新辅助放化疗与新辅助化疗对进展期胃癌的疗效及安全性比较

Comparison of efficacy and safety of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in treatment of advanced gastric cancer

目的观察新辅助放化疗与新辅助化疗对进展期胃癌的疗效及安全性。方法该院肿瘤科及胃肠外科2014年5月至2017年6月收治的有完整资料的48例ⅢA~ⅢC期局部进展期胃癌患者,其中行新辅助放化疗(观察组)21例,术前行调强放疗(IMRT)联合XELOX方案同期化疗2个周期,放疗后6~8周行D2根治术;新辅助化疗(对照组)27例,术前行XELOX方案化疗4个周期,化疗后4~6周行D2根治术;两组均根据术后中国临床肿瘤学会(CSCO)指南行辅助化疗。比较两组的客观缓解率(ORR)、病理完全缓解率(pCR)、R0切除率、中位无进展生存期(PFS)、中位总生存期(OS)及不良反应。结果(1)观察组和对照组ORR分别为80.95%和74.07%,差异无统计学意义(P>0.05);(2)观察组pCR及R0切除率均高于对照组(33.33%vs.7.41%,66.67%vs.37.04%),差异均有统计学意义(P=0.024,P=0.042);(3)观察组的中位PFS及中位OS均优于对照组(41.00个月vs.27.00个月,44.00个月vs.38.00个月),差异均有统计学意义(P=0.032,P=0.040);(4)观察组的白细胞减少发生率和手足综合征发生率均低于对照组(23.81%vs.51.85%,14.29%vs.40.74%),差异有统计学意义(P=0.049,P=0.045);两组在血小板减少、恶心呕吐及腹泻发生率方面差异无统计学意义(P>0.05)。结论新辅助放化疗治疗进展期胃癌安全有效,值得临床推广。

Objective To study the efficacy and safety of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for advanced gastric cancer.Methods Forty-eight cases of stageⅢA-ⅢC locally advanced gastric cancer with complete data in our hospital from May 2014 to June 2017 were collected.Among them,21 cases received neoadjuvant chemoradiotherapy(the observation group)of intensity-modulated radiotherapy(IMRT)combined with XELOX regimen for 2 cycles,then D2 radical surgery was performed 6-8 weeks after radiotherapy.27 cases received neoadjuvant chemotherapy(the control group)of XELOX regimen for 4cycles,then D2 radical surgery was performed 4-6 weeks after chemotherapy.Both groups received adjuvant chemotherapy for 4 cycles according to CSCO guidelines.The objective response rate(ORR),pathological complete remission(pCR)rate,R0 resection rate,median progression-free survival(PFS),median overall survival(OS)and adverse reactions in the two groups were compared.Results(1)The ORR(80.95%vs.74.07%)of the two groups were no significant difference(P>0.05).(2)The pCR rate and R0 resection rate in the observation group were higher than those of the control group(33.33%vs.7.41%,66.67%vs.37.04%),the difference was statistically significant(P=0.024,P=0.042).(3)The median PFS and median OS in the observation group were better than those of the control group(41.00 months vs.27.00 months,44.00 months vs.38.00 months),the differences were statistically significant(P=0.032,P=0.040).(4)The incidence of leukopenia and hand-foot syndrome in the observation group were lower than that in the control group(23.81%vs.51.85%,14.29%vs.40.74%),the difference between the two groups was statistically significant(P=0.049,P=0.045).There were no significant difference in incidence of thrombocytopenia,nausea,vomiting and diarrhea between the two groups(P>0.05).Conclusion Neoadjuvant chemoradiotherapy is safe and effective,which is worthy of clinical promotion.