Abstract：Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs).
Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013), VIP (January 1989-June 2013), Chinese Biomedical Literature Database (January 1978-June 2013), Cochrane Library (Issue 6, 2013), PubMed (January 1966-June 2013), and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer. The obtained data were analyzed using RevMan 5.2 and Stata 12. The difference between two groups was estimated by calculating the risk ratio (RR) with 95% confidence interval (CI). Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria. Our results showed that postoperative chemoradiotherapy significantly increased 1-, 2-, and 3-year overall survival rates (RR=1.20, 95% CI=1.10-1.30, P=0.00; RR=1.34, 95% CI=1.16-1.56, P=0.00; RR=2.62, 95% CI=1.72-3.97, P=0.00) and 3- and 5-year disease-free survival rates (RR=1.10, 95% CI=1.00-1.21, P=0.04; RR=1.27, 95% CI=1.02-1.60, P=0.04). The incidence of grade 3 or 4 gastrointestinal tract reactions, liver function impairment, bone marrow suppression, and hand-foot syndrome was low and showed little difference between two groups (P=0.03-0.78). Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer, and the patients have good tolerance to chemotherapy drugs.
Li Xiaoqi,Jiang Lei,Zhao Da et al. Randomized controlled trials of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer: a meta-analysis[J]. Chinese Journal of Radiation Oncology, 2014, 23(1): 1-4.
[1] Siegel R, Naishadham D, Jemal A.Cancer statistics, 2012[J].CA Cancer J Clin,2012,62:10-29.
[2] 郑朝旭, 郑荣寿, 陈万青.中国2009年胃癌发病与死亡分析[J].中国肿瘤,2013,22:327-332.
[3] Ali Z, Deng Y, Ma C.Progress of research in gastric cancer[J].J Nanosci Nanotechnol,2012,12:8241-8248.
[4] Ajani JA, Bentrem DJ, Besh S, et al.Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines[J].J Natl Compr Canc Netw,2013,11:531-546.
[5] Fiorica F, Cartei F, Enea M, et al.The impact of radiotherapy on survival in resectable gastric carcinoma: a meta-analysis of literature data[J].Cancer Treat Rev,2007,33:729-740.
[6] Ohri N, Garg MK, Aparo S, et al.Who benefits from adjuvant radiation therapy for gastric cancer? A meta-analysis[J].Int J Radiat Oncol Biol Phys,2013,86:330-335.
[7] Jansen EP, Boot H, van de Velde CJ, et al.Can adjuvant ch emoradiotherapy replace extended lymph node dissection in gastric cancer?[J] Recent Results Cancer Res,2012,196:229-240.
[8] Cunningham D, Allum WH, Stenning SP, et al.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer[J].N Engl J Med,2006,355:11-20.
[9] Smalley SR, Benedetti JK,Haller DG, et al.Updated analysis of SWOG-directed intergroup study 0116: a phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection[J].J Clin Oncol,2012,30:2327-2333.
[10] Kim S, Lim DH, Lee J, et al.An observational study sugge sting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach[J].Int J Radiat Oncol Biol Phys,2005,63:1279-1285.
[11] Leong CN, Chung HT, Lee KM, et al.Outcomes of adjuvant chemoradiotherapy after a radical gastrectomy and a D2 node dissection for gastric adenocarcinoma[J].Cancer J,2008, 14:269-275.
[12] Lim DH, Kim DY, Kang MK, et al.Patterns of failure in gas tric carcinoma after D2 gastrectomy and chemoradio therapy: a radiation oncologist's view[J].Br J Cancer,2004,91:11-17.
[13] Kim TH, Park SR, Ryu KW, et al.Phase 3 trial of posto perative chemotherapy alone versus chemoradiation therapy in Ⅲ-Ⅳstage gastric cancer treated with R0 gastrectomy and D2 lymph node dissection[J].Int J Radiat Oncol Biol Phys,2012,84:585-592.
[14] Kwon HC, Kim MC, Kim KH, et al.Adjuvant chemoradiation versus chemotherapy in completely resected advanced gastric cancer with D2 nodal dissection[J].Asia Pac J Clin Oncol,2010,6:278-285.
[15] Lee J, Limdo H, Kim S, et al.Phase Ⅲ trial comparingc apecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecita bine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial[J].J Clin Oncol,2012,30:268- 273.
[16] Yu C, Yu R, Zhu W, et al.Intensity-modulated radiotherapy combined with chemotherapy for the treatment of gastric cancer patients after standard D1/D2 surgery[J].J Cancer Res Clin Oncol,2012,138:255-259.
[17] 陈亚楠, 左云,宋宇.进展期胃癌术后调强放疗序贯5-Fu微泵联合吡柔比星和奥沙利铂化疗[J].肿瘤学杂志,2012,18:336-338.
[18] 郭红伟, 靳秀丽,魏桂芳,等.进展期胃癌术后多西他赛联合卡培他宾化疗及同步放疗的临床研究[J].中国癌症杂志,2010,20:699-702.
[19] 胡蓉环, 刘安文,蔡婧,等.进展期胃癌D2根治术后同步放化疗的临床观察[J].实用临床医学,2012,13:41-43.
[20] 涂向阳.局部晚期胃癌术后同步放化疗临床研究[J].实用肿瘤杂志,2011,26:62-64.
[21] 杨治花, 折虹,闫钢,等.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[J].中华放射肿瘤学杂志,2012,21:252-254.
[22] 赵景胜, 陈群,向志碧,等.45例局部晚期胃癌术后辅助同步放化疗临床研究[J].肿瘤学杂志,2010,16:760-763.
[23] 赵立新, 梁越,董宝珠,等.晚期胃癌D2根治术后辅助放化疗的临床研究[J].现代中西医结合杂志,2012,21:1283-1285.
[24] Schmidt B,Yoon SS.D1 versus D2 lymphadenectomy for gastric cancer[J].J Surg Oncol,2013,107:259-264.
[25] Abbasi SY, Taani HE, Saad A, et al.Advanced gastric cancer in jordan from 2004 to 2008: a study of epidemiology and outcomes[J]. Gastrointest Cancer Res,2011,4:122-127.
[26] Vereczkei A.Gastric surgery.Magy Seb,2012,65:108-115.
[27] Smalley SR, Gunderson L, Tepper J, et al.Gastric surgical adjuvant radiotherapy consensus report: rationale and treatment implementation[J].Int J Radiat Oncol Biol Phys,2002,52:283-293.
[28] Gomceli I, Demiriz B,Tez M.Gastric carcinogenesis[J].World J Gastro enterol,2012,37:5164-5170.
[29] Nakashima S, Hatanaka N, Yoshikawa Y, et al.Long-term survival of a case of advanced cancer of the esopha gogastric junction with complet e response to low-dose 5-fluorouracil and cisplatin chemo therapy[J].Gan To Kagaku Ryoho,2012,39:1559-1561.
[30] Chao CKS, Perez CA, Brady LW. Radiation oncology:management decisions[M]. 3rd ed. New York: Lippincott Williams & Wilkins,2011:21-23.
[31] Ohtsu A, Yoshida S, Saijo N.Disparities in gastric cancer chemothera py between the East and West[J].J Clin Oncol,2006,24:2188-2196.
[32] 郭林, 成红艳.胃癌标准D2根治术后同步放化疗临床研究进展[J].东南大学学报(医学版),2012(4):530-532.
2014, Vol. 23 
