胃癌术后不同放疗方式近中期疗效及对周围组织的影响

Effect of different radiotherapy modes and its influence on surrounding tissues in treatment of gastric cancer

目的探讨胃癌术后不同放疗方式近中期疗效及对患者周围组织的影响。方法选择2011年1月至2013年5月我院收治116例胃癌患者为研究对象,按随机数字表法分为多野照射组(38例)、三维适形放疗(3DCRT)组(39例)和调强放疗(IMRT)组(39例),3组患者在放疗结束后,观察近中期临床疗效,放疗方式对周围组织损伤及3年随访期内肿瘤复发和生存情况。结果 3组放疗后临床症状改善情况:IMRT组>3DCRT组>多野照射组,3组比较差异有统计学意义(Z=10.053,P=0.040);放疗后对周围组织的影响:白细胞下降、中性粒细胞比例增高、胰淀粉酶异常、转氨酶异常升高、放射性脊髓病例数多野照射组>3DCRT组>IMRT组(P<0.05);第1、2、3年复发率IMRT组<3DCRT组<多野照射组,其中第3年的复发率差异具有统计学意义(P<0.05),第1、2、3年生存率IMRT组>3DCRT组>多野照射组,其中第2、3年的生存率差异均具有统计学意义(P<0.05)。结论胃癌根治术后患者不同放疗方式中依据临床疗效与对周围组织损伤综合比较,IMRT优于3DCRT优于多野照射,辅助性放疗有助于降低复发率。

Objective To explore the efficacy of postoperative radiation in treatment of gastric cancer and its impact on surrounding tissue. Methods A total of 116 patients with gastric cancer from January 2011 to May 2013 in our hospital were analyzed. They were divided into multi-field irradiation group （38 cases）, three-dimen- sional conformal radiotherapy （3DCRT） group （39 cases） and intensity modulated radiation therapy （IMRT） group （39 cases）. After radiotherapy, the recent clinical efficacy of radiotherapy was observed. The damage on surrounding tissue, tumor recurrence and survival rate in 3-year follow-up period was observed. Results Im- provement of clinical symptoms after radiotherapy in 3 groups.. IMRT group〉 3DCRT group〉Multi-field irradi- ation group, three groups had significant difference （ Z=10. 053, P=0. 040）. The impact on the surrounding tissue after radiotherapy： leukopenia, neutrophils cell ratio increased pancreatic amylase abnormalities, abnormal transaminases increased, the number of cases of radioactive spinal cord： multi-field radiation group〉3DCRT group〉IMRT group （ P〈O. 05）. 1, 2, 3-year recurrence rate IMRT groupG3DCRT groupGmulti-field radia- tion group, 3-year recurrence rate had significant difference （ P G0.05）, 1, 2, 3-year survival rate IMRT group 3DCRT group〉multi-field irradiation group, the 2, 3-year survival rate with significant difference （ P G0.05）. Conclusion The results show that the clinical efficacy and damage on surrounding tissue of postoperative radiation in treatment of gastric cancer IMRT〉3DCRT〉multi-field irradiation. Adjuvant radiotherapy helps to reduce the relapse rate.