局部进展期胃癌根治术后同期放化疗与单纯化疗的临床比较

目的 比较局部进展期胃癌根治术后同期放化疗(RCT)与单纯化疗(CT)的疗效和不良反应。 方法 83例患者随机分为RCT组(43例)和CT组(40例)。RCT组采用三维适形放疗45 Gy同期口服卡培他滨化疗(1600mg/m²),放疗结束2周后继续用FOLFOX4方案巩固化疗 4~6周期。CT组采用FOLFOX4方案化疗 6~8周期。Kaplan Meier 法计算生存率等并 Logrank 检验。结果 随访率为96%,RCT和CT组随访时间满2、3年者分别为37、12例和31、10例。RCT组和CT组1、2、3年局部控制率分别为100%、97%、94%和95%、87%、73%(χ²=4.54,P=0.033),生存率分别为98%、86%、81%和93%、80%、64%(χ²=3.96,P=0.047)。RCT组和CT组治疗期间≥3级白细胞下降发生率分别为23%和15%(χ²=0.93, P=0.630), ≥3级胃肠道反应发生率分别为16%和10%(χ²=0.95,P=0.624)。结论 局部进展期胃癌根治术后RCT比CT可提高患者局部控制率和生存率,不良反应可耐受。

Clinical randomzied study of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer

Objective To investigate the efficacy and toxicity of postoperative radiochemotherapy compared with chemotherapy alone in the treatment of locally advanced gastric cancer. Methods A total of 83 patients with resected adenocarcinoma of the stomach were randomly assigned to postoperative radiochemotherapy group (RCT)(n=43) or chemotherapy alone group (CT)(n=40). Patients in RCT group received radiotherapy concurrent with capecitabine chemotherapy then followed by 4－6 cycles of FOLFOX4 chemotherapy. The total dose of radiation was 45 Gy. The dose of capecitabine was 1600 mg/m² per day. In the CT group, patients received 6－8 cycles FOLFOX4 chemotherapy. Survival was analyzed using Kaplan-Meier method and Logrank test. Results The follow-up rate was 96%. The number of patients who had a minimum of 2-,3-year follow-up time were 37,12 in the RCT group and 31,10 in the CT group. The 1-,2-,3-year local control rates for RCT and CT groups were 100%,97%,94% and 95%,87%,73%(χ²=4.54,P=0.033), respectively. The 1-,2-,3-year survival rates were 98%,86%,81% in the RCT group, with 93%,80%,64% in the CT group (χ²=3.96,P=0.047). The incidence of grade 3 hematological toxicity in the RCT and CT group was 23% vs 15%(χ²=0.93,P=0.630), and grade 3 gastrointestinal toxicity was 16% vs 10%(χ²=0.95,P=0.624). Conclusions Compared with chemotherapy alone, postoperative radiochemotherapy can improve survival of locally advanced gastric cancer patients with acceptable toxicities.