调强放疗联合替吉奥和顺铂新辅助治疗局部进展期胃癌临床研究  

Clinical study on neoadjuvant chemoradiotherapy with S-1 and cisplatin for locally advanced gastric carcinoma

作　　者：于兰[1] 程丕叶 徐燕[1] 王栾秋 

机构地区：[1]山东省青岛市中心(肿瘤)医院青岛大学医学院第二附属医院放疗科,266042

出　　处：《肿瘤研究与临床》2016年第11期739-742,747,共5页Cancer Research and Clinic

摘　　要：目的：探讨调强放疗联合替吉奥和顺铂新辅助治疗局部进展期胃癌的临床疗效和安全性。方法收集2009年1月至2012年6月62例局部进展期胃癌患者，化疗方案为替吉奥60 mg／m2，第1天至第14天，顺铂60 mg／m2，第1天，3周重复，共2个周期。同期给予调强放疗，放疗剂量45 Gy，1.8 Gy／次，1次／d，每周5次，放化疗结束3周后进行评估并行手术治疗。结果全组62例患者全部完成放疗，其中57例患者完成2个周期化疗并接受手术治疗。新辅助放化疗的有效率为69.4%（43／62），不良反应多为Ⅰ～Ⅱ级。手术切除率为93.0%（53／57），完全切除（R0切除）率为82.5%（47／57），病理反应率为82.5%（47／57），病理完全缓解（pCR）率为8.8%（5／57）。无围手术期死亡，术后并发症发生率为15.8%（9／57）。患者1、2、3年的总生存率分别为80.7%（46／57）、63.2%（36／57）、45.6%（26／57）；无局部及区域复发生存率分别为82.5%（47／57）、66.7%（38／57）、50.9%（29／57）；无远处转移生存率分别为86.0%（49／57）、68.4%（39／57）、59.6%（34／57）。结论调强放疗联合替吉奥和顺铂新辅助治疗局部进展期胃癌近期疗效较好，可提高R0切除率，延长患者生存时间，术后并发症少。Objective To investigate the efficacy and safety of neoadjuvant chemoradiotherapy with S-1 and cisplatin in locally advanced gastric carcinoma patients. Methods From January 2009 to June 2012, a total of 62 gastric carcinoma patients were enrolled. The chemotherapy regimen consisted of two cycle of S-1 （60 mg/m2, oral administration on day lst-14th） and cisplatin （60 mg/m2, intravenous infusion on day lst）. Radiotherapy was also performed with a total dose of 45 Gy delivered at 1.8 Gy/fraction, 5 fractions per week. Radical surgery was performed 3 weeks after chemoradiotherapy. Results All 62 patients completed the neoadjuvant radiotherapy, and 57 patients among them completed the neoadjuvant chemotherapy. 57 patients underwent surgery. Neoadjuvant chemoradiotherapy led to a clinical response rate of 69.4 % （43/62）, and side effects were mostly grade I or 11. The resection rate and radical resection （R0 resection） rate were 93.0 % （53/57） and 82.5 % （47/57）, respectively, and the pathological response rate and pCR rate were 82.5 % （47/ 57） and 8.8 % （5/57）, respectively. There was no postoperative death, besides, the postoperative complication rate was 15.8 % （9/57）. The 1- , 2-, and 3-year overall survival rates were 80,7 % （46/57）, 63.2 % （36/57） and 45.6 % （26/57）, local and regional recurrence-free survival rates were 82.5 % （47/57）, 66.7 % （38/57） and 50.9 % （29/57）, and distant metastasis-free survival rates were 86.0 % （49/57）, 68.4 % （39/57） and 59.6 % （34/57）, respectively. Conclusion The neoadjuvant chemoradiotherapy with S-1 and cisplatin combined with intensity modulated radiotherapy have a favorable effect for the treatment of locally advanced gastric carcinoma, which can promote the R0 resection rate and prolong the survival time with low postoperative complications.

关 键 词：胃肿瘤 肿瘤辅助疗法 替吉奥 不良反应 预后 

分 类 号：R735.2[医药卫生—肿瘤]