Wang Xin, Wang Wei-Hu, Wang Shu-Lian, Song Yong-Wen, Liu Yue-Ping, Tang Yuan, Li Ning, Liu Wen-Yang, Fang Hui, Li Ye-Xiong, Zhao Dong-Bing, Chi Yihebali, Yang Lin, Jin Jing
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100001, China.
World J Gastrointest Oncol. 2021 Oct 15;13(10):1532-1543. doi: 10.4251/wjgo.v13.i10.1532.
Adjuvant chemoradiotherapy (ACRT) with oral capecitabine and intensity-modulated radiotherapy (IMRT) were well tolerated in a phase I study in patients who had undergone partial or total gastrectomy for locally advanced gastric cancer (GC). This phase II study aimed to further determine the efficacy and toxicity of this combination after radical resection and D1/D2 lymph node dissection (LND) for patients with locally advanced GC.
To further determine the efficacy and toxicity of this combination after radical resection and D1/D2 LND for patients with locally advanced GC.
Forty patients (median age, 53 years; range, 24-71 years) with pathologically confirmed adenocarcinoma who underwent D1/D2 LND were included in this study. The patients received ACRT comprising IMRT (total irradiation dose: 45 Gy delivered in daily 1.8-Gy fractions on 5 d a week over 5 wk) and capecitabine chemotherapy (dose: 800 mg/m² twice daily throughout the duration of radiotherapy). The primary study endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), toxic effects, and treatment compliance.
The 3-year DFS and OS were 66.2% and 75%, respectively. The median time to recurrence was 19.5 mo (range, 6.1-68 mo). Peritoneal implantation ( = 10) was the most common recurrence pattern, and the lung was the most common site of extra-abdominal metastases ( = 5). Nine patients developed grade 3 or 4 toxicities during ACRT. Two patients discontinued ACRT, while eleven underwent ACRT without receiving the entire course of capecitabine. There were no treatment-related deaths.
The ACRT protocol described herein showed acceptable safety and efficacy for patients with locally advanced GC who received radical gastrectomy and D1/2 LND.
在一项针对局部晚期胃癌（GC）患者进行了部分或全胃切除术的I期研究中，口服卡培他滨和调强放疗（IMRT）的辅助放化疗（ACRT）耐受性良好。本II期研究旨在进一步确定该联合治疗方案对局部晚期GC患者进行根治性切除及D1/D2淋巴结清扫（LND）后的疗效和毒性。
进一步确定该联合治疗方案对局部晚期GC患者进行根治性切除及D1/D2 LND后的疗效和毒性。
本研究纳入了40例经病理证实为腺癌且接受了D1/D2 LND的患者（中位年龄53岁；范围24 - 71岁）。患者接受ACRT，包括IMRT（总照射剂量：45 Gy，每周5天，每天1.8 Gy分剂量，共5周）和卡培他滨化疗（剂量：放疗期间每日两次，每次800 mg/m²）。主要研究终点为无病生存期（DFS），次要终点为总生存期（OS）、毒性反应和治疗依从性。
3年DFS和OS分别为66.2%和75%。复发的中位时间为19.5个月（范围6.1 - 68个月）。腹膜种植（n = 10）是最常见的复发模式，肺是最常见的腹外转移部位（n = 5）。9例患者在ACRT期间出现3级或4级毒性反应。2例患者停止ACRT，11例患者未接受完整疗程的卡培他滨而完成了ACRT。无治疗相关死亡。
本文所述的ACRT方案对接受根治性胃切除术及D1/2 LND的局部晚期GC患者显示出可接受的安全性和疗效。
