Zhang Z X, Gu X Z, Yin W B, Huang G J, Zhang D W, Zhang R G
Department of Radiation Oncology, Cancer Institute (Hospital), Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):929-34. doi: 10.1016/s0360-3016(98)00280-6.
An attempt was made to define the role of radiotherapy before operation for AGC.
From January 1978 to May 1989, a prospective randomized trial on preoperative radiotherapy (R+S) vs. surgery alone (S) for AGC was carried out in 370 patients. Patients were randomized into a combined group (R+S, 171 patients) or a surgery alone group (S, 199 patients) by the envelope method. 8-MV photon or telecobalt was used for the preoperative radiation therapy, using anterior-posterior opposing parallel fields to deliver 40 Gy to the cardia, lower segment of the esophagus, fundus, lesser curvature, and hepatogastric ligament. Surgery was performed after 2 to 4 weeks rest.
The 5- and 10-year survival rates of the R+S Group and the S Alone Group were 30.10% and 19.75%, 20.26% and 13.30%, respectively. The survival curves of these two groups diverged right from the beginning after the operation over the ninth year. Statistics by Kaplan-Meier log rank test proves that the difference is significant (chi2 = 6.74, p = 0.0094). The immediate results were: resection rate 89.5% and 79.4% (p < 0.01); pathologic stage after resection T2 12.9% and 4.5% (p < 0.01), T4 40.3% and 51.3% (p < 0.05), lymph node metastasis rates 64.3% and 84.9% (p < 0.001); operative mortality rates 0.6% and 2.5%; intrathoracic leak rates 1.8% and 4.0%, respectively. The causes of failure were: local uncontrol and recurrence 38.6% vs. 51.7% (p < 0.025), regional lymph node metastasis 38.6% vs. 54.6% (p < 0.005), distant metastasis 24.3% vs. 24.7%.
Preoperative radiation therapy is able to improve the results of surgery for adenocarcinoma of the gastric cardia.
试图明确术前放疗在胃贲门腺癌（AGC）治疗中的作用。
1978年1月至1989年5月，对370例AGC患者进行了术前放疗（R+S）与单纯手术（S）的前瞻性随机试验。采用信封法将患者随机分为联合治疗组（R+S，171例患者）或单纯手术组（S，199例患者）。术前放疗采用8兆伏光子或远距离钴治疗，使用前后对穿平行野，给予贲门、食管下段、胃底、小弯侧和肝胃韧带40 Gy的剂量。休息2至4周后进行手术。
R+S组和单纯S组的5年和10年生存率分别为30.10%和19.75%、20.26%和13.30%。这两组的生存曲线在术后第九年开始就出现分歧。经Kaplan-Meier对数秩检验统计证明差异有统计学意义（χ2 = 6.74，p = 0.0094）。近期结果为：切除率分别为89.5%和79.4%（p < 0.01）；切除术后病理分期T2分别为12.9%和4.5%（p < 0.01），T4分别为40.3%和51.3%（p < 0.05），淋巴结转移率分别为64.3%和84.9%（p < 0.001）；手术死亡率分别为0.6%和2.5%；胸内漏发生率分别为1.8%和4.0%。失败原因如下：局部未控和复发分别为38.6%和51.7%（p < 0.025），区域淋巴结转移分别为38.6%和54.6%（p < 0.005），远处转移分别为24.3%和24.7%。
术前放疗能够改善胃贲门腺癌的手术治疗效果。
