Calvo F A, Aristu J J, Azinovic I, Abuchaibe O, Escude L, Martinez R, Tango E, Hernandez J L, Pardo F, Alvarez-Cienfuegos J
Department of Oncology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Int J Radiat Oncol Biol Phys. 1992;24(4):729-36. doi: 10.1016/0360-3016(92)90721-s.
From September 1984 to August 1991, 48 evaluable patients with resected gastric cancer and apparent disease confined to locoregional area were treated with intraoperative electron beam boost to the celiac axis and peripancreatic nodal areas (15 Gy) and external irradiation (40 to 46 Gy in 4 to 5 weeks) including the gastric bed and upper abdominal nodal draining regions. At the time of evaluation for IORT, the disease was primary in 38 cases, recurrent but resectable in four (anastomosis), and unresectable in four (nodal). Post operative complications were reversible. Acute tolerance to the complete treatment program was acceptable. Late complications included life-threatening events: Six episodes of gastro intestinal bleeding (three of them had an arteriographic documentation of arterioenteric fistula) and nine with severe enteritis (five required reoperation). Other long-term treatment related complications were six cases of vertebral collapse. The median follow-up time for the entire group is 22 months. Locoregional recurrence/persistence of disease has been identified in five patients (three with residual and/or recurrent postsurgical tumor). Systemic tumor progression has been detected in 15 patients (11 in intra-abdominal sites). Overall actuarial survival for patients with positive or negative serosal involvement was 33% versus 56%. It is concluded that the treatment program described is able to induce a high locoregional tumor control rate (100%) when used strictly in an adjuvant setting and might control long term, a small portion of patients not amenable for curative surgery (2 out of 8 patients with confirmed residual post-surgical disease). Gastrointestinal bleeding and enteritis are findings that indicate treatment intensity at the upper limits of tissue tolerance. Assessment of long term tolerance of pancreatic parenchyma and large blood vessels (tissues included in the IRORT field) are pending for longer follow-up and the appropriate selective studies.
1984年9月至1991年8月，48例可评估的胃癌患者，其疾病局限于局部区域且已行手术切除，接受了术中电子束对腹腔动脉轴和胰周淋巴结区域的增强照射（15 Gy）以及外照射（4至5周内40至46 Gy），照射范围包括胃床和上腹部淋巴结引流区。在评估术中放疗时，38例为原发性疾病，4例复发但可切除（吻合口处），4例不可切除（淋巴结转移）。术后并发症是可逆的。整个治疗方案的急性耐受性尚可。晚期并发症包括危及生命的情况：6例胃肠道出血（其中3例经动脉造影证实存在动脉肠瘘）和9例严重肠炎（5例需要再次手术）。其他与长期治疗相关的并发症为6例椎体塌陷。整个组的中位随访时间为22个月。5例患者出现局部区域复发/疾病持续存在（3例有残留和/或术后肿瘤复发）。15例患者检测到全身肿瘤进展（11例发生在腹腔内部位）。浆膜受累阳性或阴性患者的总体精算生存率分别为33%和56%。结论是，所描述的治疗方案在严格用于辅助治疗时能够诱导较高的局部区域肿瘤控制率（100%），并且可能长期控制一小部分无法进行根治性手术的患者（8例确诊术后有残留疾病的患者中有2例）。胃肠道出血和肠炎表明治疗强度达到了组织耐受性的上限。对于胰腺实质和大血管（术中放疗野内的组织）的长期耐受性评估，有待更长时间的随访和适当的选择性研究。
