目的:观察化疗-放疗-化疗(化-放-化)序贯治疗局部晚期胃癌的临床疗效和毒副反应.方法:2009年1月-2014年10月我科收治的局部晚期胃癌84例,采用同期对照研究,分为化-放-化序贯治疗组(观察组)44例和单纯化疗组(对照组)40例.观察组及对照组均采用DCF(多西他赛、顺铂、5-氟尿嘧啶)或FOLFOX4(5-氟尿嘧啶、奥沙利铂、亚叶酸钙)方案化疗3~4周期,观察组化疗2周期后开始肿瘤累及区域三维适形放疗/调强适形放射治疗(3DCRT/IMRT),放疗剂量DT(45~50.4)Gy/[(25~28)f?(5~6)w],放疗结束再予相同方案化疗1~2周期.对照组不予放疗.结果:84例患者均可评价疗效,观察组与对照组总有效率(CR+PR)分别为65.9%、37.5%,疾病控制率(CR+PR+SD)分别为88.6%、60.0%,临床症状缓解率分别为88.6%、65.0%,中位生存期分别为12.0个月、10.0个月,1、2年生存率分别为56.8% vs 32.5%、18.2% vs 7.5%.两组比较,在治疗有效率、疾病控制率、临床症状缓解率、中位生存期、1年生存率方面观察组高于对照组,差异具有统计学意义;2年生存率观察组较对照组有增高,但无统计学差异.两组Ⅲ-Ⅳ度骨髓抑制、胃肠道反应、肝肾功能受损发生率相近.结论:序贯化放疗较单纯化疗提高了局部晚期胃癌的治疗有效率,明显缓解患者的临床症状,且使部分患者改善了生存质量,延长生存期,并未增加治疗毒副反应,是不能手术局部晚期胃癌的较好治疗方案.%Objective:To evaluate the clinical efficacy and toxicity of sequential chemoradiotherapy for locally advanced gastric cancer.Methods:Between January 2009 and October 2014,84 patients with locally advanced gastric cancer were divided into sequential chemoradiotherapy group(study group n=44) and chemotherapy alone group(control group n=40).Both groups were treated with DCF or FOLFOX4 program 3~4 cycles,after two cycles of chemotherapy,study group received 3-dimensional conformal radiation therapy/intensity-modulated radiation therapy(3DCRT/IMRT),radiotherapy dose:DT=(45~50.4)Gy/[(25~28)f?(5~6)w],then followed the same chemotherapy by 1~2 cycles.Control group received chemotherapy alone 3~4 cycles.Results:The efficacy of all the patients were evaluated.The reponse rate was 65.9% in study group,that of 37.5% in control group.The disease control rate was 88.6% and 60.0% respectively.Clinical symptom remission rate in study group was 88.6%,and that in control group was 65.0%.The median duration of survival were 12.0 and 10.0 months respectively.The 1-year survival rates were 56.8% and 32.5% respectively.The 2-year survival rates were 18.2% and 7.5% respectively.We could see that there was significant difference in efficacy,disease control rate,clinical remission rate,median survival time and 1-year survival(P<0.05).The 2-year survival rate in the observation group was higher than that in the control group,but there was no significant difference compared with control group.There was no significant difference in Ⅲ-Ⅳmyelosuppression.The gastrointestinal tract,liver,and kidney dysfunction were similar in both groups(P>0.05).Conclusion:Compared with chemotherapy alone,sequential chemoradiotherapy for locally advanced gastric cancer can improve the efficiency of treatment,significantly alleviate the clinical symptoms,and improve some patients'' living quality and prolong survival time without increasing toxic reactions.It is a better treatment for inoperable locally advanced gastric cancer and this is worthy of further study.
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