Saikawa Yoshiro, Kubota Tetsuro, Takahashi Tsunehiro, Akatsu Yukako, Nakamura Rieko, Yoshida Masashi, Shigematsu Naoyuki, Otani Yoshihide, Kumai Koichiro, Hibi Toshifumi, Kitajima Masaki
Department of Surgery, School of Medicine, Keio University, 35 Sinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Oncol Rep. 2005 May;13(5):865-70.
We aim to clarify beneficial effect of pre-operative radiation with chemotherapy in highly advanced gastric cancer patients, evaluating histological response, toxicity and patients' quality of life (QOL). We used pre-operative radiation with S-1 and low-dose cisplatin to treat 8 patients with highly advanced gastric cancer (clinical stage IV) in a pilot study. Clinical staging after therapy showed 5 PRs (partial response), 2 NCs (no change), and 1 PD (partial disease) following evaluation of the primary tumor and suspicious metastatic lesions in the lymph nodes, esophagus, liver, and peritoneum, for a response rate of 62.5% (5/8 cases). Of 8 patients, 6 underwent surgery, and 2 of these 6 patients had a histologically complete response (grade 3 effect) and 3 patients had a partial response (grade 2 effect), suggesting that a high histological response (5/6 cases; 83.3%) is expected by the chemoradiation. The survival analysis showed that 5 out of the 8 patients died within 10 months after initiating therapy, while 3 patients are alive without recurrence at 15, 18, and 30 months after therapy, suggesting a relatively good outcome for clinical stage IV gastric cancer. All cases showed grade 2-4 bone marrow suppression toxicity and/or grade 0-2 gastro-intestinal toxicity, while 5 out of 8 patients (62.5%) showed improvement in appetite loss at the end of the therapy, indicating that the patients' quality of life (QOL) was preserved. Chemoradiation may be a powerful regimen for obtaining histological response with tolerable toxicity and improved QOL in highly advanced gastric cancer patients.
我们旨在阐明术前放疗联合化疗对晚期胃癌患者的有益效果，评估组织学反应、毒性和患者生活质量（QOL）。在一项初步研究中，我们使用术前放疗联合S-1和低剂量顺铂治疗8例晚期胃癌（临床IV期）患者。治疗后的临床分期显示，在评估原发肿瘤以及淋巴结、食管、肝脏和腹膜的可疑转移病变后，有5例部分缓解（PR）、2例病情稳定（NC）和1例疾病进展（PD），缓解率为62.5%（5/8例）。8例患者中，6例接受了手术，这6例患者中有2例组织学完全缓解（3级效应），3例部分缓解（2级效应），提示放化疗有望获得较高的组织学反应（5/6例；83.3%）。生存分析显示，8例患者中有5例在开始治疗后10个月内死亡，而3例患者在治疗后15、18和30个月时存活且无复发，提示临床IV期胃癌的预后相对较好。所有病例均显示2-4级骨髓抑制毒性和/或0-2级胃肠道毒性，而8例患者中有5例（62.5%）在治疗结束时食欲减退有所改善，表明患者的生活质量（QOL）得以维持。放化疗可能是一种有效的治疗方案，可使晚期胃癌患者获得组织学反应，同时毒性可耐受且生活质量得到改善。
