D2和D3手术切除的胃癌术中放疗评估
Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection.
作者信息
Qin Huan-Long, Lin Chao-Hong, Zhang Xiu-Long
机构信息
Department of Surgery, Shanghai Sixth Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China.
出版信息
World J Gastroenterol. 2006 Nov 21;12(43):7033-7. doi: 10.3748/wjg.v12.i43.7033.
AIM
To study the proper sites and doses of intraoperative radiotherapy (IORT) for gastric carcinoma and the effects of this treatment.
METHODS
A total of 106 patients with stage I-IV gastric carcinoma who received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects (including survival and complications) of these 106 cases received operation combined with IORT (IORT group) were compared with 441 cases treated during the same time period by a radical operation alone (operation group).
RESULTS
The radiation dose below 30 Gy was safe. The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage I and IV gastric cancer, but the 5-year survival rates of patients with stage II and III gastric cancers were significantly improved. The 5-year survival rates of the stages III cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved (P < 0.005-0.001). The 5-year survival rate for those patients was raised only by 4.7% (P > 0.05).
CONCLUSION
The 5-year survival rates of patients with stages II and III gastric carcinoma who received D2 lymphadenectomy combined with IORT were improved, and there was no influence on the postoperative complications and mortality.
目的
研究胃癌术中放疗（IORT）的合适部位、剂量及其治疗效果。
方法
分析106例接受D2或D3根治性手术联合IORT的Ⅰ - Ⅳ期胃癌患者。67例胃窦和胃体癌患者行远端胃切除术，照射部位为腹腔动脉和肝十二指肠韧带区域。另外39例贲门癌、胃体上部癌及全胃癌患者行近端胃切除术或全胃切除术，该组照射部位为胰腺上缘和腹主动脉旁区域。将这106例接受手术联合IORT的患者（IORT组）的治疗效果（包括生存率和并发症）与同期441例仅行根治性手术的患者（手术组）进行比较。
结果
30 Gy以下的放射剂量是安全的。手术联合IORT的治疗方法并未延长Ⅰ期和Ⅳ期胃癌患者的生存期，但Ⅱ期和Ⅲ期胃癌患者的5年生存率显著提高。接受D2切除联合IORT的Ⅲ期癌症患者的5年生存率明显提高，而接受D3根治性切除的患者仅术后3年或4年生存率有所提高（P < 0.005 - 0.001）。该组患者的5年生存率仅提高了4.7%（P > 0.05）。
结论
接受D2淋巴结清扫联合IORT的Ⅱ期和Ⅲ期胃癌患者的5年生存率提高，且对术后并发症和死亡率无影响。
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