全腹野与标准野放疗联合同步和辅助化疗治疗局部进展期胃癌。

Whole abdominal field versus standard field radiotherapy plus concomitant and adjuvant chemotherapy for patients with locally advanced gastric cancer.

机构信息

Department of Radiation Oncology, Erciyes University Medical Faculty, Kayseri, Turkey.

出版信息

J Radiat Res. 2011;52(2):168-75. doi: 10.1269/jrr.10075. Epub 2011 Feb 19.

DOI:10.1269/jrr.10075

PMID:21343682

Abstract

PURPOSE

To compare standard radiotherapy field (SRTF) with whole abdomen irradiation (WAI), used in conjunction with adjuvant chemotherapy following curative surgery in patients with gastric cancer.

METHODS AND MATERIAL

Ninety patients were included in the study and divided into two treatment arms. In the first treatment arm, SRTF, including 45 Gy radiation to the primary tumor and regional lymph nodes, was performed in 45 patients. In the second treatment arm, a total of 45.2 Gy RT was delivered; 20 Gy to the whole abdomen followed by 25.2 Gy RT to the tumor and regional lymph nodes, in 45 patients. An intravenous bolus dose of 250 mg/m(2)/week 5-fluorouracil (5-FU) was administered concomitantly with RT in both treatment arms. Patients who completed concomitant chemoradiotherapy, received adjuvant treatment, including 4 cycles of 5-FU (425 mg/m(2)) and folinic acid (20 mg/m(2)) in 4 week intervals.

RESULTS

Median age was 56 years (range: 22-81), 89% of the patients (n = 80) had serosal involvement, 78% (n = 70) were node positive. The rate of hematological (40% vs. 16%, p = 0.010) and gastrointestinal toxicities (80% vs. 53%, p = 0.010) were higher, and performance loss (60% vs. 29%, p = 0.003) was greater in the second treatment arm. Number of patients who experienced Grade 3 and Grade 4 gastrointestinal toxicities (especially diarrhea) were higher in the second treatment arm (4% vs. 16%, p = 0.049). The median follow-up was 19 months (range: 7-96). The median 5-year survival was 29% and 17%, locoregional control was 30% and 25%, and disease-free survival was 27% and 16% in the first and second treatment arms, respectively. There was no significant difference between the treatment groups in terms of survival, locoregional control and disease-free survival rates (p > 0.05).

CONCLUSION

Whole abdomen irradiation was not found to be superior to standard field radiotherapy used in conjunction with adjuvant chemotherapy in gastric cancer.

摘要

目的

比较标准放疗野（SRTF）与全腹部照射（WAI）在根治性手术后辅助化疗中的应用，以治疗胃癌患者。

方法和材料

本研究共纳入 90 例患者，分为两组治疗。在第一治疗组中，对 45 例患者进行了包括 45 Gy 肿瘤和区域淋巴结放疗的 SRTF。在第二治疗组中，共给予 45.2 Gy RT，20 Gy 全腹部照射，25.2 Gy 肿瘤和区域淋巴结照射，共 45 例患者。在两组治疗中均同时给予静脉推注剂量为 250 mg/m2/周的 5-氟尿嘧啶（5-FU）。完成同期放化疗的患者接受辅助治疗，包括 4 个周期的 5-FU（425 mg/m2）和亚叶酸（20 mg/m2），每 4 周 1 次。

结果

中位年龄为 56 岁（范围：22-81），89%（n=80）的患者有浆膜浸润，78%（n=70）的患者有淋巴结阳性。血液学毒性（40%比 16%，p=0.010）和胃肠道毒性（80%比 53%，p=0.010）发生率较高，第二治疗组的生活质量下降（60%比 29%，p=0.003）。第二治疗组出现 3 级和 4 级胃肠道毒性（尤其是腹泻）的患者较多（4%比 16%，p=0.049）。中位随访时间为 19 个月（范围：7-96）。第一和第二治疗组的中位 5 年生存率分别为 29%和 17%，局部区域控制率分别为 30%和 25%，无病生存率分别为 27%和 16%。两组在生存率、局部区域控制率和无病生存率方面无统计学差异（p>0.05）。