Lee Su Jin, Sohn Tae Sung, Lee Jeeyun, Park Se Hoon, Park Joon Oh, Lim Do Hoon, Park Young Suk, Lim Ho Yeong, Choi Min Gew, Lee Joon Ho, Bae Jae Moon, Kim Sung, Kang Won Ki
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Anticancer Res. 2014 Nov;34(11):6585-91.
We retrospectively analyzed the feasibility and adverse events for two regimens, postoperative chemoradiation (CRT) with 5-fluorouracil/leucovorin (5-FU/LV) compared to S-1 in D2-resected gastric cancer patients.
The study included 405 gastric cancer patients who underwent curative gastrectomy with D2 lymph node dissection and received adjuvant therapy between January 2008 and July 2009. Feasibility and adverse events for the CRT and S-1 regimens were analyzed.
Out of the 405 patients, 244 (60.2%) had CRT and 161 (39.8%) had S-1 treatment. The regimen was selected based on the preferences of the physician and the patient. S-1 was more frequently administered to patients with older age (age≥70) and those with early-stage disease (stage II). The stage was significantly more advanced in the CRT group compared to the S-1 group (S-1 vs. CRT: stage II, 59.6% vs. 36.1%; stage III/IV, 28.0% vs. 48.3%, respectively; p<0.001). The completion rate of the planned therapy was significantly higher in the CRT group than in the S-1 group (95.1% vs. 72.8%, respectively; p<0.001). Regarding severe adverse events (grade 3-4), neutropenia (CRT vs. S-1; 40.2% vs. 8.7%, respectively, p<0.001), nausea (CRT vs. S-1; 5.7% vs. 0%, respectively; p=0.002) and stomatitis (CRT vs. S-1; 7.4% vs. 2.5%, respectively; p=0.034) were significantly more frequent in the CRT cohort compared to the S-1 group.
Both adjuvant CRT with 5-FU/LV and adjuvant S-1 are safe and feasible in D2-resected gastric cancer patients. Patients with old age or early stage disease tend to prefer S-1 therapy to chemoradiation.
我们回顾性分析了两种治疗方案在D2根治性切除的胃癌患者中的可行性及不良事件，这两种方案分别是术后使用5-氟尿嘧啶/亚叶酸钙（5-FU/LV）进行同步放化疗（CRT）与使用S-1进行治疗。
本研究纳入了405例在2008年1月至2009年7月期间接受了D2淋巴结清扫的根治性胃切除术并接受辅助治疗的胃癌患者。分析了CRT和S-1方案的可行性及不良事件。
405例患者中，244例（60.2%）接受了CRT治疗，161例（39.8%）接受了S-1治疗。治疗方案根据医生和患者的偏好选择。S-1更常用于年龄较大（年龄≥70岁）和疾病早期（II期）的患者。与S-1组相比，CRT组患者的分期明显更晚（S-1组与CRT组：II期，分别为59.6%和36.1%；III/IV期，分别为28.0%和48.3%；p<0.001）。CRT组计划治疗的完成率显著高于S-1组（分别为95.1%和72.8%；p<0.001）。关于严重不良事件（3-4级），与S-1组相比，CRT组中性粒细胞减少（CRT组与S-1组分别为40.2%和8.7%，p<0.001）、恶心（CRT组与S-1组分别为5.7%和0%，p=0.002）和口腔炎（CRT组与S-1组分别为7.4%和2.5%，p=0.034）的发生率显著更高。
对于D2根治性切除的胃癌患者，5-FU/LV辅助CRT和S-1辅助治疗均安全可行。老年或疾病早期患者倾向于选择S-1治疗而非同步放化疗。
