Dulce M C, Kaiser J, Boese-Landgraf J, Scheffler A, Häring R, Ernst H
Abteilung für Strahlentherapie, Freien Universität Berlin.
Strahlenther Onkol. 1991 Oct;167(10):581-90.
The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week). For intraoperative and percutaneous radiotherapy the target absorbed dose was selected in a way that their combined effect on the tumor was approximately equivalent to that of a total dose of 60 Gy in the usual fractionating. Up to now, the median survival time for stage III patients (UICC 1987) has been twelve months. In five patients who died of a relapse or of peritoneal carcinosis, histologic evaluation revealed in every case a diffuse tumor type according to Lauren-classification. All relapses occurred within the first eight months. The two-year survival rate according to Kaplan-Meier is 67% for stage III. Advanced resectable gastric cancer of the intestinal tumor type seems to profit from adjuvant intraoperative radiotherapy. The results warrant further research within the framework of a prospective randomized multicenter study.
我们的初步研究目的是确定胃癌术中放疗是否不仅能预防局部复发，还能提高生存率。自1987年11月以来，26例可切除胃癌患者术中使用直线加速器以快电子进行照射（单次剂量：12至16戈瑞）。术后进行经皮放疗，剂量为24至38戈瑞（每周4次，每次2戈瑞）。对于术中及经皮放疗，目标吸收剂量的选择方式是使其对肿瘤的联合效应大致等同于常规分割总剂量60戈瑞的效应。到目前为止，Ⅲ期患者（国际抗癌联盟1987年分期）的中位生存时间为12个月。在5例死于复发或腹膜癌的患者中，组织学评估显示根据劳伦分类法均为弥漫型肿瘤。所有复发均发生在头8个月内。根据 Kaplan-Meier法，Ⅲ期患者的两年生存率为67%。肠型进展期可切除胃癌似乎从辅助性术中放疗中获益。这些结果值得在前瞻性随机多中心研究框架内进一步研究。
