1年内影像学评价复发转移分别为23.3%和40.0%,且差异有统计学意义（P〈0.05）;两组血清肿瘤标记物持续异常水平无统计学差异。结论进展期胃癌术后辅助性化疗后序贯三维适形放疗能够提高患者近期局部区域控制率,减少局部复发,疗效满意,但毒副作用明显,安全性及耐受性有待进一步探讨。

ObjectiveTo study the curative effect of sequential three-dimensional conformal radiotherapy after postoperative chemotherapy of S-1 combined oxaliplatin for advanced gastric cancer, whether it can improve the local control rates, reduce local recurrence and prolong survival period, and to explore the safety and tolerability.Methods60 patients with advanced gastric cancer after operation were collected, and randomly divided into A, B groups, group A was as the control group with pure postoperative chemotherapy, a total of 30 cases, was given postoperative adjuvant chemotherapy for 6 cycles, chemotherapy regimens： oxaliplatin 130 mg/m2 d1＋TS-1 60 mg bid d1-28. Group B was as the observation group, given three-dimensional conformal radiotherapy after 6 cycles of chemotherapy, a total of 30 cases. Observed the gastrointestinal reaction, routine blood, tumor marker, tumor imaging evaluation results. SPSS 18.0 software was used for statistical analysis.Results After treatment, the decrease of white blood cells and hemoglobin, gastrointestinal reaction in observation group were obvious than the control group, the difference was statistically significant （P〈0.05）, but the adverse reaction was light,Ⅰ-Ⅱ degreewas in the majority,Ⅲ-Ⅳ was extremely low; recurrence and metastasis rates with imaging evaluation in 1 year of observation group and the control group were 23.3% and 40%, and the difference was statistically significant （P〈0.05）; serum tumor markers of two groups continued to abnormal levels had no significant difference.Conclusion Sequential three-dimensional conformal radiotherapy after postoperative chemotherapy of S-1 combined oxaliplatin for advanced gastric cancer can improve the recent local control rates, reduce local recurrence, curative effect is satisfied, but had obvious side effects, safety and tolerability remains to be further discussed.