Post-operative radiochemotherapy for gastric cancer: Adoption and adaptation
Post-operative radiochemotherapy for gastric cancer: Adoption and adaptation
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DOI：
10.1016/j.clon.2004.09.017
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发表时间：
2005-04-01
影响因子：
3.4
通讯作者：
Brierley, J
中科院分区：
文献类型：
--
作者：
Ringash, J;Khaksar, SJ;Brierley, J
目的：组间研究0116(INT-0116)显示，胃癌术后放化疗可使3年生存率绝对提高11%，但在常规大视野模拟试验中报告了33%的严重急性胃肠道反应。我们采用了适形放射治疗技术，并对连续20名患者进行了毒性和预后评估。方法：先前开发的用于胃淋巴瘤的适形放射治疗技术适用于INT-0116中定义的靶区体积。五野计划采用较大的前野，加上不对称匹配的上AP：PA野和下侧野。连续两个周期的非转移性胃癌患者接受5-FU(425 mg/m(2)/d×5天)和亚叶酸钙(20 mg/m(2)/d×5天)同步放疗(45Gy25次)前1周期和后2周期(45Gy25次)的治疗。使用RTOG和NCI共同毒性标准每周前瞻性记录急性毒性。结果：20例患者中19例完成了放疗，14例完成了所有的化疗周期。1例死于中性粒细胞缺乏性败血症。最大急性毒性[等级(数)]分别为：5(1)、4(0)、3(4)、2(10)、1(4)、0(1)。有2例出现1级晚期毒性反应。两年的总生存率为70%(95%可信区间：50-90)。结论：适形放射治疗可改善急性毒性(3级或更高毒性为25%，INT-0116报告为41%)。存活率与INT-0116治疗组相当(2年时约为60%)。INT-0116的结果可以在研究环境之外获得；然而，有必要进一步努力提高治疗效果并将毒性降至最低。(C)2004年皇家放射科医师学会。爱思唯尔有限公司出版。保留所有权利。
Aims: Intergroup study 0116 (INT-0116) showed an 11% absolute improvement in 3-year survival with post-operative radiochemotherapy for gastric cancer, but reported 33% severe acute GI toxicity using conventional simulation with large fields. We adapted the treatment using conformal radiotherapy techniques and assessed toxicity and outcome in 20 consecutive patients.Methods: A conformal radiotherapy technique previously developed for gastric lymphoma was adapted to treat the target volume defined in INT-0116. The five-field plan used a large anterior field, plus asymmetrically matched upper AP:PA fields and lower lateral fields. Consecutive patients with ECOG PS 0-2 and stage IB-IV non-metastatic gastric cancer were treated with 5-FU (425 mg/m(2) daily X 5 days) and leucovorin (20 mg/m(2) daily x 5 days) for one cycle prior to and two cycles following concurrent radiation (45 Gy/25 fractions) with identical drug dosages on the first 4 and last 3 days of radiation. Acute toxicity was prospectively recorded weekly using RTOG and NCI common toxicity criteria. Patient charts were reviewed in November 2003 and late toxicity and outcome were recorded.Results: Nineteen of 20 patients completed radiotherapy and 14 completed all chemotherapy cycles. One patient died of neutropenic sepsis. Maximum acute toxicity [grade (number)] was: 5(1), 4(0), 3(4), 2(10), 1(4), 0(1). There were two grade 1 late toxicities. Two-year overall survival is 70% (95% confidence interval: 50-90).Conclusions: Conformal radiotherapy may improve acute toxicity (25% grade 3 or greater toxicity as compared with 41% reported in INT-0116). Survival is comparable to that achieved in the INT-0116 treatment arm (approximately 60% at 2 years). INT-0116 results can be achieved outside a study setting; however, further efforts to improve treatment efficacy and minimize toxicity are warranted. (c) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.