Jansen Edwin P M, Boot Henk, van de Velde Cornelis J H, van Sandick Johanna, Cats Annemieke, Verheij Marcel
Department of Radiotherapy, Antoni van Leeuwenhoek Hospital, The Netherlands.
Recent Results Cancer Res. 2012;196:229-40. doi: 10.1007/978-3-642-31629-6_16.
Surgical resection remains the essential part in the curative treatment of gastric cancer. However, with surgery only, long-term survival is poor (5-year survival <25 % in Europe). Randomized studies, which compared limited (D1) lymph node dissection with more extended (D2) resections in the Western world, failed to show a survival benefit for more extensive surgery. A substantial increase in survival was found with perioperative chemotherapy in the MAGIC study. In addition, the SWOG/Intergroup 0116 study showed that postoperative chemoradiotherapy (CRT) prolonged 5-year overall survival compared to surgery only. However, it has been argued that surgical undertreatment undermined survival in this trial. In a randomized Korean study, patients with advanced stage gastric cancer who received postoperative CRT had better outcome after a D2 dissection. At our institute phase I-II studies with adjuvant cisplatin and capecitabine-based CRT have been performed in over 120 patients with resected gastric cancer. Retrospective comparison of patients treated in these studies with those that had surgery only in the D1D2 study, demonstrated that postoperative CRT was associated with better outcome, especially after D1 or a R1 resection. For daily practice, it remains unclear whether patients after optimal (D2) gastric surgery will benefit from postoperative CRT. This is currently being tested in prospective randomized phase III trials (CRITICS; TOPGEAR).
手术切除仍然是胃癌根治性治疗的关键部分。然而，仅靠手术，长期生存率较低（在欧洲5年生存率<25%）。在西方世界，比较有限（D1）淋巴结清扫与更广泛（D2）切除的随机研究未能显示更广泛手术对生存有益。在MAGIC研究中，围手术期化疗使生存率大幅提高。此外，SWOG/肿瘤协作组0116研究表明，与单纯手术相比，术后放化疗（CRT）延长了5年总生存率。然而，有人认为该试验中手术治疗不足影响了生存。在一项韩国随机研究中，接受术后CRT的晚期胃癌患者在D2清扫后预后更好。在我们研究所，已经对120多名接受胃癌切除的患者进行了基于顺铂和卡培他滨的辅助CRT的I-II期研究。对这些研究中接受治疗的患者与在D1D2研究中仅接受手术的患者进行回顾性比较，结果表明术后CRT与更好的预后相关，尤其是在D1或R1切除后。对于日常临床实践而言，最佳（D2）胃癌手术后的患者是否能从术后CRT中获益仍不清楚。目前正在前瞻性随机III期试验（CRITICS；TOPGEAR）中对此进行验证。
