Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma
Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma
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DOI：
10.1200/jco.2004.01.015
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发表时间：
2004-07-15
影响因子：
45.3
通讯作者：
Gunderson, LL
中科院分区：
文献类型：
--
作者：
Ajani, JA;Mansfield, PF;Gunderson, LL
在西方，大约50%的局限性胃癌患者实现了根治性（RO）切除，超过60%的患者在RO切除后死于癌症。一项多机构的术前放化疗研究，以评估RO切除率，病理完全缓解（pathCR）率，安全性和生存率在可切除的胃癌患者。患者和方法手术患者局限性胃腺癌是合格的。分期还包括腹腔镜检查和超声内镜检查（EUS）。患者接受氟尿嘧啶、亚叶酸钙和顺铂诱导化疗（最多2个28天周期），随后接受45戈伊放疗加氟尿嘧啶。然后，患者分期和手术attempted.Results三十四例患者在三个机构登记。1例不合格患者被排除。大多数患者患有近端癌和EUST 3 N1指定。33例患者中有28例（85%）接受了手术。RO切除率为70%，pathCR率为30%。8例患者（24%）出现病理部分缓解（原发灶残留癌< 10%）。EUS T + N和术后T + N相关性显示显著的分期降低（P = < .01）。33例患者的中位生存期为33.7个月。达到pathCR或pathPR的患者的中位生存时间（63.9个月）显著长于达到pathPR以下的患者（12.6个月; P = 0.03）。有两个治疗相关的deaths.Conclusion我们的数据表明，术前诱导化疗，然后放化疗的三步策略导致大量的病理反应，导致持久的生存时间。这种策略值得与术后辅助放化疗进行直接比较。(C)2004年，美国临床肿瘤学会。
Purpose In the West, curative (RO) resection is achieved in approximately 50% of patients with localized gastric carcinoma, and more than 60% die of cancer following an RO resection. A multi-institutional study of preoperative chemoradiotherapy was done to assess the RO resection rate, pathologic complete response (pathCR) rate, safety, and survival in patients with resectable gastric carcinoma.Patients and Methods Operable patients with localized gastric adenocarcinoma were eligible. Staging also included a laparoscopy and endoscopic ultrasonography (EUS). Patients received up to two 28-day cycles of induction chemotherapy of fluorouracil, leucovorin, and cisplatin, followed by 45 Gy of radiation plus concurrent fluorouracil. Patients were then staged and surgery was attempted.Results Thirty-four patients were registered at three institutions. One ineligible patient was excluded. Most patients had a promixal cancer and EUST3N1 designation. Twenty-eight (85%) of 33 patients underwent surgery. The RO resection rate was 70% and pathCR rate was 30%. A pathologic partial response (< 10% residual carcinoma in the primary) occurred in eight patients (24%). EUS T plus N and postsurgery T plus N correlation showed significant downstaging (P = < .01). The median survival time for 33 patients was 33.7 months. Patients achieving a pathCR or pathPR had a significantly longer median survival time (63.9 months) than those achieving less than pathPR (12.6 months; P = .03). There were two treatment-related deaths.Conclusion Our data suggest that the three-step strategy of preoperative induction chemotherapy followed by chemoradiotherapy resulted in substantial pathologic response that resulted in durable survival time. This strategy is worthy of a direct comparison with postoperative adjuvant chemoradiotherapy. (C) 2004 by American Society of Clinical Oncology.