中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

新辅助放化疗用于局部进展期胃癌治疗临床价值

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  1. 1复旦大学附属肿瘤医院放疗科，上海 200032；2复旦大学上海医学院肿瘤学系，上海 200032
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

局部进展期胃癌术后有相当比例的局部区域复发和远处转移发生率，提示单纯手术可能不足，进一步的综合治疗有望减少复发提高疗效。对于局部进展期胃癌，包含手术、放疗和化疗的最佳的综合治疗模式仍然存在很多争议。目前，主要存在3种治疗模式，包括围手术期化疗、术后化疗和术后放化疗模式。术前放化疗模式目前主要来自于食管胃结合部肿瘤的临床试验数据，而对于胃癌则尚无随机试验证实，还处于临床试验阶段。在开展临床试验时存在很多须注意的地方，例如：进行准确的术前分期；选择合适分期（局部进展期）的人群；标准化上消化道肿瘤部位并选择合适部位肿瘤病人；标准化放疗的剂量和靶区体积；选择合适的同期化疗和非放疗化疗药物；选择合适的疗效评价体系；优化手术标准，同时重视病人营养状态的评估和适当的干预。

关键词: 局部进展期胃癌, 放射治疗, 新辅助放化疗

Abstract:

Role of neoadjuvant (chemo)-radiotherapy in local advanced gastric cancer        ZHANG Zhen，LI Gui-chao. Department of Radiation Oncology，Fudan University Shanghai Cancer Center，Shanghai 200032，China
Corresponding author：ZHANG Zhen，E-mail：zhenzhang6@
hotmail.com
Abstract    Considerable local regional recurrence and distant metastasis of locally advanced gastric cancer suggest that surgery alone maybe inadequate and further comprehensive treatment is expected to reduce recurrence and improve efficacy. For locally advanced gastric cancer，there is still a lot of debate about the optimal multidisciplinary treatment modalities, including surgery，radiation，and chemotherapy. At present，there are three main treatment modalities, including perioperative chemotherapy, postoperative chemotherapy and postoperative chemoradiotherapy. The neoadjuvant chemoradiotherapy model is mainly derived from the clinical data of the esophagogastric junction (EGJ) tumor，however，there is no randomized trial designed special for gastric cancer patients. Furthermore，for clinical trials, there are still many aspects that need attention，including accurate preoperative staging，selection of the appropriate cohort (locally advanced stage)，standardization of upper digestive tract tumor site and selection of the appropriate parts of the tumor population，standardization of radiotherapy dosage and clinical target volume, select the appropriate chemotherapy and non-radiotherapy chemotherapy，choose appropriate therapeutic evaluation system，and suggestions to optimize the operation standard，meanwhile，we should pay attention to the assessment of nutritional status of patients and appropriate intervention. This overview discusses the role of neoadjuvant (chemo)-radiotherapy in the treatment of locally advanced gastric cancer and some relative aspects.

Key words: locally advanced gastric cancer, radiotherapy, neoadjuvant chemoradiotherapy