Foo M, Crosby T, Rackley T, Leong T
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Velindre Cancer Centre, Cardiff, UK.
Clin Oncol (R Coll Radiol). 2014 Sep;26(9):541-50. doi: 10.1016/j.clon.2014.06.004. Epub 2014 Jul 1.
The prognosis of patients with locally advanced gastric cancer remains poor, despite radical surgical resection. Adjuvant therapy has been shown to improve survival and, in Western countries, is delivered either postoperatively (chemoradiotherapy) or perioperatively (chemotherapy). Debate continues as to which of these represents the optimal strategy. High-dose gastric irradiation comes at the expense of significant toxicity, and increasing efforts have focused on attempts to reduce toxicity and normal tissue doses. The development of advancing radiotherapy technologies now allows improved target delineation and coverage. However, gastric irradiation remains technically challenging and requires an understanding of postoperative surgical anatomy, patterns of failure and lymph node drainage, as well as an appreciation of the uncertainties around organ motion and filling. Ongoing trials are examining the optimal strategy in which to incorporate (chemo)-radiotherapy, as well as the addition of targeted therapies, in gastric cancer. This overview discusses the current role and evidence for (chemo)-radiotherapy, as well as the technical challenges encountered in the radiotherapeutic management of resectable gastric cancer.
尽管进行了根治性手术切除，局部晚期胃癌患者的预后仍然很差。辅助治疗已被证明可提高生存率，在西方国家，辅助治疗在术后（放化疗）或围手术期（化疗）进行。关于哪种方式是最佳策略的争论仍在继续。高剂量胃部照射会带来显著的毒性，因此人们越来越致力于降低毒性和减少正常组织的剂量。先进放疗技术的发展现在使得靶区勾画和覆盖得到改善。然而，胃部照射在技术上仍然具有挑战性，需要了解术后手术解剖结构、失败模式和淋巴结引流情况，以及认识到器官运动和充盈方面的不确定性。正在进行的试验正在研究将（化疗）放疗以及添加靶向治疗纳入胃癌治疗的最佳策略。本综述讨论了（化疗）放疗的当前作用和证据，以及可切除胃癌放射治疗管理中遇到的技术挑战。
