Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Strahlenther Onkol. 2013 May;189(5):417-23. doi: 10.1007/s00066-013-0309-2. Epub 2013 Apr 6.
In a retrospective analysis, adjuvant intensity-modulated radiation therapy (IMRT) combined with modern chemotherapy improved advanced gastric cancer survival rates compared to a combination of three-dimensional conformal radiation therapy (3D-CRT) and conventional chemotherapy. We report on the long-term outcomes of two consecutive patient cohorts that were treated with either IMRT and intensive chemotherapy, or 3D-CRT and conventional chemotherapy.
Between 2001 and 2008, 65 consecutive gastric cancer patients received either 3D-CRT (n = 27) or IMRT (n = 38) following tumor resection. Chemotherapy comprised predominantly 5-fluorouracil/folinic acid (5-FU/FA) in the earlier cohort and capecitabine plus oxaliplatin (XELOX) in the latter. The primary endpoints were overall survival (OS) and disease-free survival (DFS).
Median OS times were 18 and 43 months in the 3D-CRT and IMRT groups, respectively (p = 0.0602). Actuarial 5-year OS rates were 26 and 47 %, respectively. Within the IMRT group, XELOX gave better results than 5-FU/FA in terms of OS, but this difference was not statistically significant. The primary cause of death in both groups was distant metastasis. Median DFS times were 14 and 35 months in the 3D-CRT and IMRT groups, respectively (p = 0.0693). Actuarial 5-year DFS rates were 22 and 44 %, respectively. Among patients receiving 5-FU/FA, DFS tended to be better in the IMRT group, but this was not statistically significant. A similar analysis for the XELOX group was not possible as 3D-CRT was almost never used to treat these patients. No late toxicity exceeding grade 3 or secondary tumors were observed.
After a median follow-up period of over 5 years, OS and DFS were improved in the IMRT/XELOX treated patients compared to the 3D-CRT/5-FU/FA group. Long-term observation revealed no clinical indications of therapy-induced secondary tumors or renal toxicity.
在一项回顾性分析中，与三维适形放疗（3D-CRT）联合常规化疗相比，辅助调强放疗（IMRT）联合现代化疗可提高晚期胃癌患者的生存率。我们报告了连续两批患者队列的长期结果，这些患者接受了 IMRT 和强化化疗或 3D-CRT 和常规化疗。
2001 年至 2008 年间，65 例连续胃癌患者在肿瘤切除后接受 3D-CRT（n=27）或 IMRT（n=38）治疗。化疗主要包括早期队列中的 5-氟尿嘧啶/亚叶酸（5-FU/FA）和后者中的卡培他滨加奥沙利铂（XELOX）。主要终点是总生存期（OS）和无病生存期（DFS）。
3D-CRT 和 IMRT 组的中位 OS 时间分别为 18 和 43 个月（p=0.0602）。5 年 OS 率分别为 26%和 47%。在 IMRT 组中，XELOX 在 OS 方面优于 5-FU/FA，但差异无统计学意义。两组的主要死亡原因均为远处转移。3D-CRT 和 IMRT 组的中位 DFS 时间分别为 14 和 35 个月（p=0.0693）。5 年 DFS 率分别为 22%和 44%。在接受 5-FU/FA 的患者中，IMRT 组的 DFS 趋势较好，但无统计学意义。由于几乎从未使用 3D-CRT 治疗这些患者，因此无法对 XELOX 组进行类似分析。未观察到 3 级或以上的晚期毒性或继发性肿瘤。
在中位随访 5 年以上后，与 3D-CRT/5-FU/FA 组相比，接受 IMRT/XELOX 治疗的患者的 OS 和 DFS 得到改善。长期观察未发现治疗引起的继发性肿瘤或肾毒性的临床迹象。
