Gunderson Leonard L, Callister Matthew D, Jaroszewski Dawn E, Ross Helen J, Borad Mitesh J, Gray Richard J, Lanza Louis A, Harold Kristi L, Pockaj Barbara A, Trastek Victor F
Department of Radiation Oncology.
Gastrointest Cancer Res. 2009 Mar;3(2 Suppl):S26-32.
The standard of care for resectable gastric or gastroesophageal (GE) junction cancer for patients who can tolerate a surgical procedure is surgical resection, but surgery alone is not optimal treatment for patients at high risk for relapse. For patients with lower-risk lesions (confined to gastric wall, nodes negative; T1-2N0M0), local-regional relapse risks are low, and adjuvant radiotherapy is usually not recommended, except in select instances. Since both local-regional and systemic relapses are common after resection of high-risk gastric or GE junction cancers (beyond wall, nodes positive, or both; T3-4N0, TanyN+), adjuvant treatment is indicated for these patients. The results of phase III trials that demonstrate a survival benefit for adjuvant preoperative radiotherapy, postoperative chemoradiation, or preoperative chemoradiation vs. surgery alone will be presented and compared with the results of adjuvant perioperative chemotherapy. Results of Surveillance, Epidemiology, and End Results (SEER) analyses and meta-analyses that support the role of adjuvant radiotherapy or chemoradiation will be summarized.
对于能够耐受手术的可切除胃癌或胃食管交界（GE）癌患者，标准治疗方法是手术切除，但对于复发风险高的患者，单纯手术并非最佳治疗方案。对于低风险病变患者（局限于胃壁、淋巴结阴性；T1-2N0M0），局部区域复发风险较低，除特定情况外，通常不建议进行辅助放疗。由于高风险胃癌或胃食管交界癌切除术后局部区域和全身复发均很常见（超出胃壁、淋巴结阳性或两者皆有；T3-4N0、TanyN+），因此这些患者需要进行辅助治疗。将展示并比较III期试验结果，这些试验表明辅助术前放疗、术后放化疗或术前放化疗与单纯手术相比具有生存获益，并与辅助围手术期化疗结果进行比较。还将总结监测、流行病学和最终结果（SEER）分析以及支持辅助放疗或放化疗作用的荟萃分析结果。
