摘要
目的观察局部晚期胃癌奥沙利铂（OXA）＋5氟尿嘧啶（5-fu）／亚叶酸钙（LA）同步放疗和单纯化疗的疗效和生存期。方法采用随机数字法将83例局部晚期胃癌患者随机分为同步放化疗组（Ⅰ组40例）与单纯化疗组（Ⅱ组43），Ⅰ组为同步放化疗，行影像学可见的肿瘤原发灶和转移淋巴结放疗，同时行OXA＋5-fu／LA方案化疗，每2周为一周期，放疗期间化疗3个周期，放疗结束后辅助3个周期；Ⅱ组单纯行化疗，应用OXA＋5-fu／LA方案，直至病情进展或无效，共5～8个周期，平均7个周期。结果Ⅰ组完全缓解10．5％，部分缓解60．5％，有效率71％，无变化18．4％，进展13．2％。Ⅱ组分别为7．1％，38．1％，45％，30．9％，26．2％。Ⅰ组手术切除率为32．5％，Ⅱ组行切除率为27．9％（P=0．649），根治性切除率分别为77．8％和57．1％（P=0．161）。Ⅰ组、Ⅱ组患者中位生存期（MST）分别为24个月和11个月．2年生存率分别为42．6％和31．7％，两组差异有统计学意义（P=0．015）；其中Ⅰ、Ⅱ组行手术治疗的患者MST分别为45个月和28个月，2年生存率分别为65．8％和56．3％，两组差异无统计学意义（P=0．371）。不能手术切除的Ⅰ、Ⅱ组MST分别为14个月和9个月，2年生存率分别为28．3％和20．7％，两组差异有统计学意义（P=0．017），毒副反应为胃肠道反应和骨髓抑制，但均可耐受，无治疗相关性死亡。结论OXA＋LA＋5-fu同步放疗治疗不能手术切除的局部晚期胃癌可以耐受，可提高局部控制率和延长生存期，明显缓解症状，提高生活质量。
Objective To evaluate the efficacy of r oxaliplatin plus 5-fluorouracil/leucovorin calcium （LV） combined with concurrent radiotherapy in the treatment of local advanced gastric cancer. Methods 83 patients with local advanced gastric cancer were randomized into 2 groups. Group Ⅰ （ n = 40） underwent irradiation at the dose of 40 - 45 Gy 5 times a week on the primary tumor and the lymph nodes with the size ≥ 10 mm in short axis, and receiving intravenous drip of OXA 85 mg/m^2 for 2 h, intravenous injection of LV 200 mg/m^2 , and then intravenous injection of 5-fu 300 mg/m^2 , followed by continuous intravenous infusion of 5-fu 500 mg/m^2, for 22 h, with 2 weeks as a cycle. Three cycles of chemotherapy were given during the radiotherapy. Then operative evaluation was conducted. Those resectable underwent operation and then 3 cycles of adjuvant chemotherapy. Those un-resectable underwent continuous 3 cycles of chemotherapy. Group Ⅱ （n = 43） received only chemotherapy. The treatment was repeated until disease progression or prohibitive toxicity. Results 38 patients were evaluated in Group Ⅰ , the result showed complete remission （CR） in 4 patients （ 10. 5% ）, partial remission （PR） in 23 （60. 5% ）, no-change （NC） in 7 （ 18.4% ）, progressive disease （PD） in 5 （ 13.2% ）, with the remission rate （RR） of 71% （ 27/ 40）.42 patients were evaluated in Group Ⅱ, the result showed CR in 3 patients （7.14%）, PR in 16 （ 14. 3% ）, NC in 13（30. 9% ） ,and PD in 9（26. 2% ）with the RR of 45% （19/43）. The resection rates of Groups Ⅰ and Ⅱ were 32.5% and 27.9% respectively （P = 0. 649）. The R0 resection rates of Groups Ⅰ and Ⅱ were 77.8% and 57. 1% respectively（ P = 0. 161 ）. The mean survival times of the resectable patients in Groups Ⅰ and Ⅱ were 45 months and 28 months respectively, and the 2-year overall survival （OS） of the resectable patients in Groups Ⅰ and Ⅱ were 65.8% and 56.3% respectively （ P = 0. 371 ）. The mean sur
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第36期2547-2549,共3页
National Medical Journal of China
基金
山东省自然科学基金资助项目（y2006c61）
关键词
胃肿瘤
放射治疗剂量
药物疗法
Stomach neoplasms
Radiatherapy dosage
Drug therapy
