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目的:探讨同步放化疗治疗胃癌术后腹腔淋巴结转移的临床疗效。方法:收集新疆医科大学第一附属医院肿瘤中心2007年1月至2009年11月收治胃癌根治术后出现腹腔淋巴结转移患者83例,随机分为治疗组和对照组。治疗组41例,给予三维适形放疗同步XELOX方案(奥沙利铂+希罗达)化疗;对照组42例,给予XELOX方案化疗。两组患者一般临床资料具有可比性结果:治疗组和对照组客观有效率分别为80.5%和57.1%,两者比较有显著性差异(P=0.01),治疗组和对照组患者的腹痛、腹胀、腰痛总的控制率分别为87.8%和52.4%,有显著性差异(P<0.001)。治疗组与对照组1、2年生存率分别为41.0%vs.19.5%、17.9%vs.4.9%,差异均具有统计学意义(P<0.001)。治疗组因腹腔淋巴结转移导致死亡的患者占25.0%,明显低于对照组的61.5%(P<0.001)。治疗组骨髓抑制和胃肠道反应的发生率明显高于对照组(P<0.001),但不良反应主要为RTOG 1级和2级,经对症治疗后均好转。结论:胃癌术后腹腔淋巴结转移对同步放化疗较敏感,同步放化疗可改善因腹腔淋巴结转移导致的症状,降低死亡率,延长生存期
Objective: To investigate the clinical efficacy of concurrent chemoradiotherapy in the treatment of postoperative abdominal lymph node metastasis of gastric cancer. Methods: Totally 83 patients with celiac lymph node metastasis who underwent radical gastrectomy from January 2007 to November 2009 in Cancer Center of the First Affiliated Hospital of Xinjiang Medical University were randomly divided into treatment group and control group. In the treatment group, 41 cases were treated with three-dimensional conformal radiotherapy (XELOX) program (oxaliplatin plus Xeloda). In control group, 42 cases were given XELOX chemotherapy. The general clinical data of two groups of patients have comparable results: The objective and effective rates of the treatment group and the control group were 80.5% and 57.1%, respectively, with significant difference (P = 0.01). The treatment group and the control group had abdominal pain, bloating , The total control rate of low back pain was 87.8% and 52.4% respectively, with significant difference (P <0.001). The 1-year and 2-year survival rates of the treatment group and the control group were 41.0% vs.19.5%, 17.9% vs.4.9%, respectively, with significant differences (P <0.001). In the treatment group, 25.0% of the patients died of abdominal lymph node metastasis, which was significantly lower than 61.5% of the control group (P <0.001). The incidence of myelosuppression and gastrointestinal reaction in the treatment group was significantly higher than that in the control group (P <0.001). However, the adverse reactions were mainly grade 1 and grade 2 of RTOG, and were all improved after symptomatic treatment. Conclusion: The postoperative lymph node metastasis of gastric cancer is more sensitive to concurrent chemoradiotherapy. Chemoradiation can improve the symptoms caused by lymph node metastasis, reduce the mortality and prolong survival