进展期胃癌根治切除术后三维适形放疗联合化疗近期疗效分析

Short-term efficacy of three-dimensional conformal radiotherapy combined with concurrent chemotherapy in advanced gastric cancer after radical resection

目的探讨进展期胃癌根治切除术后三维适形放疗联合同期化疗的近期疗效。方法对2010年3月~2014年5月就诊收治的行胃癌根治术后(D2淋巴结清扫,R0、R1,其中45例R0,57例R1)的102例胃癌患者临床资料做回顾性分析。根据术后放疗方式的不同分为观察组(采用三维适形放疗联合同期化疗)和对照组(单纯化疗)各51例。比较两组患者短期治疗疗效及不良反应发生情况并采用Cox回归模型探讨影响患者预后的相关因素。结果两组患者均顺利的完成治疗,经治疗结束后1个月观察组的近期总有效率、肿瘤控制率均分别高于对照组(P<0.05)。观察组的总生存期3年存活率、中位OS时间、疾病无进展3年存活率、中位PFS时间均分别高于对照组(P<0.05)。两组患者不良反应大多为Ⅰ-Ⅱ级,Ⅲ级不良反应发生率相近,且所有患者在治疗期间均未出现4级不良反应及化疗相关性死亡。组织学分级低、有淋巴结转移、肿瘤控制率差、EOCG评分高是影响进展期胃癌根治切除术后患者预后的独立预后危险因素(P<0.05)。结论在进展期胃癌根治切除术后患者中应用三维适形放疗联合同期化疗治疗可有效地提高其短期治疗疗效,延长生命时间,且组织学分级低、有淋巴结转移、肿瘤控制率差、EOCG评分高是影响进展期胃癌根治切除术后患者预后的独立危险因素。

Objective To investigate the short-term efficacy of three-dimensional conformal radiotherapy combined with concurrent chemotherapy in advanced gastric cancer after resection and prognosis.Methods The clinical data of 102 patients with gastric cancer underwent radical gastrectomy（D2 lymphadenectomy,R0,R1,Of these,45 were R0 and 57 R1）from March 2010 to May 2014 were retrospectively analyzed.According to the different methods of postoperative radiotherapy,the patients were divided into observation group（using three-dimensional conformal radiotherapy combined with concurrent chemotherapy）and control group（chemotherapy alone）.The short-term therapeutic efficacy and adverse reaction were compared between the two groups and the Cox regression model To explore the factors that affect the prognosis of patients.Results The total effective rate and tumor control rate in the observation group were higher than those in the control group（P〈0.05）.The survival rate was 3 years,the median OS time,the disease had no 3-year survival rate,the median PFS time（P〈0.05）,respectively,compared with the control group.Adverse reactions were mostly gradeⅠ-Ⅱ,gradeⅢ adverse reactions were similar,and all patients during the treatment did not appear 4 adverse reactions and chemotherapy-related deaths.The prognosis of patients with advanced gastric cancer after radical resection was significantly higher than that of control group（P〈0.05）.Conclusion Three-dimensional conformal radiotherapy combined with concurrent chemotherapy can improve the short-term therapeutic effect and prolong the life time,and the histological grade is low.The lymph node metastasis,tumor control rate is poor.EOCG High score is an independent prognostic risk factor for prognosis of patients with advanced gastric cancer after radical resection.