姑息性放射治疗晚期胃癌患者胃出血的临床观察  

Clinical observation on palliative radiotherapy for gastric hemorrhage in patients with advanced gastric cancer

作　　者：刘怡 倪峰 曹广鑫 王鼎 LIU Yi;NI Feng;CAO Guangxin;WANG Ding(Department of Radiotherapy,Affiliated Tumor Hospital of Nantong University,Nantong Tumor Hospital,Nantong 226006,China)

机构地区：[1]南通大学附属肿瘤医院/南通市肿瘤医院放疗科,江苏南通226006 [2]南通大学附属肿瘤医院/南通市肿瘤医院胃肠外科,226006

出　　处：《临床肿瘤学杂志》2023年第10期935-939,共5页Chinese Clinical Oncology

基　　金：江苏省中医药科技发展计划资助项目(YB2020067)。

摘　　要：目的探讨通过姑息性放疗(RT)缓解晚期胃癌相关胃出血的疗效,确定最佳RT方案。方法回顾性分析了2016年1月至2022年2月在我院接受姑息性RT治疗胃癌相关胃出血的53例患者。分析RT前1个月内的基线血红蛋白(Hb)、RT结束时的Hb、RT结束后1个月的Hb和RT结束后2个月的Hb。RT后再出血被定义为Hb水平下降至7.0 g/dL或需要额外输血。结果38例患者放疗后出血得到控制。从姑息性RT开始到出血控制的中位时间为12.5天(1~68天)。RT前1个月基线Hb水平中位为6.85 g/dL(3.4~10.7),RT后即刻、1个月和2个月Hb基线水平中位值分别为8.20 g/dL、10.20 g/dL和10.80 g/dL,高于基线Hb水平(P<0.001)。RT后中位累积无出血(CRR)持续时间为51天(4~370天)。根据生物有效剂量(BED)10分层,BED_(10)<39.2Gy组和BED_(10)≥39.2Gy组中位CRR持续时间分别为44天和74天,差异有统计学意义(P<0.001)。Cox风险比例回归模型分析显示,年龄较小(P=0.001)、RT后化疗(P<0.001)和高BED_(10)(P=0.024)是延长再出血时间的影响因素。结论高BED_(10)的姑息性RT是一种有效控制晚期胃癌相关胃出血的方式。Objective To explore the efficacy of palliative radiotherapy(RT)in alleviating gastric bleeding associated with advanced gastric cancer and determine the optimal RT regimen.Methods A retrospective analysis was conducted on 53 patients who received palliative RT treatment for gastric cancer related gastric bleeding in our hospital from January 2016 to February 2022.Analyze baseline hemoglobin(Hb)within one month before RT,Hb at the end of RT,Hb at one month after RT,and Hb at two months after RT.Re bleeding after RT is defined as a decrease in Hb level to 7.0 g/dL or the need for additional blood transfusion.Results The bleeding in 38 patients was controlled after radiotherapy.The median time from palliative RT to bleeding control was 12.5 days(1-68 days).The median baseline Hb level in the first month of RT was 6.85 g/dL(3.4-10.7),while the median baseline Hb levels immediately,1 month,and 2 months after RT were 8.20 g/dL,10.20 g/dL,and 10.80 g/dL,respectively,which were higher than the baseline Hb level(P<0.001).The median cumulative no bleeding(CRR)duration after RT was 51 days(4-370 days).According to the biological effective dose(BED_(10))stratification,the median CRR duration was 44 days in the BED_(10)<39.2 Gy group and 74 days in the BED_(10)≥39.2 Gy group,respectively,with statistically significant differences(P<0.001).Cox risk proportional regression model analysis showed that younger age(P=0.001),post RT chemotherapy(P<0.001),and higher BED_(10)(P=0.024)were influencing factors for prolonging rebleeding time.Conclusion Palliative RT with high BED_(10)is an effective way to control gastric bleeding associated with advanced gastric cancer.

关 键 词：胃癌 放疗 出血 姑息治疗 

分 类 号：R735.2[医药卫生—肿瘤]