24例局部进展期胃癌术中放疗预后分析

目的 初步探索局部进展期胃癌手术联合术中放疗的治疗效果.方法 对24例局部进展期胃癌患者手术加术中放疗的临床病理资料进行前瞻性研究.运用Kaplan-Meier法计算患者无瘤生存率和总生存率,运用Cox比例风险回归模型对患者术后复发的影响因素进行分析.结果 24例患者中,21例患者行D2淋巴结清扫胃癌根治术;3例患者接受了姑息性切除手术,其中2例患者镜下切缘阳性,1例患者肉眼切缘阳性.所有患者均接受了术中放疗(1500 cGy,6 MeV).所有患者未出现手术并发症和放疗并发症.术后中位随访时间为19.5个月(2~63个月),1例患者出现局部复发,2例患者出现肺转移,3例患者出现腹腔转移,7例患者出现肝转移,局部控制率为95.8%.Kaplan-Meier法计算结果 显示,术后患者的中位无进展生存期为18个月,中位总生存期为23个月,5年总生存率为35.4%.Cox比例风险回归分析未发现无进展生存的独立影响因素.结论 术中放疗是局部进展期胃癌综合治疗的有效手段之一,可以提高局部进展期胃癌的局部控制率.

Prognostic analysis of intraoperative radiotherapy in 24 cases of locally advanced gastric cancer patients

Objective To evaluate the outcomes of surgery combined with intraoperative radiotherapy in the manage-ment of locally advanced gastric cancer. Method 24 patients with locally advanced gastric cancer who underwent sur-gery and intraoperative radiotherapy were included in the prospective analysis. Kaplan-Meier analysis was used to calcu-late the recurrence-free survival rate and overall survival rate, and Cox proportional hazard model was utilized to investi-gate the factors influencing postoperative recurrence. Result Of the 24 patients, 21 received radical gastrectomy with D2 lymphadenectomy, 3 patients had palliative surgery, in which 2 had R1 resection and 1 had R2 resection. All patients were treated with intraoperative radiotherapy (1500 cGy, 6 MeV). There was no report of post-operative or radiotherapy related complications. After a median follow-up of 19.5 months (2-63 months), local recurrence developed in 1 patient, 2 had lung metastasis, and peritoneal cavity recurrence was observed in 3, while liver metastasis developed in 7 patients, and the local control rate reached 95.8%. In Kaplan-Meier analysis, the postoperative median progression-free survival (PFS) and overall survival was 18 months and 23 months, respectively, and the 5-year overall survival rate was 35.4%. No independent factors of PFS were founded in Cox proportional hazards model analysis. Conclusion Intraoperative ra-diotherapy is an efficient and comprehensive strategy in the management of locally advanced gastric cancer, with a re-markable increase in the improvement of local control rate.