局部晚期胃癌放化疗不同联合方式及放化疗转化手术治疗的疗效分析

The clinical efficacy of different combinations of chemoradiotherapy and the conversion therapy efficacy of chemoradiotherapy in the initially unresectable locally advanced gastric cancer

目的:观察分析不能手术局部晚期胃癌放化疗联合的临床疗效及转化治疗疗效,对比不同放化疗联合模式的疗效差异。方法:回顾性分析2010年06月至2020年06月于我院收治的不能手术的局部晚期胃癌患者75例,其中同步放化疗组33例,序贯放化疗(化疗-放疗-化疗)组42例,观察放化疗联合的临床疗效及转化治疗成功率,对比分析两种治疗方式的临床效果。结果:客观有效率(ORR)53.3%,疾病控制率(DCR)85.3%,转化手术切除率30.7%;同步放化疗组与序贯放化疗组的ORR分别为66.7%和42.9%,差异有统计学意义(P<0.05);同步放化疗组转化手术成功率优于序贯放化疗组(36.4%vs 26.2%),但差异没有统计学意义(P>0.05);未手术患者中位生存时间(MST)为14.3个月,1、2年生存率分别为63.5%,15.4%,同步放化疗组生存优于序贯放化疗组,但差异无统计学意义(P>0.05);转化手术成功的患者中,R0切除的生存明显优于行R1/R2切除患者(P<0.05)。结论:对于初始不能手术的局部晚期胃癌,联合放化疗是有效的治疗手段,同步放化疗较序贯放化疗明显提高了客观有效率,有提高转化手术切除率的趋势。

Objective:To analysis the clinical efficacy and the situation of conversion therapy of chemoradiotherapy in the initially unresectable locally advanced gastric cancer,compared the clinical efficacy between synchronous chemoradiotherapy and sequential chemoradiotherapy.Methods:We retrospectively investigated 75 patients with nitially unresectable locally advanced gastric cancer who were admitted to the The Affiliated Cancer Hospital of Guizhou Medical University from June 2010 to June 2020,including synchronous chemoradiotherapy group(33 cases)and sequential radiotherapy group(42 cases),observe the clinical efficacy and the success rate of conversion therapy of chemoradiotherapy,and compare the clinical efficacy between synchronous chemoradiotherapy and sequential chemoradiotherapy.Results:The objective response rate(ORR)was 53.3%,disease control rate(DCR)was 85.3%,conversion therapy rate was 30.7%.The ORR of synchronous chemoradiotherapy group and sequential radiotherapy group were 66.7%and 42.9%,the difference was statistically significant(P<0.05).Synchronous chemoradiotherapy group had a better conversion rate than sequential chemoradiotherapy group,but the difference was not statistically significant(P>0.05).Median survival time(MST)of patients without conversion surgery was 14.3 months,the 1-year survival rate and 2-years survival rate were 63.5%and 15.4%,synchronous chemoradiotherapy group had better a survival than sequential chemoradiotherapy group,but the difference was not statistically significant(P>0.05).For patients achieved conversion therapy,the survival situation in R0 resection patients is obviously better than patients with R1/R2 resection(P<0.05).Conclusion:For patients with initially unresectable locally advanced gastric cancer,chemoradiotherapy is an effective treatment,that can make some patients achieved conversion surgery that prolonged survival.Synchronous chemoradiotherapy significantly improved the objective efficiency compared with sequential chemoradiotherapy,and tended to improve the rate of conversion therapy.