Adjuvant Chemoradiation for Surgical Resected Gastric Cancer Patients: CGH Experience

胃癌病患術後合併化學治療及放射治療：結果報告

10.6316/TRO/200815(4)279

蕭世禎(Su-Zun Shaw)；宋詠娟(Yung-Chuan Sung)；黃清水(Ching-Shui Huang)；石敏官(Min-Yen Shi)；劉漢鼎(Han-Ting Liu)；游佩潔(Pei-Chieh Yu)；吳錦榕(Ching-Jung Wu)

胃癌 ； 術後化學放射治療 ； 急性副作用 ； Gastric cancer ； Adjuvant chemoradiation ； Acute side effects

放射治療與腫瘤學

15卷4期（2008 / 12 / 01）

279 - 287

英文

目的：國外Intergroup 0116隨機取樣的分析報告指出，胃癌病患術後接受同步化學治療和放射治療可以增進病患中位存活率，並降低局部復發。我們醫院採用雷同的化療放射治療方法治療了35位病患。進行了追蹤分析，結果與各位分享。 材料與方法：自1999年8月至2006年8月，35位胃癌病患在術後接受同步化學治療和放射治療。方法是Fluorouracil 425mg/平方公尺加上Leucovorin 20mg/平方公尺經5天的注射，一個月之後，接同步化學治療和放射治療(CRT)，放射治療在五週內給予4500cGy，化學治療以相同的藥物在放射療程期間前4天及最後3天給予。而一個月之後，再接兩次或多次的化學治療。 結果：追蹤時間從1.6個月到71.9個月，中位追蹤時間為13.2個月。至2007年5月底，57%的病患仍然存活，一年及三年的存活率為71%及56%。整個治療過程相當安全，嚴重的副作用（第三級）只有少數。局部復發率只有5.6%，而遠處復發為25.7%。比較不同組的生存率發現，在CRT之後接受含兩次以上化療的病患，其生存率較少於兩次的高。主要為Signet ring cell的組織型態生存率比起其他組織型態差，統計學上是有意義的。 結論：同步化學治療和放射治療對術後的胃癌病患是安全及有幫助的。

Purpose: The benefits of adjuvant chemoradiation (CRT) after surgical resection for gastric cancer patients has been firmly established since randomized study published by Intergroup 0116 reporting a definite improvement in median survival. We would like to share our experience in a retrospective study of 35 patients in our hospital using a similar regimen. Materials and Methods: From August 1999 to August 2006, 35 patients received postoperative CRT after curative surgical resection. The adjuvant CRT consisted of 425 mg/m^2 of fluorouracil plus 20 mg/m^2 leucovorin for 5 days, and then one month later followed by 4500 cGy of radiotherapy for 5 weeks with fluorouracil and leucovorin on the first 4 and last 3 days of radiotherapy. Two or more 5-day cycles of fluorouracil and leucovorin were given one month after completion of CRT. Results: During a median follow up of period of 13.2 months, 57% of patients were alive with free of disease. One year and 3 year overall survival were 71% and 56% respectively. The whole treatment course was well tolerated with a few incidences of severe (grade Ⅲ) acute side effects and local-regional relapses occurred in 5.7% of patients and 25.7% had distant relapses. Compared survivals between different subgroups, we found patients with primary signet ring cell histology bear a significantly poorer survival than other histological types. Patients who received 2 or more cycles of chemotherapy after CRT did better in overall survival than patients who did less. Conclusion: Our study found chemoradiation safe and beneficial for gastric cancer patients after curative surgical resection.