同步放化疗对局部晚期胃癌患者生活质量及并发症的影响

目的:观察同步放化疗对局部晚期胃癌患者的近期疗效，患者生活质量的影响及并发症分析。方法:将55例不能手术的局部晚期胃癌患者随机分为2组，28例进行同步放化疗治疗，先行XELOX方案化疗1周期，于2周期化疗第2天同时进行适形放疗，并按化疗周期进行3、4周期XELOX方案治疗。27例患者进行4周期XELOX方案化疗。结果:无进展生存期（PFS）同步放化疗组为7.1个月，化疗组为5.1个月(P＜0.05)；肿瘤客观缓解率（ORR）同步放化疗组67.8%，化疗组40.7%（P＜0.05）；1年生存率同步放化疗组60%高于化疗组51%，两者比较无统计学意义(P＞0.05)；QLQ-C30评定:治疗后同步放化疗组PA(疼痛症状)评分、SL(失眠症状)评分低于单纯化疗组(28.5±20.1 vs 40.3±21.0;35.4±19.6 vs 44.5±18.9）,P＜0.05,PF(躯体功能)评分高于化疗组(64.2±19.4 vs 60.3±20.4),P＜0.05。同步放化疗组患者AP（食欲减退）、NV（恶心呕吐）与FA（乏力）评分高于单纯化疗组(51.5±20.6 vs 48.3±20.7；46.2±18.7 vs 40.1±13.6；63.0±23.7 vs 60.03±22.6)，但P＞0.05，而RF (角色功能)、EF(情绪功能)、CF(认知功能)、SF(社会功能)、QL(总体健康状况)相当，无统计学意义。治疗组Ⅲ/Ⅳ级消化道毒性及Ⅲ/Ⅳ级血液毒性发生率高于对照组(28.6% vs 18.5%；25.0% vs 18.5%)，但P值比较无差异。结论:同步放化疗对局部晚期胃癌患者近期疗效优于化疗组；与单纯化疗比较，同步放化疗患者疼痛、失眠、躯体症状改善、总体生活质量状况相当。患者可耐受同步放化疗消化道毒性及血液毒性。

Influence of chemoradiotherapy on the quality life and complications for advanced gastric carcinoma

Objective:To investigate the influence of chemoradiotherapy on patients quality of life and complications of locally advanced gastric carcinoma patients (Ⅱ-Ⅲc).Methods:All 55 cases of locally advanced gastric cancer patients who can not accepted operation were randomly divided into two groups.After treated with XELOX scheme 1 cycle of chemotherapy,28 patients were accepted 3-dimensional conformal radiation therapy.In the second day of the next cycle of chemotherapy and chemotherapy cycle XELOX regimen for 3,4 cycle.27 patients received XELOX scheme chemotherapy for 4 cycle.Results:The progress free survival (PFS) of chemoradiotherapy group was 7.1 months while the chemotherapy group was 5.1 months(P＜0.05).The objective response rates of tumor (ORR) were 67.8% and 40.7%,respeccivelly（P＜0.05）；The 1 year survival rate was 60% in the concurrent chemoradiotherapy group and 51% in the chemotherapy group.QLQ C30 evaluation:the score of PA and SL was lower to the chemotherapy(28.5±20.1 vs 40.3±21.0;35.4±19.6 vs 44.5±18.9），the PF score was higher than chemotherapy(64.2±19.4 vs 60.3±20.4),P＜0.05.AP，NV and FA symptom scores of the chemoradiotherapy were higher than the pure chemotherapy group (51.5±20.6 vs 48.3±20.7；46.2±18.7 vs 40.1±13.6；63.0±23.7 vs 60.03±22.6)， but P＞0.05,the PF,RF,EF,CF,SF were almost the same.P＞0.05.The Ⅲ/Ⅳ incidence of hematological and gastrointestinal of the chemoradiotherapy were higher than the chemotherapy(25.0% vs 18.5%;28.6% vs 18.5%),but P＞0.05.Conclusion:The chemoradiotherapy can improve the efficacy of locally advanced gastric carcinoma patients (Ⅱ-Ⅲc) without operation.Compared with simple chemotherapy,chemoradiotherapy could improve the symptoms of pain,sleep and physical function.The gastrointestinal and hematological toxicity could be tolerated.