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晚期胃癌D2根治术后化疗联合放疗的有效性及不良反应
作者:曹晓刚 
单位:新汶矿业集团中心医院肿瘤科  山东 新泰 271219 
关键词:胃肿瘤/外科学 手术后期间 胃肿瘤/放射疗法 胃肿瘤/药物疗法 复发 存活率 毒性作用 临床对照试验 
DOI:R735.2;R730.56
出版年,卷(期):页码:2015,30(6):533-536
摘要:
目的 探讨晚期胃癌D2根治术后化疗联合放疗的有效性及不良反应。方法 选取50例接受D2根治术的胃癌晚期患者,随机分为放化疗组和单纯化疗组两组,每组25例。放化疗组患者FP方案化疗1个周期(5-FU 1000 mg/m2,d1-5,顺铂60 mg/m2,d1),第28天开始行局部放疗。同时口服卡培他滨1650 mg/(m2·d),依据直肠癌同步放化疗规定对剂量进行适时调整。完成放疗后4周继续给予FP方案化疗3个周期,共9周;化疗组FP方案化疗6个周期,每2个周期之间间隔3周。结果 放化疗组与单纯化疗组完成治疗、不良反应下中止治疗、拒绝继续治疗的发生率分别为72.0%(18/25)、24.0%(6/25)、4.0%(1/25)和80.0%(20/25)、12.0%(3/25)、8.0%(2/25),差异均无统计学意义(均P>0.05)。放化疗组的呕吐发生率较单纯化疗组低(P<0.05),但腹泻、2级胃肠道不良反应、中性粒细胞减少症、肠梗阻影响下再次接受开腹手术发生率均明显比单纯化疗组高(均P<0.05);放化疗组患者的复发率明显比单纯化疗组低[24.0%(6/25) vs 48.0%(12/25),P<0.05];放化疗组与单纯化疗组患者的3年、5年无瘤生存率、5年总体生存率分别为76.0%(19/25)、60.0%(15/25)、64.0%(16/25)和64.0%(16/25)、52.0%(13/25)、60.0%(15/25),差异均无统计学意义(均P>0.05)。结论 晚期胃癌D2根治术后化疗联合放疗能够显着降低复发率,但会增加不良反应。
Objective To assess the efficacy and adverse reactions of chemoradiotherapy after D2 radical resection for advanced gastric cancer. Methods Fifty patients with advanced gastric cancer after D2 radical resection were randomly assigned to chemoradiotherapy group and chemotherapy group with 25 cases in each. Patients in chemoradiotherapy group received one cycle of FP chemotherapy regime (5-FU 1 000 mg/m2, d1-d5, cisplatin 60 mg/m2, d1), and local radiation at d28;meanwhile oral capecitabine[1 650 mg/(m2·d)]was given and the dose was adjusted accordingly. After completion of radiotherapy for 4 weeks, 3 cycles of FP chemotherapy was given for total 9 weeks. Patients in chemotherapy group received 6 cycles of FP chemotherapy with an interval of 3 weeks between cycles. Results The rates of completed treatment, discontinued treatment due to adverse reactions and refused treatment in chemoradiotherapy and chemotherapy groups were 72.0%(18/25), 24.0%(6/25), 4.0%(1/25) and 80.0%(20/25), 12.0%(3/25), 8.0%(2/25), respectively (all P>0.05). The incidence rate of vomiting in chemoradiotherapy group was lower (P<0.05), but the incidence rates of diarrhea, grade Ⅱ gastrointestinal reaction, neutropenia, laparotomy due to ileus in chemoratiotherapy group were significantly higher than those in chemotherapy group (all P<0.05). The relapse rate in chemoradiotherapy group was significantly lower than that of chemotherapy group[24.0%(6/25) vs 48.0%(12/25), P<0.05]. The 3-, 5-year disease-free survival rates (DFS) and 5-year overall survival rates (OS) in chemoratiotherapy group and chemotherapy group were 76.0%(19/25), 60.0%(15/25), 64.0%(16/25);and 64.0%(16/25), 52.0%(13/25), 60.0%(15/25);the differences were not statistically significant (all P>0.05). Conclusion Chemoratiotherapy after D2 radical resection for advanced gastric cancer patients may reduce relapse rate, but increase adverse reactions.
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