从复发模式看胃癌围手术期放疗的研究进展

Perioperative radiotherapy on local-advanced gastric cancer--From the perspective of failure pattern

远处转移、腹膜复发和局部区域复发是胃癌术后复发的三大模式,以及致死原因。其中,远处转移或腹膜复发更常见且发生较早,而单纯局部区域失败发生相对较晚且较为少见。多项研究显示,术前放疗可以起到缩瘤降期、提高R0切除率的作用,术后放疗可减少局部区域复发,但围手术期放疗能否进一步改善患者生存仍存在争议。我们认为这一定程度上是由胃癌复发和转移的特点所导致的。作为一种局部治疗手段,放疗是手术不足的补充。因此,目前不建议对可R0切除、淋巴结清扫足够的胃癌患者均行围手术期放疗,而是需要在准确临床和病理分期基础上,对其复发和转移模式的精准预测,进而筛选出可能从放疗获益人群。

Distant metastasis,peritoneal recurrence and locoregional recurrence are the three major patterns of gastric cancer(GC)recurrence after surgery and the causes of patients'death.Among them,distant organ metastasis or peritoneal recurrence after surgery is more common and occurs earlier,while locoregional failure alone occurs later with a relatively lower incidence.Several studies have confirmed that preoperative radiotherapy can shrink tumors and increase R0 resection rates,and postoperative radiotherapy helps reduce local recurrence.However,whether perioperative radiotherapy can further improve patient survival is still controversial..We believe that this is partly due to the characteristics of recurrence and metastasis.As a local treatment,radiotherapy is complement to the inadequacy of surgery.Thus,we believe that perioperative radiotherapy is not recommended for patients with standard R0 surgery and adequate lymph node dissection,but rather requires accurate prediction of their recurrence and metastasis patterns based on accurate clinical and pathological staging,and thus screening of those who may benefit from radiotherapy.