3DRT辅助卡培他滨与奥沙利铂化疗方案对进展期胃癌术后生存研究

Effect of three-dimensional conformal intensity-modulated radiotherapy combined with capecitabine and oxaliplatin chemotherapy on postoperative survival in patients with advanced gastric cancer

目的 探讨三维适形调强放疗联合奥沙利铂＋卡培他滨化疗治疗进展期胃癌对其术后中位生存时间的影响。方法 自临沂市中心医院2010年2月至2012年1月选取进展期胃癌患者中选取74例,根据治疗方案分为术后化疗组（37例）与术后放化疗组（37例）。两组均采用腹腔镜D2根治术,术后化疗组采用奥沙利铂联合卡培他滨化疗,术后放化疗组采用奥沙利铂联合卡培他滨化疗＋三维适形调强放疗,两组均化疗4个周期。疗程结束后统计对比两组不良反应发生情况、中位无进展生存时间、中位生存时间、治疗后1、3、5年疾病复发率及病死率。结果 术后放化疗组骨髓抑制率（41%）、肝功能异常率（30%）、呕吐恶心率（30%）、白细胞减少率（46%）与术后化疗组（35%、35%、24%、41%）相比,差异无统计学意义（P〉0.05）。术后放化疗组中位无进展生存时间、中位生存时间较术后化疗组长,差异有统计学意义（P〈0.05）。两组治疗后1、3、5年疾病复发率比较,术后放化疗组（8%、14%、16%）较术后化疗组（32%、41%、46%）低,差异有统计学意义（P〈0.05）;术后放化疗组病死率11%（4/37）较术后化疗组30%（11/37）低,差异有统计学意义（P〈0.05）。结论 三维适形调强放疗联合奥沙利铂＋卡培他滨化疗治疗进展期胃癌,可有效延长患者中位生存时间,降低疾病复发率,且不会增加不良反应发生风险。

Objective To investigate the effect of three-dimensional conformal intensity-modulated radiotherapy combined with oxaliplatin plus capecitabine chemotherapy upon the postoperative median survival time of patients diagnosed with advanced gastric cancer. Methods A total of 74 patients with advanced gastric cancer admitted to Linyi Central Hospital from February 2010 to January 2012 were recruited and divided into the postoperative chemotherapy group （n=37） and postoperative radiotherapy and chemotherapy group （n=37） according to the treatment plan. All patients in two groups were treated with laparoscopic D2 radical operation. In the postoperative chemotherapy group, patients were treated with oxaliplatin combined with capecitabine. In the postoperative radiotherapy and chemotherapy group, patients were treated with oxaliplatin combined with capecitabine plus three-dimensional conformal radiotherapy. In both groups, 4 cycles of chemotherapy were delivered. The incidence of adverse reactions, median progression-free survival, median overall survival, and 1-, 3-and 5-year recurrence rate and mortality rate were statistically compared between two groups. Results In the postoperative radiotherapy and chemotherapy group, the incidence rate of bone marrow suppression （41%）, abnormal liver function （30%）, nausea and vomiting （30%） and neutropenia （46%） did not significantly differ from 35%, 35%, 24% and 41% in the postoperative chemotherapy group （all P〉0.05）.In the postoperative radiotherapy and chemotherapy group, the median progression-free survival and median overall survival were significantly longer compared with those in the postoperative chemotherapy group （both P〈0.05）.The 1-, 3-and 5-year recurrence rates were 8%, 14% and 16% in the postoperative radiotherapy and chemotherapy group, significantly lower than 32%, 41% and 46% in the postoperative chemotherapy group （all P〈0.05）.The mortality rate was 11%（4/37） in the postoperative radiotherapy and chemotherapy group, which was significantly lower than 30%（11/37） in the postoperative chemotherapy group （P〈0.05）. Conclusions Three-dimensional conformal radiotherapy combined with oxaliplatin plus capecitabine chemotherapy can effectively prolong the median survival, reduce the recurrence rate and does not enhance the risk of adverse events for patients with advanced gastric cancer.