胃癌放射治疗进展

Progress in the Radiotherapy of Gastric Cancer

早期胃癌单纯手术治疗可以取得较好的效果,但是进展期胃癌的比例高于75%,局部进展期胃癌患者即使根治性手术切除预后仍较差。有证据显示辅助治疗可以改善胃癌患者生存,在西方国家,辅助治疗的手段为术后放化疗或围手术期化疗。哪种治疗策略最佳一直在争议中,然而高剂量的胃部照射会带来明显的毒性反应,所以降低正常器官的剂量和毒性也越来越受到关注。放射治疗技术的不断进步带来了靶区勾画和放疗实施的改善,但是胃癌放疗仍然面临着技术性挑战并且需要对术后解剖结构、复发模式和淋巴引流综合深刻的理解,以及器官移动与充盈的理解和识别。临床试验正试图探索胃癌包括(放)化疗和靶向治疗的最佳治疗策略。全文就胃癌放(化)疗进展及胃癌放射治疗管理中面临的技术挑战进行综述。

Early staged gastric cancer can obtain good effect by surgery alone,but the proportion of advanced gastric cancer is higher than 75%,the prognosis of patients with locally advanced gastric cancer remains poor,despite radical surgical resection. Adjuvant therapy has been shown to improve survival,and in western countries,it is delivered either postoperatively（chemoradiotherapy） or perioperatively（chemotherapy）. Debate continues as to which of these represents the optimal strategy. High-dose gastric radiation results in the expense of significant toxicity and increasing efforts have focused on attempts to reduce normal tissue doses and toxicity. The development of radiotherapy technologies permits improved target delineation and radiation delivery. However,gastric radiotherapy remains technically challenging and requires a comprehensive understanding of postoperative surgical anatomy,patterns of failure and lymph node drainage,as well as an identification of the uncertainties around organ motion and filling.Ongoing trials are examining the optimal strategy in which to combine chemoradiotherapy,as well as the addition of targeted therapies in gastric cancer. This overview discusses the development of chemoradiotherapy,as well as the technical challenges encountered in the radiotherapy management of resectable gastric cancer.