Hematology - Oncology Department, Hotel Dieu de France University Hospital, Alfred Naccache BLVD, Achrafieh, Beirut, Lebanon.
Radiat Oncol. 2010 Jun 4;5:50. doi: 10.1186/1748-717X-5-50.
Studies have shown that surgery alone is less than satisfactory in the management of early gastric cancer, with cure rates approaching 40%. The role of adjuvant therapy was indefinite until three large, randomized controlled trials showed the survival benefit of adjuvant therapy over surgery alone. Chemoradiation therapy has been criticized for its high toxicity.
24 patients diagnosed between September 2001 and July 2007 were treated with adjuvant chemoradiation. 18 patients had the classical MacDonald regimen of 4500 cGy of XRT and chemotherapy with 5-fluorouracil (5FU) and leucovorin, while chemotherapy consisted of 5FU/Cisplatin for 6 patients.
This series consisted of non-metastatic patients, 17 females and 7 males with a median age of 62.5 years. 23 patients (96%) had a performance status of 0 or 1. The full course of radiation therapy (4500 cGy) was completed by 22 patients (91.7%). Only 7 patients (36.8%) completed the total planned courses of chemotherapy. 2 local relapses (10%), 2 regional relapses (10%) and 2 distant relapses (10%) were recorded. Time to progression has not been reached. 9 patients (37.5%) died during follow-up with a median overall survival of 75 months. Patients lost a mean of 4 Kgs during radiation therapy. We recorded 6 episodes of febrile neutropenia and the most frequent toxicity was gastro-intestinal in 17 patients (70.8%) with 9 (36%) patients suffering grade 3 or 4 toxicity and 5 patients (20%) suffering from grade 3 or 4 neutropenia. 4 (17%) patients required total parenteral nutrition for a mean duration of 20 days. 4 patients suffered septic shock (17%) and 1 patient developed a deep venous thrombosis and a pulmonary embolus.
Adjuvant chemo-radiation for gastric cancer is a standard at our institution and has resulted in few relapses and an interesting median survival. Toxicity rates were serious and this remains a harsh regimen with only 36.8% of patients completing the full planned courses of chemotherapy. This is due to hematological toxicity, mainly febrile neutropenia. This should prompt us to review the subsequent chemotherapy protocol and make it more tolerable.
研究表明，单纯手术治疗早期胃癌效果并不理想，治愈率接近 40%。辅助治疗的作用一直不明确，直到三项大型随机对照试验显示辅助治疗比单纯手术有生存获益。放化疗因其毒性高而受到批评。
2001 年 9 月至 2007 年 7 月期间诊断的 24 例患者接受了辅助放化疗。18 例患者采用经典的 MacDonald 方案，接受 4500cGy 的放疗和氟尿嘧啶（5FU）+亚叶酸的化疗，6 例患者采用氟尿嘧啶/顺铂化疗。
本系列包括非转移性患者，17 名女性和 7 名男性，中位年龄 62.5 岁。23 例（96%）患者的体能状态为 0 或 1。22 例（91.7%）患者完成了全剂量放疗（4500cGy）。只有 7 例（36.8%）患者完成了总计划化疗疗程。记录到 2 例局部复发（10%）、2 例区域复发（10%）和 2 例远处复发（10%）。无进展时间尚未达到。9 例（37.5%）患者在随访期间死亡，中位总生存期为 75 个月。患者在放疗期间平均体重减轻 4 公斤。我们记录了 6 例发热性中性粒细胞减少症发作，最常见的毒性是 17 例患者（70.8%）的胃肠道毒性，其中 9 例（36%）患者发生 3 或 4 级毒性，5 例（20%）患者发生 3 或 4 级中性粒细胞减少症。4 例（17%）患者需要全胃肠外营养，平均持续时间为 20 天。4 例患者发生感染性休克（17%），1 例患者发生深静脉血栓形成和肺栓塞。
我们机构采用辅助放化疗治疗胃癌，复发率低，中位生存期长。毒性发生率较高，且只有 36.8%的患者完成了全计划化疗疗程，这是一个严峻的方案。这主要是由于血液学毒性，特别是发热性中性粒细胞减少症。这促使我们重新审查后续的化疗方案，使其更具耐受性。
