Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastric Cancer. 2012 Dec;12(4):205-9. doi: 10.5230/jgc.2012.12.4.205. Epub 2012 Dec 31.
In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.
在胃腺癌中，即使在完全切除后，仍有很高的局部区域复发率，因此进行了各种研究试图寻找术后辅助治疗的作用。其中，Intergroup 0116 试验是一项具有里程碑意义的试验，结果表明与单纯手术相比，辅助放化疗有明确的生存获益。然而，由于淋巴结清扫有限，INT 0116 试验对于全球接受 INT 0116 方案作为辅助治疗方式存在重大限制。最近，发表了几项针对 D2 淋巴结清扫的胃癌患者的随机研究。这篇综述总结了手术后失败模式的相关数据以及早期的前瞻性研究，包括 INT 0116 研究。作者将介绍最新的研究，包括 ARTIST 试验，并讨论对于接受扩大淋巴结清扫和辅助化疗的患者是否应应用外照射放疗。
