Adjuvant chemoradiotherapy in gastric cancer: Wave goodbye to extensive surgery?
Adjuvant chemoradiotherapy in gastric cancer: Wave goodbye to extensive surgery?
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胃癌辅助放化疗：告别大范围手术？
DOI：
10.1007/bf02573057
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发表时间：
2002
影响因子：
3.7
通讯作者：
D. Roukos
中科院分区：
文献类型：
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作者：
D. Roukos
在世界范围内，胃癌仍然是最常见的恶性肿瘤之一，是癌症死亡的主要原因，尽管发病率下降。虽然在美国，2002年预计只有22，600例新病例，但真实的病例死亡率仍然很高，表明在诊断的胃癌治疗方面进展甚微。然而，对改善患者结局的希望提供了来自美国的最新报告。1因为到目前为止，还没有可靠的证据证明胃癌切除术后辅助治疗的有效性，2 4这项随机试验具有临床重要性，但同时提出了几个重要的问题。在这项大型、仔细监测的多机构试验中，556例胃或胃食管交界处腺癌切除术后的患者被随机分配到手术加术后放化疗或单纯手术组。辅助治疗包括氟尿嘧啶加甲酰四氢叶酸，然后进行4500 cGy的放射治疗。放化疗显著提高了中位总生存期9个月。死亡的风险比为1.35（95%置信区间，1.09至1.66; P=. 005）。3例患者（1%）死于放化疗的毒性反应;放化疗组中分别有41%和32%的患者发生3级和4级毒性反应。Macdonald等人1得出结论，所有接受根治性切除术的胃或胃食管交界处腺癌复发高风险患者均应考虑术后放化疗。
Worldwide, gastric cancer remains one of the most common malignancies and a leading cause of cancer death, despite declining incidence. Although in the United States only 22,600 new cases are expected in 2002, real case-mortality remains high, indicating little progress in the treatment of diagnosed gastric cancer. However, hopes for an improved patient outcome provides a most recent report from the United States. 1 Because up until now there was no credible evidence for the effectiveness of adjuvant treatment after gastric resection for cancer, 2 4 this randomized trial is clinically important but simultaneously raises several important questions. In this large, carefully monitored, multi-institutional trial, 556 patients after resection for adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy or surgery alone. The adjuvant treatment consisted of fluorouracil plus leucovorin followed by 4500 cGy of radiation. Chemoradiotherapy improved significantly the median overall survival by 9 months. The hazard ratio for death was 1.35 (95% confidence interval, 1.09 to 1.66; P=. 005). Three patients (1%) died from toxic effects of the chemoradiotherapy; grade 3 and grade 4 toxic effects occurred in 41% and 32% of the patients in the chemoradiotherapy group, respectively. Macdonald et al. 1 concluded that postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.