三维适形放疗同步替吉奥胶囊治疗局部晚期胃癌疗效观察

Effect Observation of three-dimensional conformal radiotherapy (3D-CRT ) combined with S-1 in the treatment of advanced gastric cancer

目的观察三维适形放疗同步替吉奥胶囊化疗治疗局部晚期胃癌的疗效及毒副反应。方法 40例患者随机入组,其中治疗组23例局部晚期胃癌患者接受同步放化疗,采用6MV X线照射,DT 40~50 Gy,4~5周完成。采用三维适形放疗技术,常规分割放疗2.0 Gy/d,5 d/周。对照组17例于放疗第1天开始行一线方案(如ECF、DCF、FOLFOX、FOLFIR I等)化疗2个周期以上,评价两组胃癌患者的疗效及毒副作用。结果治疗组中1例因突发心脏病退出。治疗组客观缓解率(ORR)为72.7%,疾病控制率(DCR)为90.9%;对照组ORR为41.2%,DCR为82.4%。治疗组O R R高于对照组(P=0.047),差异具有统计学意义,而DCR差异无统计学意义(P=0.428)。两组患者中位无进展生存时间分别为7.6个月和5.8个月,差异具有统计学意义(P<0.05)。两组主要的毒副反应均为骨髓抑制和消化道反应,其中Ⅲ~Ⅳ级骨髓抑制治疗组的发生率较高,但差异无统计学意义(P>0.05)。结论三维适形放疗同步替吉奥治疗局部晚期胃癌的有效率高、中位无进展生存时间较单纯化疗高,不良反应可耐受,对于不可切除或不愿手术治疗的患者是一种有效的治疗方法。

Objective To evaluate the efficacy and toxicity of three-dimensional conformal radiotherapy（3D-CRT） combined with S-1 in the treatment of advanced gastric cancer.Methods A total of 40 patients were divided into the experimental group and the control group.23 cases were given concurrent chemoradiotherapy and 17 cases chemother- apy.The fractionated dose of 3D-CRT was 2.0 Gy/d, 5 d/w.The total dose was 40- 50 Gy, S-1 was concurrently taken orally, 40-60 mg po, twice a day. 17 patients in the control group were treated by the first-line chemotherapeutic regimens recommended by NCCN such as ECF, DCF, FOLFOX and FOLFIRI regimens etc. Results In the experimental group ,the objective response rate（ORR） was 72.7% and the disease control rate（DCR） was 90.9%.In the con- trol group,ORR was 41.2% and DCR 82.4%.ORR of the expertmental group was higher than that of the control group（P = 0.047）,with difference of statistical significance.While the difference of DCR showed statistical significance （P =0.428）.There was statistical difference between the two groups in ORR and no difference in DCR.The progress-flee survival rate（PFS） of the experimental group and the control group was 7.6 months and 5.8 months respective- ly.There was statistical significance （P 〈 0.05）.The major adverse events were hematological toxicity, gastrointestinal reaction including nausea, vomiting and diarrhea.The incidence of grade 3/4 hematological toxicity in chemoradiotherapy group was higher than that of the group（P 〈 0.05）.Conclusion 3D-CRT combined with S-1 has a higher efficacy, longer PFS and tolerable side effects.It is a promising and safe treatment for the patients with advanced gastric cancer.