TREATMENT OUTCOME IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER RECEIVING ADJUVANT CHEMORADIOTHERAPY

局部侵襲性胃腺癌接受手術後化療合併放療之療效評估

黃士銘(Shih-Ming Huang) ； 陳彥超(Yen-Chao Chen) ； 梁為民(Wei-Man Leung) ； 蔡介生(Chien-Sheng Tsai) ； 范綱行(Kang-Hsing Fan) ； 洪宗民(Tsung-Min Hung) ； 葉永堅(Wing-Keen Yap) ； 黃炳勝(Bing-Shen Huang)

《放射治療與腫瘤學》 24卷1期 (2017/03) Pp. 1-11

https://doi.org/10.6316/TRO/201724(1)1

摘要

Background : The benefits of adjuvant chemoradiotherapy (CRT) for patients with locally advanced gastric cancer after D2 lymph node dissection remain debatable. This study investigated the treatment outcome in patients with stage II-III gastric cancer receiving curative resection plus adjuvant chemoradiotherapy (CRT). Method : Between January 2006 and December 2013, 71 patients who underwent radiotherapy with a diagnosis of gastric adenocarcinoma were registered. Tumors were staged according to the American Joint Committee on Cancer criteria (AJCC) version 7.0. Forty patients who had stage II and III disease undergoing curative resection were included in this analysis. Of them, 38 patients (95%) received D2 lymph node dissection. The RT field included tumor bed, remnant stomach, and regional lymph nodes with a standard prescribed dose of 45 Gy. Concurrent chemotherapy consisted of cisplatin, 5-fluorouracil and leucovorin, or fluorouracil plus leucovorin. The study endpoints were overall survival (OS) and progression-free survival (PFS), both of which were calculated using the Kaplan–Meier method. The log-rank test and Cox regression analysis were performed to examine the effects of explanatory variables on OS and PFS. Result : 30 patients died in the median follow-up duration of 22.8 months (range, 3.2 ~ 76.5), Thirty-four (80%) experienced recurrent disease (distant metastasis in 29, local relapse in 11, regional recurrence in 10). Twenty-four patients had grade 2 or above acute gastrointestinal or hematological toxicities. Three patients (8%) died from neutropenic infection during the adjuvant CRT. Multivariate analyses showed pathological T4b stage [P = .02, HR = 2.51, 95% CI = 1.16–5.46] and pathological N3b stage [P = .008, HR = 2.61, 95% CI = 1.28–5.32] were the independent prognostic factors for OS and PFS, respectively. Conclusion : In stage II-III gastric cancer patients receiving adjuvant CRT, treatmentrelated toxicities were the major concerns. Pathological T4b was the independent prognostic factor for OS, whereas N3b for PFS. A multi-institutional trial is recommended to optimize the treatment strategy and patient selection.

關鍵字

Gastric cancer ； Adjuvant chemotherapy ； Adjuvant chemoradiotherapy

並列摘要

背景及研究目的：在局部侵襲性胃癌病人進行治癒性手術切除併第二型淋巴結廓清術後加上輔助化療與放射線療法的好處仍然未定論。本研究針對第二期至第三期胃癌病人並接受治癒性手術後放射線合併化療，進行治療結果的分析。試驗設計與方法：在西元 2006 年至 2013 年，共 71 位胃癌病人接受了胃癌切除手術併輔助性放射線治療，皆依照 AJCC 第七版分期。其中，總共收錄 40 位病患，病理分期第二至三期，皆接受治癒性胃癌切除手術與淋巴結廓清術。其中 38 位病患接受第二型淋巴結廓清術。放射線劑量為 45 Gy、放射治療的範圍包括 tumor bed、剩餘胃部與鄰近淋巴區域。化療採用鉑金類藥物、氟尿嘧啶類藥物與葉酸類藥物。研究目的為整體存活率（overall survival）、無惡化存活期（progression-free survival），皆使用存活分析（Kaplan-Meier）作計算，並使用對數等級檢定（log-rank）與 cox 比例風險模式找出危險因子。結果：在 22.8 個月（範圍 3.2-76.5）追蹤之後，30 個病人死亡。34 個病患有復發產生（遠端轉移 29 位、局部復發 11 位、區域性復發 10 位）。24 位病患有第二級以上急性腸胃道副作用或血液性副作用。在輔助治療的過程中有三位病患因低白血球性發燒死亡。多變因分析中，腫瘤分期（T-stage）與淋巴侵犯程度（N-stage）分別為整體存活率與無惡化存活期之預測因子。結論：在第二與第三期局部侵襲性胃腺癌病人，要使用化療合併放射線治療之前，必須優先考慮治療的副作用。腫瘤分期（T-stage）與淋巴侵犯程度（N-stage）分別為整體存活率與無惡化存活期之預測因子。目前仍需更多的前瞻性研究來決定最佳的治療計畫與決定適合的病人族群。

並列關鍵字

胃癌 ； 輔助性化學治療 ； 輔助性放射線併化學治療