胃癌同步放化疗的临床疗效(2)
本组90.7%的患者有轻重不等的胃肠道副反应,经辅助治疗及对症处理绝大部分都能缓解,只有1例患者不能耐受而终止治疗。但无一例出现胃穿孔和肠坏死。本组病例均未出现肝、肾功能损害,67.4%的患者有轻重不等的白细胞下降,经对症处理后均能恢复完成治疗。本组部分治疗前予营养支持的病例放化疗的急慢性毒性反应明显减轻,患者对放化疗的耐受性提高。本组部分患者给予三维适形治疗,其放化疗毒性反应相对较轻,这可能是三维适形治疗提高了局部肿瘤剂量,降低了周围正常组织受照剂量。所以笔者建议,有条件的患者尽量给予三维适形或调强治疗。
总之,本研究结果提示,对未手术的胃癌同步放化疗可以提高近期疗效,改善患者生存质量。但还需临床更多的病例积累和证实,同时对于胃癌患者化疗的最佳方案选择还有待于临床进一步研究。
[参考文献]
[1]刘鹏,邓清华.胃癌放射治疗进展[J].国外医学:肿瘤学分册,2005,32:552.
, http://www.100md.com
[2] Mineur L,Lacaine F,Ychou M,et al.Chemoradiotherapy in the adjuvant treatment of gastric adenocarcinomas:real progress?[J].Cancer Radiother,2002,6(Suppl 1):13s-23s.
[3]孙菁,孙益红,秦新裕,等.胃癌术后腹腔淋巴结转移放疗的疗效分析[J].中华放射肿瘤学杂志,2007,15:277-280.
[4]Glimelius B.Role of adjuvant chemoradiotherapy for abdominal malingnancies[J].Dig Surg,2003,20(3):169-179.
[5]Powers B E,Gillette E L.Effects of irradiation on the supportive tissues of the gastrointestinal tract[M]// Potten C S,Hendry J H.Radiation and gut.New York:Elsevier Science,1995:221-229.
, 百拇医药
[6]Layke J C,Lopez P P.Gastric cancer:diagnosis and treatment options[J].Am Fam Physician,2004,69(5):1133-1140.
[7]高汝贵,李光.消化道肿瘤[M]//刘泰福.现代放射肿瘤学.上海:复旦大学出版社•上海医科大学出版社,2001:381.
[8]George T,Steven E,Srollit L,et al.Results of irradiation or chemoradiation for primary unresctable,locally recurrent or grossly incomplete resection of gastric adenocarcinomas [J].Int J Radiat Oncol Biol Phys,2000,46(1):109-118.
, http://www.100md.com
[9]Macdonald J S,Smalley S R,Benedetti J,et al.Chemoradiotherapy after surgery compared with surgery alone for adonocarcinoma of the stomach or gastroesophageal junction [J].N Engl J Med,2001,345(10):725-730.
[10]Hallissey M T,Dunn J A,Ward L C,et al.The second British stomach cancer group trial of adjuvant radiothcrapy or chemotherapy in resectable gatric cancer:fiveyears followup [J].Lancet,1994,343(8909):1309-1312.
[11]Janunger K G,Hafstrm L,Nygren P,et al.A systematic overview of chemotherapy effects in gastric cancer[J].Acta Oncol,2001,40(2-3):309-326.
, 百拇医药
[12]Bleiberg H,Goffin J C,Dalesio O,et al.Adjuvant radiotherapy and chemotherapy in resectable gastric cancer.A randomized trial of the gastrointestinal tract cancer cooperative group of the EORTC[J].Eur J Surg Oncol,1998,15:535-543.
[13]Guzel Z,Szawlowski A,Jezioski K,et al.Postoperative radiotherapy for gastric cancer[J].Eur J Cancer,1999,35(suppl 4):S 154.
[14]Safran H,Wanebo H J,Hesketh P J,et al.Paclitaxel and concurrent rdoation for gastric cancer[J].Int J Radiat Oncol Biol Phys,2000,46(4):889-894.
[15]王舒宝.胃癌37年临床研究的结果分析——附2326例报告[J].中国肿瘤临床,1999,26(5):325-330.
[收稿日期] 2009-06-24, 百拇医药(李 华 胡艳文 田大龙 胡其伟 喻志冲 王贺芳 刘 辉)
总之,本研究结果提示,对未手术的胃癌同步放化疗可以提高近期疗效,改善患者生存质量。但还需临床更多的病例积累和证实,同时对于胃癌患者化疗的最佳方案选择还有待于临床进一步研究。
[参考文献]
[1]刘鹏,邓清华.胃癌放射治疗进展[J].国外医学:肿瘤学分册,2005,32:552.
, http://www.100md.com
[2] Mineur L,Lacaine F,Ychou M,et al.Chemoradiotherapy in the adjuvant treatment of gastric adenocarcinomas:real progress?[J].Cancer Radiother,2002,6(Suppl 1):13s-23s.
[3]孙菁,孙益红,秦新裕,等.胃癌术后腹腔淋巴结转移放疗的疗效分析[J].中华放射肿瘤学杂志,2007,15:277-280.
[4]Glimelius B.Role of adjuvant chemoradiotherapy for abdominal malingnancies[J].Dig Surg,2003,20(3):169-179.
[5]Powers B E,Gillette E L.Effects of irradiation on the supportive tissues of the gastrointestinal tract[M]// Potten C S,Hendry J H.Radiation and gut.New York:Elsevier Science,1995:221-229.
, 百拇医药
[6]Layke J C,Lopez P P.Gastric cancer:diagnosis and treatment options[J].Am Fam Physician,2004,69(5):1133-1140.
[7]高汝贵,李光.消化道肿瘤[M]//刘泰福.现代放射肿瘤学.上海:复旦大学出版社•上海医科大学出版社,2001:381.
[8]George T,Steven E,Srollit L,et al.Results of irradiation or chemoradiation for primary unresctable,locally recurrent or grossly incomplete resection of gastric adenocarcinomas [J].Int J Radiat Oncol Biol Phys,2000,46(1):109-118.
, http://www.100md.com
[9]Macdonald J S,Smalley S R,Benedetti J,et al.Chemoradiotherapy after surgery compared with surgery alone for adonocarcinoma of the stomach or gastroesophageal junction [J].N Engl J Med,2001,345(10):725-730.
[10]Hallissey M T,Dunn J A,Ward L C,et al.The second British stomach cancer group trial of adjuvant radiothcrapy or chemotherapy in resectable gatric cancer:fiveyears followup [J].Lancet,1994,343(8909):1309-1312.
[11]Janunger K G,Hafstrm L,Nygren P,et al.A systematic overview of chemotherapy effects in gastric cancer[J].Acta Oncol,2001,40(2-3):309-326.
, 百拇医药
[12]Bleiberg H,Goffin J C,Dalesio O,et al.Adjuvant radiotherapy and chemotherapy in resectable gastric cancer.A randomized trial of the gastrointestinal tract cancer cooperative group of the EORTC[J].Eur J Surg Oncol,1998,15:535-543.
[13]Guzel Z,Szawlowski A,Jezioski K,et al.Postoperative radiotherapy for gastric cancer[J].Eur J Cancer,1999,35(suppl 4):S 154.
[14]Safran H,Wanebo H J,Hesketh P J,et al.Paclitaxel and concurrent rdoation for gastric cancer[J].Int J Radiat Oncol Biol Phys,2000,46(4):889-894.
[15]王舒宝.胃癌37年临床研究的结果分析——附2326例报告[J].中国肿瘤临床,1999,26(5):325-330.
[收稿日期] 2009-06-24, 百拇医药(李 华 胡艳文 田大龙 胡其伟 喻志冲 王贺芳 刘 辉)