摘要
[目的]比较分析进行术前放化疗(Preoperative chemoradiotherapy,pCRT)联合手术与单纯手术治疗胃食管结合部癌患者的复发模式。[方法]复发模式分析对象是本院以不同方式进行治疗的患者。术前放化疗包括5个紫杉醇和卡铂联合化疗疗程(5周),放疗剂量为每次1.8Gy,共45Gy。[结果]从2007~2014年接受治疗并可以纳入分析的有341例,其中大部分组织学检测为腺癌(约为72.6%)。在接受肿瘤切除治疗的287例患者中,包括了81.9%只进行手术的患者和86.5%进行了术前放化疗联合手术的患者。仅进行手术的患者术后复发率为57.1%,进行pCRT联合手术的患者复发率为34.7%。pCRT使原位区域复发(LRR)率由33.8%下降到15.7%(P<0.01),腹膜癌发病率由13.8%下降至5.9%(P<0.01),且pCRT对血性转移率的降低有显著效果(36.3%降至29.4%,P<0.05)。LRR有5.2%发生在放疗目标区域内部,2.1%发生在区域边缘,6.3%在区域外部,另有0.7%的情况,复发位点与放疗区域关系不明确。在pCRT联合手术后,只有1.4%患者只在放疗区域内部复发。[结论]术前CRT可减少胃食管癌患者原位区域复发以及腹腔转移。只有5.2%的LRR发生在放疗目标区域内部,大部分发生在原发位点外。
[Objective]Comparing and analyzing the recurrence patterns of preoperative chemoradiotherapy（CRT）plus surgery and simply surgery on gastroesophageal cancer patients.[Methods]The data for this analysis was from gastroesophageal cancer patients treated with different therapy.The preoperative CRT included five 1-week concurrent chemotherapy courses of a combined dosage of paclitaxel and carboplatin to the tumor and pathologic lymph nodes with margin.The radiotherapy dosage was 45 Gy in 1.8-Gy fractions.[Results]From 2007 to 2014,341 patients were capable to be involved in the analysis,and most of their histological test showed as adenocarcinoma（72.6%）.In the 287 patients who accepted resection,81.9% were allocated to only surgery,while 86.5% were treated with preoperative CRT and surgery.The recurrence of the patients who had only surgery was 57.1%,while it was 34.7% to those who had CRT plus surgery.The preoperative CRT reduced the rate of locoregional recurrence（LRR）from 33.8% to15.7%（P〈0.001）,and decreased the peritoneal carcinomatosis from 13.8% to 5.9%（P〈0.001）.The preoperative CRT also had significant effect on reducing the hematogenous dissemination from 36.3% to29.4%（P〈0.001）.5.2% LRR happened inside of the radiation target volume,2.1%in the margins,and6.3% outside of the target.There was 0.7% LRR,the recurrence spot had unclear relation with the radiation target volume.Only 1.4% of the patients had infield recurrence after preoperative CRT plus surgery.[Conclusion]Preoperative CRT can reduce the LRR and peritoneal carcinomatosis in gastroesophageal cancer patients.Only 5.2% of the recurrence happened within the radiation target volume,most of them wererelated to outfield failures.
作者
王键
WANG-jian(Department of General Surgery, Yulin First Hospital, Shaanxi, Yulin 719000, China)
出处
《中国中西医结合消化杂志》
CAS
2018年第5期400-405,共6页
Chinese Journal of Integrated Traditional and Western Medicine on Digestion
关键词
术前放化疗(pCRT)
胃食管癌
复发模式
复发位点
Preoperative chemoradiotherapy （pCRT）
gastroesophageal cancer
recurrence patternssites of relapse
