CAJ | 학술논문

目的：比较局部进展期胃癌根治术后三维适形放疗联合同期化疗与单纯化疗的疗效及安全性。方法将76例拟行胃癌根治术的病理诊断为Ⅱ～Ⅳ期的患者随机分为2组，观察组38例术后给予三维适形放疗联合S－LOX方案化疗，对照组38例仅给予S－LOX方案化疗。化疗方案为奥沙利铂130 mg／㎡静滴第1，8天，替吉奥胶囊40 mg／m22次／d口服第1—14天，3周为1个周期，共6个周期。 R0术后总放疗剂量45 Gy／25次，R1术后残存区瘤床局部加量6～10 Gy。结果76例患者均完成治疗。观察组1，2，3年累积总体生存率分别为92％，82％和55％，中位生存时间33．1个月；对照组分别为82％，63％和45％，中位生存时间27．6个月。2组总体生存曲线比较差异无统计学意义（P＞0．05）。观察组1，2，3年无疾病进展生存率分别是74％，63％和29％，中位无进展生存时间26．6个月；对照组分别是55％，34％和5％，中位无进展生存时间19．3个月。2组无进展生存曲线比较差异有统计学意义（P＜0．05）。2组Ⅲ～Ⅳ度骨髓抑制和消化道反应发生率比较差异均无统计学意义。结论局部进展期胃癌根治术后同步放化疗可提高近期疗效，延长患者的疾病无进展生存时间，不良反应患者可以耐受，值得推广应用。
목적：비교국부진전기위암근치술후삼유괄형방료연합동기화료여단순화료적료효급안전성。방법장76례의행위암근치술적병리진단위Ⅱ～Ⅳ기적환자수궤분위2조，관찰조38례술후급여삼유괄형방료연합S－LOX방안화료，대조조38례부급여S－LOX방안화료。화료방안위오사리박130 mg／㎡정적제1，8천，체길오효낭40 mg／m22차／d구복제1—14천，3주위1개주기，공6개주기。 R0술후총방료제량45 Gy／25차，R1술후잔존구류상국부가량6～10 Gy。결과76례환자균완성치료。관찰조1，2，3년루적총체생존솔분별위92％，82％화55％，중위생존시간33．1개월；대조조분별위82％，63％화45％，중위생존시간27．6개월。2조총체생존곡선비교차이무통계학의의（P＞0．05）。관찰조1，2，3년무질병진전생존솔분별시74％，63％화29％，중위무진전생존시간26．6개월；대조조분별시55％，34％화5％，중위무진전생존시간19．3개월。2조무진전생존곡선비교차이유통계학의의（P＜0．05）。2조Ⅲ～Ⅳ도골수억제화소화도반응발생솔비교차이균무통계학의의。결론국부진전기위암근치술후동보방화료가제고근기료효，연장환자적질병무진전생존시간，불량반응환자가이내수，치득추엄응용。
Objective It is to compare the efficacy and safety of three-dimensional conformal radiotherapy (3D-RCT) combine with concurrent chemotherapy and chemotherapy alone for advanced gastric cancer.Methods 76 cases of patients with gastric cancer undergoing radical gastrectomy as pathologically staged II to IV were divided into two groups with 38 cases in each group.The cases were treated with 3D-RCT combined with concurrent chemotherapy in observation group and with the same chemotherapy alone in control group.The chemotherapy regimen:oxaliplatin 130 mg/m2 intravenous infusion in the 1st and 8th day;oral administration of 40 mg/m2 of S-1 capsules 2 times/day from the 1st day to the 14th day;3 weeks as a cy-cle and were treated for six cycles.The R0 cases were irradiated with a total dose of 45 Gy/25 times.The R1 cases of residual area tumor bed were added 10 Gy amount.Results All 76 patients completed treatment.The observation group of overall sur-vival rate of 1-, 2-and 3-year was 92%, 82%and 56%respectively, the median survival period was 33.1 months;the control group of overall survival rate of 1-, 2-and 3-year was 82%, 63%and 45%respectively, the median survival pe-riod was 27.6 months.There was no significant difference in overall survival between 2 groups (P>0.05).The progression free survival of 1-, 2-and 3-year was 74%, 63% and 29% respectively in observation group, the median progression free survival was 26.6 months;and it was 55%, 32%and 5%respectively in the control group, the median progression free survival was 19.3 months.There was significant difference in progression free survival curve between the both groups ( P<0.05).There was no significant difference in the rate of bone marrow inhibition of III to IV degrees and digestive tract reaction between the both groups (P>0.05).Conclusion The chemotherapy combined with 3D-CRD in postoperative of locally ad-vanced gastric cancer can improve short-term effects, prolong the survival time of patients, and the adverse reaction can be tol-erated, so it is worthy of popularization and application.