Kim Michelle M, Rana Vishal, Janjan Nora A, Das Prajnan, Phan Alexandria T, Delclos Marc E, Mansfield Paul F, Ajani Jaffer A, Crane Christopher H, Krishnan Sunil
Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Acta Oncol. 2008;47(3):421-7. doi: 10.1080/02841860701621233.
Local progression of advanced gastric cancer often manifests as bleeding, dysphagia/obstruction, or pain. We evaluated the magnitude and durability of palliation with radiotherapy (RT).
From 1996 to 2004, 37 gastric cancer patients were treated with palliative RT (median dose 35 Gy in 14 fractions). Nearly two-thirds of all patients received concurrent chemoradiation therapy (CRT). Index pre-treatment symptoms were gastric bleeding, dysphagia/obstruction, and pain in 54%, 43%, and 19% of patients, respectively.
The rates of control for bleeding, dysphagia/obstruction, and pain were 70% (14/20), 81% (13/16), and 86% (6/7), respectively. These symptoms were controlled without additional interventions for a median of 70%, 81%, and 49% of the patient's remaining life, respectively. Patients receiving CRT had a trend towards better median overall survival than those receiving RT alone (6.7 vs. 2.4 months, p=0.08). Lower (<41 Gy) biologically effective dose (BED, assuming an alpha/beta ratio of 10 for early responding tissues) predicted for poorer local control (6-month local control 70% vs. 100%, p=0.05) while T4 tumors had a trend towards inferior local control (6-month LC 56% vs. 100%, p=0.06).
Palliative RT controls symptoms for most of the remaining life in the majority of gastric cancer patients. The role of a higher dose of RT (BED >or=41 Gy), especially in patients with T4 tumors, remains to be established. In order to accurately define the role for radiotherapy in palliation of these symptoms, prospective randomized studies need to be conducted.
进展期胃癌的局部进展常表现为出血、吞咽困难/梗阻或疼痛。我们评估了放射治疗（RT）姑息治疗的程度和持久性。
1996年至2004年，37例胃癌患者接受了姑息性放疗（中位剂量35 Gy，分14次）。近三分之二的患者接受了同步放化疗（CRT）。治疗前的主要症状分别为胃出血、吞咽困难/梗阻和疼痛，各占患者的54%、43%和19%。
出血、吞咽困难/梗阻和疼痛的控制率分别为70%（14/20）、81%（13/16）和86%（6/7）。这些症状在无需额外干预的情况下，分别在患者剩余生命的中位数时间内得到控制，比例分别为70%、81%和49%。接受CRT的患者中位总生存期有比单纯接受RT的患者更好的趋势（6.7个月对2.4个月，p = 0.08）。较低（<41 Gy）的生物等效剂量（BED，假设早期反应组织的α/β比值为10）预示局部控制较差（6个月局部控制率70%对100%，p = 0.05），而T4肿瘤有局部控制较差的趋势（6个月局部控制率56%对100%，p = 0.06）。
姑息性放疗在大多数胃癌患者的大部分剩余生命中控制症状。更高剂量放疗（BED≥41 Gy）的作用，尤其是在T4肿瘤患者中，仍有待确定。为了准确界定放疗在缓解这些症状中的作用，需要进行前瞻性随机研究。
