Georgios V Koukourakis, Department Radiation Oncology, Anticancer Institute of Athens "Saint Savvas", Athens 115 22, Greece.
World J Gastrointest Oncol. 2011 Sep 15;3(9):131-6. doi: 10.4251/wjgo.v3.i9.131.
Despite the fact that gastric cancer is decreasing in incidence in the United States, it remains one of the most commonly diagnosed and most fatal cancers worldwide. In localised disease, surgery remains the cornerstone of treatment. Nevertheless, the low overall survival rates at 5 years due to locoregional and distant recurrences has led to a large debate regarding the role of radiation therapy and chemotherapy in addition to curative resection. Recent data have shown that, even with improved surgical techniques, locoregional failure rates in these patients ranged between 57% and 88%. Failures were noted in the gastric bed, regional nodes, gastric remnant, anastomosis and duodenal stump, all of which can be encompassed in a regional radiation field, indicating the need of further locoregional treatment. In this article, a comprehensive literature review of the reliable medical databases of PubMed and Cochrane is made and we present all available information on the role of radiation therapy in the preoperative and postoperative setting of gastric cancer. Data reported show that in locally advanced gastric cancer the addition of radiation therapy post surgery has significantly improved disease-free survival as well as overall survival. Moreover, in unresectable gastric cancer, the combination of radiation therapy with chemotherapy has significantly improved mean and overall survival rates. The role of radiation therapy in patients with resectable gastric cancer is being further evaluated in ongoing phase III trials.
尽管在美国胃癌的发病率正在下降，但它仍是全球最常见的诊断和最致命的癌症之一。在局部疾病中，手术仍然是治疗的基石。然而，由于局部和远处复发，5 年总生存率低，导致关于放疗和化疗在根治性切除之外的作用的大量争论。最近的数据表明，即使手术技术有所提高，这些患者的局部区域失败率仍在 57%至 88%之间。失败发生在胃床、区域淋巴结、胃残端、吻合口和十二指肠残端，所有这些都可以包括在局部放射治疗区域内，这表明需要进一步的局部区域治疗。本文对 PubMed 和 Cochrane 的可靠医学数据库进行了全面的文献复习，并提供了关于放疗在胃癌术前和术后应用的所有现有信息。报告的数据显示，在局部进展期胃癌中，手术后加放疗显著改善了无病生存率和总生存率。此外，在不可切除的胃癌中，放疗联合化疗显著提高了平均生存率和总生存率。放疗在可切除胃癌患者中的作用正在正在进行的 III 期临床试验中进一步评估。
