替吉奥胶囊单药联合放疗治疗晚期胃癌的临床观察

摘要

目的 观察替吉奥胶囊(S-1)单药化疗联合同步放疗治疗晚期胃癌的疗效及毒副反应.方法 83例晚期胃癌患者均接受同步放化疗,依据化疗方案分为治疗组(n=43)和对照组(n=40).两组放疗计划均为:6MV x线照射,DT 40～50Gy,4～5周完成.治疗组于放疗第1天开始口服S-1 40～60mg,每天2次,6周为1周期；对照组于放疗第1天开始行一线方案(如ECF、DCF、FOLFOX、FOLFIRI等)化疗2个周期以上.评价两组胃癌患者的疗效及毒副作用.结果 82例患者可评价疗效,治疗组中1例因消化道不良反应退出.治疗组获CR 3例,PR 21例,SD 14例,PD 4例,RR为57.1％ (24/42)；对照组获CR 2例,PR 15例,SD 15例,PD 8例,RR为42.5％ (17/40)；两组RR的差异无统计学意义(P＞0.05).治疗组的进食梗阻、疼痛等主观症状改善率为81.0％ (34/42),高于对照组的50.0％ (20/40),差异有统计学意义(P=0.008).治疗组和对照组治疗后1年生存率分别为23.8％ (10/42)和20.0％ (8/40),差异无统计学意义(P＞0.05).全组患者的主要毒副反应为血液学毒性、肝功能损害、放射性胰腺炎和胃肠道反应.治疗组3～4级白细胞减少、1～2级转氨酶升高和3～4级恶心呕吐的发生率均低于对照组(P＜0.05).结论 S-1联合放疗可以提高晚期胃癌患者生活质量,不良反应能够耐受,值得临床进一步探讨.%Objective To evaluate the efficacy and toxicity of S-1 combined with three-dimensional conformal radiotherapy (3D-CRT) in treatment of advanced gastric cancer.Methods A total of 83 patients were divided into two groups:43 cases with concurrent chemoradiotherapy (treatment group) and 40 cases with combined chemotherapy (control group).The fractionated dose of 3D-CRT was 2Gy,5f/w.The total dose was 40-50Gy.S-1 was concurrently taked orally,40-60mg po,twice a day and 6 weeks was one cycle.Forty gastric patients in control group were treated by the first-line chemotherapeutic regimens such as ECF,DCF,FOLFOX,FOLFIRI regimens,etc.Results A total of 82 patients could be evaluated.In treatment group,3 cases achieved CR,with PR in 21 cases,SD in 14 cases,PD in 4 cases.The response rate(RR) was 57.1％ (24/42).In control group,2 cases achieved CR,with PR in 15 cases,SD in 15 cases,PD in 8 cases.RR was 42.5％ (17/40).There were no statistical difference between two groups (P ＞0.05).The one year overall survival rate of treatment group and control group was 23.8％ and 20.0％ with no statistical significance (P ＞0.05).Compared with control group,the subjective symptoms of treatment group improved significantly(81.0％ vs.50.0％,P =0.008).The major adverse events were hematological toxicity,hepatic function damage,radioactive pancreatitis and gastrointestinal reaction.The incidences of grade 3/4 neutropenia,grade 1/2 elevated transaminase and grade 3/4 nausea and vomiting in treatment group were lower than those in control group (P ＜ O.05).Conclusion S-1 combined with 3D-CRT is a promising and safe treatment to improve the quality of life of patients with advanced gastric cancer,which deserves further clinical study.